Scientific Poster Session II: Students Research-in-Progress

Students Research in Progress
  Sunday, November 12, 2023
  12:45 PM–02:15 PM

Abstract

Introduction: Pharmacist-led medication discharge counseling has been shown to improve patient health care quality outcomes such as reduced rates of medication errors, hospital readmissions, and improved medication adherence. Automated phone calls to discharged patients identified key medication-related issues post-hospital discharge from the post-operative unit. This project is designed to provide targeted medication discharge counseling focused on antithrombotic (anticoagulants and antiplatelet) therapy for thromboembolism prophylaxis among the post-operative orthopedic population.

Research Question or Hypothesis: Antithrombotic medication discharge counseling by pharmacists will reduce the % of medication questions/concerns from discharged patients.

Study Design: A multidisciplinary team identified targeted medication discharge counseling focused on antithrombotic (anticoagulants and antiplatelet) therapy, which are critical in venous thromboembolism (VTE) prevention among post-op orthopedic population with plans to implement Plan, Do, Study, Act cycles.

Methods: Mayo Clinic Arizona utilizes the Cipher Program that inquires through automated phone calls to discharged patients of any issues identified post-hospital discharge. From January to August 2023, the top three concerns identified were prescription obtained, other clinical concerns, and medication questions/concerns among top three units. Medication questions or concerns accounted for 7.6% of all issues reported by patients. Using Epic Plummer Chart, adult patients in the post-operative (3E) unit being discharged on antithrombotic therapy are identified within 48 hours of estimated discharge date. A pharmacy student, in collaboration with a decentralized pharmacist, completes discharge medication reconciliation and provides medication counseling to patient and caregiver(s), if present. A standardized note template and counseling points are developed to provide consistency to patients. Counseling efficacy will be measured using the Cipher program results post-intervention evaluating the % of medication questions/concerns from patients discharged from 3E comparing pre- vs. post-intervention with a primary endpoint of less than 6% from 7.6% at baseline.

Results: In progress.

Conclusion: In progress.

Presenting Author

Ashkan Rastegar BS
Mayo Clinic Arizona

Authors

Christine Aliory APRN, CNS, MSN
Mayo Clinic Arizona

Lisa Buss Preszler PharmD, RPh, BCACP
Mayo Clinic Arizona

Kristen Mah PharmD, RPh
Mayo Clinic Arizona

Christi Jen PharmD, RPh, BCPS, BCEMP, FASHP, FAzPA
Mayo Clinic Arizona

Haley Welch BS
Mayo Clinic Arizona