TY - JOUR
T1 - Leveraging the outpatient pharmacy to reduce medication waste in pediatric asthma hospitalizations
AU - Hoefgen, Erik R.
AU - Jones, Yemisi
AU - Courter, Joshua
AU - Hare, Andrew
AU - Torres Garcia, José A.
AU - Simmons, Jeffrey
N1 - Funding Information:
Funding: Dr. Hoefgen was supported by funds from the Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS), under grant number and title General Pediatrics Research Fellowship T32HP10027.
Publisher Copyright:
© 2020 Society of Hospital Medicine.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Background and Objective: Previous local quality improvement focused on discharging patients with inhaled corticosteroids (ICS) "in-hand" decreased healthcare reutilization after hospitalization for an asthma exacerbation. However, as a result of these new processes, some patients admitted for an asthma exacerbation received more than one ICS inhaler during their admission, contributing to medication waste and potential patient confusion regarding their discharge medication regimen. We sought to decrease this waste. Methods: We conducted a quality improvement project to reduce the prescribing of multiple ICS inhalers to patients at a large academic children's hospital. Our primary outcome measure was the monthly percentage of patients admitted with an asthma exacerbation who were administered more than one ICS inhaler. A secondary outcome measure evaluated the reliability of the new process of using the hospital-based outpatient pharmacy to supply ICS "in-hand" and verify insurance coverage. After the process map review, we hypothesized a delay in the initial ICS treatment decision would allow for both a finalized discharge medication plan and a standardized process to verify outpatient insurance coverage. Results: The mean percentage of patients receiving more than one ICS inhaler decreased from our baseline of 7.4% to 0.7%. Verification of outpatient prescription insurance coverage via the outpatient pharmacy increased from 0.7% to 50%. The average inpatient cost (average wholesale price) for ICS decreased by 62% to $90.25. Conclusions: Our process change to use the outpatient pharmacy to dispense and verify insurance coverage for ICS medication was associated with a reduction in medication waste during admission for an asthma exacerbation.
AB - Background and Objective: Previous local quality improvement focused on discharging patients with inhaled corticosteroids (ICS) "in-hand" decreased healthcare reutilization after hospitalization for an asthma exacerbation. However, as a result of these new processes, some patients admitted for an asthma exacerbation received more than one ICS inhaler during their admission, contributing to medication waste and potential patient confusion regarding their discharge medication regimen. We sought to decrease this waste. Methods: We conducted a quality improvement project to reduce the prescribing of multiple ICS inhalers to patients at a large academic children's hospital. Our primary outcome measure was the monthly percentage of patients admitted with an asthma exacerbation who were administered more than one ICS inhaler. A secondary outcome measure evaluated the reliability of the new process of using the hospital-based outpatient pharmacy to supply ICS "in-hand" and verify insurance coverage. After the process map review, we hypothesized a delay in the initial ICS treatment decision would allow for both a finalized discharge medication plan and a standardized process to verify outpatient insurance coverage. Results: The mean percentage of patients receiving more than one ICS inhaler decreased from our baseline of 7.4% to 0.7%. Verification of outpatient prescription insurance coverage via the outpatient pharmacy increased from 0.7% to 50%. The average inpatient cost (average wholesale price) for ICS decreased by 62% to $90.25. Conclusions: Our process change to use the outpatient pharmacy to dispense and verify insurance coverage for ICS medication was associated with a reduction in medication waste during admission for an asthma exacerbation.
UR - http://www.scopus.com/inward/record.url?scp=85077401999&partnerID=8YFLogxK
U2 - 10.12788/jhm.3275
DO - 10.12788/jhm.3275
M3 - Article
C2 - 31433770
AN - SCOPUS:85077401999
VL - 15
SP - 28
EP - 34
JO - Journal of Hospital Medicine
JF - Journal of Hospital Medicine
SN - 1553-5592
IS - 1
ER -