Preventing Medication-Related Problems in Care Transitions to Skilled Nursing Facilities

Study Overview
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Brief Summary
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The Pharmacy Integrated Transitions (PIT) program, utilizes a crossover randomized control design to evaluate the impact of a clinical pharmacist in decreasing medication related problems during a patient's transition from hospital to skilled nursing facility (SNF).

Detailed Description
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Standard hospital discharge processes (e.g. as recommended by the Joint Commission Center for Transforming Healthcare), include hospital staff completing a paper-based discharge summary and medication reconciliation form. To reduce the likelihood of medication-related problems during care transitions, the Pharmacy Integrated Transitions (PIT) program aims to improve the standard transition process by adding a coordinating transitional pharmacist to provide a structured synchronous warm-handoff between clinical teams at the hospital and the Skilled Nursing Facility, in addition to reconciling, adjusting, and monitoring medications during and after discharge from the hospital.

Official Title
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Preventing Medication-Related Problems in Care Transitions to Skilled Nursing Facilities Using a Pharmacy Integrated Transitional Team

Conditions
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Care Transition

Intervention / Treatment
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* Other: Structured hand-off
* Other: Medication Management


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 years of age and older patients receiving inpatient care at University of Washington Mountlake, University of Washington Northwest, Harborview, and Valley Medical Center hospitals with a planned discharge to collaborating independently operating skilled nursing facility sites. Exclusion Criteria: Under 18 years of age patients with a discharge for planned hospice care

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: Independently operated collaborating skilled nursing facilities in Washington state will be randomized to intervention (receiving an added clinical pharmacist in the transition from hospital to skilled nursing facility) and control (usual care). Halfway through the study time period, following a crossover design intervention and control sites with be exchanged.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Clinical Pharmacist in Transition of Care<br>A clinical pharmacist will be provided as a patient discharges from one of four University of Washington (UW) medical centers to a skilled nursing facility randomized to the intervention arm. Pharmacist will perform additional clinical review and communication tasks with hospital and SNF clinical staff. | Other: Structured hand-off<br>* A clinical pharmacist will be utilized to provide a structured handoff at the end of the hospital stay between hospital and SNF skilled nursing facility.<br>Other: Medication Management<br>* The clinical pharmacist consults with hospital and SNF teams to reconcile, adjust and monitor medications to provide comprehensive medication management during care transitions.<br>|
| No Intervention: Patient transitions from hospital to post-acute care<br>Patient will transition from one of four University of Washington (UW) medical centers to a skilled nursing facility randomized to the control arm. Patients will receive the standard discharge process. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Medication Related Problems | Number of medication related problems experienced by patients within 30 days of hospital discharge | 30 days post hospital discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Death | Number of deaths experienced by patients within each cohort | 30 Days post discharge | 
| Readmissions | Number of readmissions within 30 days of index hospital discharge | 30 Days | 
| Fidelity of intervention | Components of the intervention successfully completed | Through intervention completion, around 3 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Care Transition, Medication-Related Problems, Post-Acute Care, Skilled Nursing Facility, Hospital Systems, Medication Safety