| Description |
Background: Approximately 58% of discharged patients are prescribed new medications. Discontinuing medication bedside delivery requires patients to fill prescriptions independently, introducing barriers that contribute to non-adherence. Local Problem: A cardiovascular unit (CVU) experienced increased post-discharge phone calls after bedside medication delivery was discontinued. Charge nurses (CNs) spent approximately 15-30 minutes per call assisting patients with medication issues. This project aimed to improve prescription filling and reduce post-discharge phone calls by implementing a standardized discharge process to minimize barriers. Methods: A prior needs assessment identified common barriers. A new discharge process addressing these barriers was developed and implemented using biweekly Plan-Do-Study-Act (PDSA) cycles for rapid improvements. Feasibility, usability, and satisfaction were evaluated through staff surveys, and prescription fill rates were analyzed pre- and post-implementation over four months. Interventions: The process targeted CVU-specific barriers using evidence-based strategies. Registered nurses (RNs) confirmed pharmacy access before closing and provided medication coupons and education leaflets. Health unit coordinators (HUCs) verified medication stock at pharmacies and ensured clinic phone numbers were on discharge paperwork. Instruction sheets were created, and a resource folder was placed at the CN desk. The interventions were refined through PDSA cycles over two months. Results: Among 22 staff surveyed (5 HUCs, 17 RNs, and 2 CNs), over 90% worked more than 24 hours per week. Task completion varied, with 50-68.8% of staff performing each intervention consistently. Most staff found interventions beneficial (80-93.3%), the process simple and efficient (83.3%), and instructions clear (80-93.8%). While 83.3% supported continuation, 11.2% did not. Staff reported fewer calls about prescription stock and pharmacy hours (n=9), medication costs (n=8), medication education questions and missing clinic phone numbers (n=5), though two reported no change. Six noted continued questions about new medications. Multiple staff members appreciated the opportunity to address barriers before discharge and educate patients, and one staff member suggested creating a quick reference guide for the new process. Prescription fill rates remained stable. Pre-implementation, 81-84% of prescriptions were filled on discharge day, with a mean pickup time of 0.67-0.87 days (range: 0-60). Post-implementation, same-day pickups ranged from 74-85%, with a longer mean pickup time of 1.61-1.94 days (range: 0-83). Pickup variability increased, with standard deviation rising from ~4.2 to ~7.5 days, though this variability may be due to factors beyond the unit's control. The median pickup time remained 0 days. Conclusion: Unit-specific discharge interventions reduced post-discharge calls and improved staff satisfaction, even if it did not significantly impact prescription fill rates. Limitations include challenges with generalizability, as interventions were specifically designed for this CVU and may not apply to other units. Staffing variability and prescription fill data collection further impacted results. The process has the potential for expansion across units or system-wide to enhance discharge consistency, staff collaboration, and patient education. |
