But what happens when patients go home and they have to manage their medications themselves. For some this isn’t a problem; however for others getting the maximum benefit from their medications is a challenge . I’m sure many of us have heard stories of people taking the wrong medications, not understanding what they are taking and deciding not to take to take anything because they don’t see the need.
For these people the result is a trip or several trips back to hospital. As many as 10% of patients that do return are due to medication related harm.
This is where a 20,000 Days initiative called SMOOTH (Safer Medicines Outcomes on Transfer Home) comes into play – a patient focused initiative that seeks to reduce harm by providing 90% of high risk patients from medical and surgical wards with a medication management plan at discharge – this will involve talking to patients about what changes have been made to their medications, providing them with information and a card that lists medications, what they are for, and side effects.
The care doesn’t stop when patients leave hospital and a lot of work is being done on working with primary care providers such as GPs and Pharmacists to facilitate the smoother transition of patients back into in the community.
Patients are telling us they want good education around their medicines, so one of the things we are doing is sitting down with patients, while in hospital and asking them the question – ‘what matters to them when it comes to managing their meds at home’? If they think a particular medication is of no value, it’s exploring why and breaking down some of those barriers or preconceptions.
For example a patient was put on blood pressure (BP) tablets while in hospital but on discharge was told by his Doctor that his BP was now fine. Although he needed to continue his meds at home he thought he was cured and didn’t need to take them anymore.
How we provide this information and how complex the information is, is also important. For example, a patient was told he would have to take a diuretic to reduce the swelling in his legs. The patient had no idea what a diuretic was. “If you say it takes water out of my legs – that I understand”
I think the message from this is let’s ask our patients about what makes sense to them.
For some patients waiting for prescriptions on discharge was a bone of contention– with one patient having to wait up to 7 hours. If SMOOTH can facilitate an earlier prescription on discharge, patients can leave hospital earlier and new patients can be admitted sooner. It’s a win –win.
At the moment the SMOOTH initiative is managed by 3 Pharmacists – Ahmed Marmoush, Rebecca Lawn and Sonia Varma, who facilitate discharges for medical and surgical patients at high risk of medication related harm. We would ideally like to see all patients who are admitted to hospital, however; as this initiative is quite new we wanted to start with a smaller group and work with people who may benefit the most. These are high risk patients, and the level of risk is determined by several criteria including: the age of the patient (>65years), chronic health condition, the number of medications patients are on and the type of medicines for example insulin, anticoagulants or opiates.
Patients who fulfil a set of criteria receive a cumulative score and those that are deemed ‘high risk’ on the basis of the score and other factors are candidates for the SMOOTH Service.
The tool we use to determine patients who are most at risk of medical related harm is called ART (Assessment of Risk Tool) and I’m proud to say ART was the winner for the most innovative idea under the Medication Safety category at the Health Roundtable Innovation Awards Meeting held in Sydney this month.
ART is used by pharmacists to prioritise clinical pharmacy interventions in high risk patients to reduce medication harm. Clinical pharmacists use this tool to prioritise medication reconciliation (a process to ensure accurate medication history is available at the points of transfer). The systematic approach of being able to prioritise has enabled the department to consistently deliver high rates of intervention (>80%) in high risk patients.
While it’s still early days I’m incredibly proud of what the SMOOTH service have accomplished. We are continuously learning from our experience and have found the Institute for Healthcare Improvement (IHI) training and support very useful.
As well as providing the tools we need to implement our initiative, collect data and, measure outcomes, it also prompts ideas and questions you may not necessarily have thought of. I guess in a sense it keeps you on the right track.
Overall we are finding the SMOOTH Project satisfying and rewarding and believe we can make a real difference in keeping our high risk patients well and at home. What’s even better is we are having fun while doing this quality activity
We have also learnt some valuable lessons by experiencing the delivery of our service through the patient eyes and have gained valuable knowledge by talking with other teams who are part of the 20,000 Days Campaign. For example the Transitions of Care Team are looking at introducing a goal discharge date for some patients, which means we can tailor our interventions and planning in advance.
The end result will be an improved patient experience, reduced time in hospital for our patients and a reduction in bed days.
If you have a patient that you think would benefit from the SMOOTH Service, please discuss it with your team pharmcist or you can contact the SMOOTH team on *3284
Clinical Lead SMOOTH Service and Pharmacy Services Manager