Title/Description: Discharge Medication Planning, Education, and Procurement

Transcription

1 University of Kentucky / UK HealthCare Policy and Procedure Policy # A Title/Description: Discharge Medication Planning, Education, and Procurement Purpose: To educate patients discharged from UK HealthCare facilities regarding all aspects of their discharge medications, including where medications can be procured. Policy Procedure Providing Medication Education and Information Responsibility for Provision of Education Components of Educational Sessions Patients' Right to Refuse Education Documentation of Assessment and Educational Information Provided General Guidelines for Documentation Procedures for Documentation of Education Assisting the Patient in Obtaining Discharge Medications Access to Discharge Medications Indigent Patient Drug Fund Special Considerations Persons and Sites Affected Policies Replaced Effective Date Review/Revision Dates Policy The registered nurse, in collaboration with the patient care team, is responsible for conducting a discharge medication assessment for the patients to which they are assigned. This includes responsibility for the following four (4) areas as they relate to discharge medications: 1. Assessment of educational needs, 2. Provision of education and information, 3. Documentation of the discharge planning and assessment activity, and 4. Assistance with obtaining discharge medications. Procedure It is the goal of UK HealthCare to assist patients in achieving the highest level of self-care. Appropriate and individualized education about medications is an essential component of that goal. Patient education is a collaborative, inter-disciplinary process, requiring the expertise of all members of the health care team. The patient's learning needs and readiness to learn are assessed Policy # A02-030, Discharge Medication Planning, Education, and Procurement 1

2 throughout the education process. Each member of the health care team evaluates the effectiveness of the education process and develops alternative strategies as needed. The registered nurse, in collaboration with the health care team, is responsible for assessing each patient's learning needs, planning appropriate interventions for patient education, implementing the educational plan, and evaluating the outcome of the process. Providing Medication Education and Information Due to complexity and the various individuals involved with providing discharge education, the following counseling guidelines have been developed. The intent of these guidelines is two-fold: 1. To assign responsibility for conducting the educational assessments; and 2. To confirm that documentation of educational assessments, sessions, and information provided to the patient is complete. Responsibility for Provision of Education The registered nurse is responsible for confirming that patients receive appropriate medication education. When the patient's learning needs are such that another discipline is better able to provide the education, the registered nurse shall collaborate with that discipline. The transplant coordinator is responsible for documenting the education provided, including diary instruction, to patients on the heart/lung, renal, or liver transplant services. The registered nurse or patient care facilitator, in collaboration with the health care team, is responsible for communicating the patient's educational needs directly to any home health agency or long term care facility health care professionals. The registered nurse or patient care facilitator is responsible for verifying that the home health agency staff receives copies and documentation of necessary discharge forms, medication administration form, and patient information sheets. The patient's primary pharmacist or his or her designee is responsible for providing and documenting additional education whenever the registered nurse determines that such education is needed. The patient s registered nurse is responsible for contacting the pharmacist with the referral. This additional education may include but is not limited to: 1. Patients who are discharged on multiple medications or when the risk of interactions is high; 2. Patients who have difficulty understanding their medications or schedule; 3. Patients who have many questions regarding their medication therapy; 4. Patients who have a history of non-compliance with their medications; or 5. Patients who are discharged on medications with which the nurse is un-familiar. The Nutrition Department shall provide patient education regarding drug-food interactions for patients on warfarin or monoamine oxidase (MAO) inhibitors. Pharmacy is responsible for providing the Nutrition Department with a daily report listing all patients receiving either of these two medications. The Nutrition Department may print either of these reports itself. Policy # A02-030, Discharge Medication Planning, Education, and Procurement 2

