A Novel Discharge Medication Process: A Needs Assessment

Bedside medication delivery programs involve delivering discharge medications to hospitalized patients before discharge. These programs have significantly reduced 30-day hospital readmissions and emergency department visits (Prusaczyk, Mixon, & Kripalani, 2020). Bedside medication delivery programs also increase the number of patients who obtain medications by removing barriers commonly associated with obtaining prescriptions, including cost and transportation. Intermountain Medical Center (IMC) discontinued its medication delivery service in August 2021. Local Problem: Since the discontinuation of bedside medication delivery, providers now send electronic prescriptions to the patient's preferred outpatient pharmacy. Patients are then expected to obtain their medications after discharge. This process change has led to increased post- discharge patient phone calls to the unit regarding medication questions and an increase in the charge nurse (CN) workload. Methods: A needs assessment was performed at IMC on CVU3 and CVU4 to help identify a new medication discharge process within the CV Hospitalist (CVH) service. IMC is an urban, level 1 trauma center that serves the Salt Lake Valley. CVU3 and CVU4 are two 28-bed units that service a variety of cardiovascular patients. Interventions: A strengths, weaknesses, opportunities, and threats (SWOT) analysis was conducted to assess current needs. A survey was sent to CNs on CVU3 and CVU4 to examine their satisfaction with the new medication delivery process, how the change has affected their workflow, and common patient concerns they encountered. Readmission data was collected to assess if discontinuation of bedside medication delivery services increased 30-day readmission rates. Data was analyzed and categorized using descriptive statistics. Results were presented to the CVH and their nurse coordinators to develop a new medication discharge process based on evidence and analysis of the current medication discharge process. An executive summary was presented to CVU leadership with proposed plans for intervention implementation. Results: Readmission data was collected between 2018 and 2019 before bedside medication delivery services were discontinued and between 2021 and 2023, the timeframe after the program's discontinuation. The year 2020 was omitted due to the COVID-19 pandemic. Between 2018 and 2019, 8061 patients were discharged. Of those, 935 were readmitted within 30 days. Between 2021 and 2023, 8242 patients were discharged, and 925 patients were readmitted in 30 days. CN survey results demonstrated dissatisfaction with the current medication discharge process. Three major patient concerns emerged, including medication unavailability at the outpatient pharmacy, the outpatient pharmacy being closed, and educational concerns. Data was presented to CVH and their RN coordinators, and a new discharge process was developed. The new process was proposed to CVU leadership for future implementation. Conclusion: This needs assessment developed a new medication discharge process with buy-in from the CVH and their nursing coordinators. Further quality improvement projects could examine the implementation of this new process to determine its sustainability, benefits to patients, and satisfaction of CNs.