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MUSC Takes Home Award for Excellence in Medication-Use Safety

Mar 28, 2011

THE DAYS AND WEEKS AFTER A KIDNEY TRANSPLANT are a critical time for patients. Many are already on complex medication regimens at the time of their procedure, yet will take even more agents afterward to prevent organ rejection and infection.

When data revealed that 29 percent of kidney transplant patients at the Medical University of South Carolina (MUSC) in Charleston had prolonged hospitalization, and that 10 to 15 percent of patients were readmitted at seven, 14, and 30 days, staff there knew it was time to reevaluate the MUSC’s protocols.

Over an 18-month period, MUSC implemented a multi step initiative to decrease length of stay, preventable admissions, and adverse drug events for kidney transplant recipients. This initiative not only produced a stunning improvement in outcomes but also garnered the team the 2010 ASHP Foundation Award for Excellence in Medication-Use Safety.

Building on Pharmacists’ Involvement

Pharmacists’ were already an integral part of the transplant service team at MUSC when the data came in, so it was natural that they would have a voice in revising the protocols, said Heather Kokko, Pharm.D., team chair and interim director of pharmacy services.

“We had a pharmacist in that group the longest out of all service areas,” she said. “When we noticed that a lot of the patient issues revolved around medication use, we knew we had to focus on medication education and access. Fortunately, the transplant service team is a collaborative group in terms of their relationship with pharmacy.”

David Taber, Pharm.D., BCPS

In addition to pharmacists and other health professionals, members of the multidisciplinary team include physicians, nurses, and hospital executives. Once the team saw what the needs were and how pharmacists could improve outcomes, it was only a matter of formalizing the process, said David Taber, Pharm.D., BCPS, clinical pharmacy specialist. “It came together on a few fronts, when leaders in the transplant team and the pharmacy department got together and pulled people in.”

Addressing Challenges

The data revealed that adverse drug events were a major cause of preventable readmissions. To address this, pharmacists began to counsel patients before discharge, and now pharmacists review all discharge orders. The transplant services team shifted focus from inpatient to outpatient care. However, the team encounter

ed a speed bump because outpatient medications had to be obtained at the transplant center two blocks away from the hospital.

“One of the challenges the transplant group had was how to get the meds into the patient’s room when we were doing medication education,” said Taber. “We used to count on caregivers to go pick up the meds and bring them back, and that was causing delays.”

 

Heather Kokko, Pharm.D.

The solution was to fill prescriptions in the same building as the transplant center, and transitioning to outpatient status now begins at bedside with readily accessible medications. The patients are given bottles of their medications just like they would have at home, and they have to give themselves their own medications while at the hospital under nurse supervision.

“The purpose is to make sure they know how to use their meds when they get home, where there isn’t a nurse to help them,” said Kokko.

These changes vastly improved patient outcomes by cutting medication errors and adverse drug reactions by 40 percent, acute rejection rates by 25 percent, infection rates by 10 percent, delayed discharges by 14 percent, and the seven-day readmission rate by a stunning 50 percent.

According to Taber, the goal now is to maintain vigilance. “Anything you can to do improve care like that is good for the patient and good for the institution as well,” he said. “It is a win-win situation, and we have to make sure we keep our eye on our target and not let the numbers slip.”

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