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

University of Washington

Status: Completed

Conditions: Care Transition

Treatments: Other: Transitional medication monitoring; Other: Structured hand-off; Other: Medication reconciliation during transitional period; Other: Teleconsultation

Study type: Interventional

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT05241951

1R01HS027805 (U.S. AHRQ Grant/Contract)

STUDY00011018

Details and patient eligibility

About

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).

Full description

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.

Enrollment: 1,052 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

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 to one of 14 collaborating SNF's on a day when the PIT program pharmacist is conducting the intervention

Exclusion criteria

• Under 18 years of age
• patients with a discharge on hospice care
• patients discharged on days that the pharmacist is not conducting the intervention

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

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1,052 participants in 2 patient groups

Clinical Pharmacist in Transition of Care

Experimental group

Description:

A clinical pharmacist will be provided as a patient discharges from one of four University of Washington (UW) medical centers to one of 14 post acute skilled nursing facilities randomized to the intervention arm. The coordinating transitional pharmacist will conduct (1) a comprehensive medication review including medication reconciliation, adjustment, and monitoring during the transitional period from hospital to SNF, 2) a structured handoff between clinical teams at the hospital and SNF.

Treatment:

Other: Teleconsultation

Other: Medication reconciliation during transitional period

Other: Structured hand-off

Other: Transitional medication monitoring

Patient transitions from hospital to post-acute care

No Intervention group

Description:

Patient will transition from one of four University of Washington (UW) medical centers to one of 14 post-acute skilled nursing facilities randomized to the control arm. Patients will receive the standard discharge process.