Reducing Skilled Nursing Facility Rehospitalizations With Effective Pharmacy Intervention

November 10, 2020

With one in five Medicare beneficiaries readmitted to the hospital within 30 days of release, hospitals are increasingly looking to enhance their discharge management. But it is challenging when skilled nursing facilities, the most common setting for discharged patients, see one in four of them readmitted within 30 days. As a result, facility performance is more important than ever as hospitals seek to keep its patients as healthy as possible and avoid financial consequences. And one way to improve quality metrics is involving pharmacy to address the most common causes of readmission.

Primary Readmission Occurrences

A key factor in preventing readmissions is to figure out why they occur in the first place. In one study, discharges that led to a readmission or death were more likely to occur among patients who were hospitalized for a general medical condition, a pulmonary condition or congestive heart failure, or a cardiac or vascular condition, and were more likely to have common comorbidities such as coronary artery disease, diabetes, and chronic obstructive pulmonary disease (COPD).

While certain rehospitalizations are unavoidable, there is research that suggests that many are preventable. One aspect of care that may help reduce potentially avoidable readmissions is medication management for the most common conditions leading to hospitalizations. Consequently, consultant pharmacists can play a central role in reducing risk.

For example, with COPD, pharmacologic interventions prevent disease progression, lessen symptoms and complications, and improve patients’ quality of life, but managing drug therapies for the disease, which can include inhaled beta2-agonists, inhaled anticholinergics, corticosteroids, mucolytics, expectorants, and antibiotics, can be challenging, especially in the presence of complications. Consultant pharmacists can help by advising on special considerations such as the use of systemic steroids for COPD flare ups, which can lead to hospitalization by altering glucose control, which can result in a diabetic emergency, and contributing to mental status changes, osteoporosis, and skeletal muscle breakdown that can cause serious falls.

Practices and Performance

In addition to drug class and disease-specific drug management, consultant pharmacists can assist in many operational workflow steps to further reduce hospitalizations among residents suffering from conditions and comorbidities that carry a higher risk. Primary activities these clinical professionals can perform include:

• Initial Assessment: With increasingly high acuity among incoming residents, pharmacists should be part of the initial observation and assessment process, which includes medications and required therapies, and take part in change of status reviews as well.
• Care Planning: Consultant pharmacists can contribute to the comprehensive written care plan by both identifying problems associated with medication therapy and concerning medications as well as reducing risk from drugs that can cause or aggravate common health problems.
• Care Coordination: Medication reconciliation is imperative to know which medications patients were taking before their hospital stay, what was given while there, and drugs prescribed at discharge to the facility. Consultant pharmacists should perform these comprehensive reviews at admission and at regular intervals afterwards.

Proactive Intervention

Since 26 percent of potentially preventable readmissions are related to Topimedications, pharmacists can help reduce that rate by paying particular attention to how drugs used to treat a high-risk condition are affecting the resident. That means ensuring medications are safe, free of harmful side effects, and appropriate based on the resident’s diagnosis. Part of this process also should involve medication optimization services designed to reduce polypharmacy.

Moreover, a consultant pharmacist has a collaborative role to play in prevention as a member of the multidisciplinary team by helping to identify emerging symptoms caused by medication use, critical since early intervention and prompt treatment can make a significant difference in outcomes.

PharMerica’s consultant pharmacists can be invaluable in reducing medication-related preventable readmissions. Learn how PharMerica’s team of clinicians can help your organization reduce risk and improve health and outcomes. Contact [email protected] or call 855-637-1755.