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Pharmacist Team Brings “Med Rec” to New Level

Jennifer Rief, Pharm.D, center, teaches two pharmacy residents about the “Safe Med” program.

A TEAM OF PHARMACISTS with Novant Health is on a mission to improve continuity of care by counseling patients with complex medical conditions within a week of hospital discharge. Novant serves more than five million residents in North Carolina and South Carolina across nine hospitals as well as nursing homes, physician practices, outpatient surgery centers, and rehabilitation and  community health outreach programs.

Only two years old, the Safe Med team of six pharmacists is already making substantial progress with the thousands of patients whom team members have counseled. Over that time period, the team cut patient hospital admissions related to adverse drug events (ADEs) from 18 percent to 4 percent.

Safe Med received the ASHP Research and Education Foundation’s Award for Excellence in Medication-Use Safety in 2008. The $50,000 award, supported by Cardinal Health, recognizes pharmacist-led, multidisciplinary teams for significant, institution-wide system improvement in medication use.

“Novant’s program dramatically improves the care of these high-risk patients through the work of these dedicated pharmacists,” said Stephen J. Allen, M.S., FASHP, executive vice president and chief executive officer of the Foundation. “It truly is a proven model that should inspire other health systems to consider implementing.”

Assessment and Education

The teammates view the foundation’s recognition as further evidence that they are making a difference in the lives of patients.

“We’re improving the care of patients by showing that pharmacists are medication experts who can decrease ADEs through a partnership with physicians and nurses,” said team leader Terri Cardwell, Pharm.D.

Terri Cardwell, Pharm.D., team leader of Novant Health’s “SafeMed” program.

Team members focus on patients who are 65 years or older and on medications that are most likely to cause ADEs, such as digoxin, hypoglycemics, and warfarin. They work with both hospital staff and ambulatory care providers to ensure consistent,effective medication use across the continuum of care.

Team members obtain hospital records and assess each patient’s medication regimen. They then speak with the patient and caregivers to educate them on how the medications should be used and provide a medication list that the patient can bring to his or her providers. The team members also provide a reconciled list of the patient’s medications to providers with recommendations for appropriate therapy.

Cardwell said that the team has uncovered many instances of potential harm during their reconciliation process. For example, one patient was prescribed digoxin in the hospital and told to continue taking medications he had at home. However, one of the drugs the man had at home was a version of digoxin with a different name. Luckily, a team member caught the problem in time. “It makes us all feel good that we’re helping the patients and their families understand their medication regimens,” Cardwell said.