Objective: We sought to improve adherence to medication plans, a critical aspect of the hospital-to-home transition. Our primary aim was to increase the percentage of patients leaving the hospital with new medications filled to 50% by Dec 2015. Our secondary aim was to improve caregiver understanding of discharge medication profiles, as measured by caregiver ability to correctly teach-back discharge medication instructions at the time of a post-discharge phone call, and caregiver satisfaction with explanation of medication side effects as reported on the pediatric HCAHPS survey. Methods: This observational time series was conducted at our academic urban children’s hospital within a hospital between Jan 2014–Dec 2015. Our inter-professional improvement team including resident & attending physicians, nurses, and pharmacists performed a series of planned sequential interventions. EHR chart review and post-discharge phone call transcripts were reviewed for patients discharged from the pediatric hospitalist service. For our process measure, monthly rates of discharge medications filled prior to discharge were displayed on Statistical Process Control charts and established rules for detecting special cause were applied. For outcome measures, Chi square analysis compared caregivers’ ability to teach-back medication instructions and medication-related pediatric HCAHPS data was collected. Figure 1 highlights aims, key drivers and interventions. Results: Among 1784 charts reviewed from 2014-2015, 67% were successfully contacted by post-discharge phone call and 57% had new meds prescribed at discharge. Figure 2 shows the % new meds filled prior to discharge, which increased from 6% in 2014 to 48% by the end of 2015. Caregivers with medications filled prior to discharge were more likely to correctly teach-back medication instructions at the time of a follow-up phone call (98% v 89%, p=0.004). HCAHPS scores for explanation of medication side effects increased from 46% (below national avg) in 2014 to 81% (above national avg) for the last 6 mos of 2015. Conclusions: While we demonstrated significant increase (48%), we did not meet our goal (50%) medication prescriptions filled at discharge. We did see better care-giver understanding of medication profiles. Keys to success included opening an on-site outpatient pharmacy and educating staff about its services. We feel these changes should promote adherence to medication plans. Next steps will include expanding bedside med delivery and teaching by pharmacists
Caption Under Figure 2: A marked increase in % of patients with medication in hand upon discharge from the hospital from ∼6% in 2014, to ∼48% in 2015 was noted.