3 1. The Nutrition Department at Chandler Hospital shall provide this education seven (7) days a week for patients discharged between 8:00 a.m. and 4 p.m. Patients discharged at any other times shall receive this education from nursing. 2. The Nutrition Department at UK HealthCare Good Samaritan Hospital shall provide this education Monday through Saturday for patients discharged between 8:00 a.m. and 4:00 p.m. Patients discharged at any other times shall receive this education from nursing. Components of Educational Sessions Medication education includes providing the patient and/or family member with the following information (as appropriate): 1. Generic/trade name; 2. Dose/route/dosage form/schedule; 3. Special directions for administration; 4. Self-monitoring procedures; 5. Proper storage; 6. What to do if a dose is missed; 7. Anticipated concerns of cost/availability; 8. Demonstration of proper use; 9. Intended use/action directions for preparing precautions/side effects drug & food interactions; 10. Refill information; 11. Written material 1 ; 12. Compliance issues; 13. When to call MD/Pharmacist; and 14. Drug-drug interactions. Patients' Right to Refuse Education Patients have a right to excellence in the education process. Patients also have the right to refuse education. A patient's refusal of teaching does not prevent health care team members from offering informal teaching according to the patient's willingness. The offer for formal teaching is repeated. Refusal is documented in the patient record. Documentation of Assessment and Educational Information Provided The documentation of education and other discharge activities is done consistently between disciplines. Below are interdisciplinary documentation forms that are used by all health care providers to accomplish this goal: 1 Materials used in providing education to patients on medications and possible interactions are developed collaboratively with nursing, pharmacy, dietetics/nutrition, and medical staff members. Medication instruction sheets are available in both English and Spanish. Policy # A02-030, Discharge Medication Planning, Education, and Procurement 3

4 1. Discharge Instructions Sheet (patient receives copy): The nurse is responsible for documenting discharge instructions. Documentation shall be indicated on the Discharge Instructions sheet (form J635a used in outpatient or procedural areas). 2. Inpatient discharge instruction materials are provided through the patient education tool and the patient receives a copy. Documentation of education provided to patients is indicated on the Medication Information sheet or within the patient s medical record. Documentation that patients received information regarding potential drug-food interactions is completed via the patient education tool and documented in the information sheet or the patient s medical record. General Guidelines for Documentation 1. All forms are reviewed with the patient prior to discharge. 2. All written information is legible. Medical abbreviations (e.g., qid, prn,) are not used. 3. The Medication Information sheet or nursing discharge documentation record including the patient education tool includes all medications that the patients will take at home. Note: Patients with a current complete medication list may be excluded. 4. The Medication Information sheet or nursing discharge documentation record including the patient education tool includes information regarding generic/trade name, when to take the medication, how to take the medication, and any special instructions. The patient s caregiver shall be provided with a copy of the discharge summary, including the discharge medications. In addition, the referring physician is provided with an electronic link to the UK MD portal. Procedures for Documentation of Education 1. Any additional information sheets given to the patient are documented on the Medication Information sheet or nursing discharge documentation record. 2. Patient/family refusal to receive the sheets or the education is documented in the medical record. 3. A pharmacist or dietitian is consulted if the patient or family member requires additional medication education. Copies of the Discharge Instruction sheet and Medication Information sheet (as appropriate) is provided to the patient/family or home care provider. 4. The medical record reflects which Discharge Instructions and Medication Information were provided to the patient. Assisting the Patient in Obtaining Discharge Medications All health care providers are responsible for recognizing the need for assistance in obtaining medication upon discharge and identifying issues regarding continuation of medication therapy upon discharge. This assessment is designed to be an on-going process throughout the patient's entire admission. The Meds-To-Beds Pharmacy program shall assist in the discharge prescription process by offering concierge delivery to bedside upon discharge. Enrollment, benefits investigation, and coordination of care is communicated and documented in the patient's electronic health record. Policy # A02-030, Discharge Medication Planning, Education, and Procurement 4

5 Access to Discharge Medications Patients who are directed to continue medications upon discharge (or Emergency Department visit) can obtain such medications from UK Outpatient Pharmacy or the pharmacy of their choice. Due to the complexity of the reimbursement system, it is necessary to categorize the process into payer types. In the event that a situation cannot be resolved by following the procedures listed below, the patient's nurse, pharmacist, physician, dietitian, patient care facilitator, and social worker shall work towards resolving any issues. 1. Private Payer and/or Third Party Reimbursement (a) A pharmacy of the patient's choice. (b) UK Outpatient Kentucky Clinic Pharmacies are open Monday through Friday 7:30 a.m. to 9:00 p.m., Saturday 9:00 a.m. to 5:00 p.m., and Sunday 1p.m. to 5 p.m. To expedite the dispensing process, providers shall e-prescribe medication orders or unit clerks shall fax completed hand-written prescriptions to the pharmacy. This is coordinated through the Meds-to-Beds technician, when feasible. If paper prescriptions were faxed, patients shall present the original copy of the prescription to the pharmacist when picking up their medications. The KCP requires copies of insurance cards and financial information, including vouchers, before prescriptions can be processed (see Special Considerations section). (c) Select retail pharmacies are open 24 hours a day, including most major holidays. 2. Kentucky Medicaid Recipient (KMA Patient): (a) KMA patients must use KMA provider pharmacies. (b) Most community pharmacies are KMA providers, including UK Outpatient Pharmacies. KMA guidelines require that outpatient medications be prescribed from the Outpatient KMA Formulary of Accepted Drugs and be prescribed for an FDAapproved indication. As long as these criteria are met, patients have minimal difficulty in obtaining outpatient prescriptions from any KMA provider pharmacy. (c) The physician shall be an eligible KMA provider (or provide attending s name). As much licensing information as possible is included. (d) Prior authorization: If a physician wishes to prescribe a medication that is not on the Outpatient KMA Formulary of Accepted Drugs but is for an FDA-approved indication, KMA guidelines require prior authorization before reimbursement is issued to the provider. Note: KMA does not support the use of any medication for a non-fda approved indication. Decentralized pharmacists are aware of FDA indications, therefore, assistance can be obtained from them if there are questions regarding the need for prior authorization. If prior authorization is required, the physician or designated member of the health care team is responsible for obtaining prior authorization. 3. Obtaining prior-authorization mechanisms: Policy # A02-030, Discharge Medication Planning, Education, and Procurement 5

6 (a) The KMA pre-authorization forms are completed and faxed to the number on the form. (b) KMA prior-authorization requires the following information: i. Patient name and Medicaid number; ii. iii. iv. Doctor's name, provider number, and phone number; Drug strength and quantity; Whether the drug has been taken before and if any prior authorization exists; v. Diagnosis (related to the use of the drug); and vi. Other drugs tried. Indigent Patient Drug Fund In the event that a patient expresses concern over the financial burden associated with his or her discharge prescriptions, a social worker is contacted, who then determines the appropriate means of discharge medication procurement. If the patient qualifies, a voucher is issued to the patient for the purchase of discharge prescriptions. Every attempt is made to determine such a need in advance to discharge and have the prescriptions filled at the UK Outpatient Pharmacy during business hours. In the event that the patient is discharged at a time when the UK Outpatient Pharmacy is closed, vouchers may be filled at a designated external retail pharmacy. Special Considerations Outpatient pharmacies have financial and insurance information, including vouchers, before the prescriptions can be processed. When prescriptions are faxed to the UK Pharmacy, the prescription is accompanied by patient demographics and insurance information. When available, copies of the patient's insurance card(s) are faxed to the pharmacy. A phone number of a contact person at UK HealthCare also accompanies the faxed prescriptions. The inpatient primary pharmacist or his or her designee is contacted for assistance in the rare event of one of the following situations: 1. A patient is prescribed an outpatient medication that is not commonly available in community pharmacies; 2. The patient has drug benefits, but his or her insurance card is not accepted by accessible pharmacies. This may involve the dispensing of an initial hour supply (or the entire prescribed amount) from the UK Outpatient Pharmacy to last the patient until their community pharmacy can obtain the prescribed medication. Patients are charged for these doses. The goal is to recognize the need for such arrangement early on in the admission process and/or discharge process. By doing so, delays can be prevented and patients do not go without obtaining their medications in a timely manner. Initial supplies are not routinely dispensed from the inpatient pharmacy. In the event a patient or family member is not physically capable of obtaining prescriptions from either of the community pharmacies listed above, a social worker is contacted for assistance. Any discharge medications dispensed by the provider is labeled according to state law requirements and properly documented in the patient s electronic medical record. Doses are sent Policy # A02-030, Discharge Medication Planning, Education, and Procurement 6

7 home with the patient in a child-resistant container and properly labeled. Labels include the following: 1. Name, address, phone number of the hospital pharmacy or clinic; 2. Patient name; 3. Physician name; 4. Name of the medication; 5. Directions for use; and 6. Prescription number or medical record number. Persons and Sites Affected Enterprise Chandler Good Samaritan Kentucky Children s Ambulatory Department Policies Replaced Chandler HP02-14 Good Samaritan Kentucky Children s CH Ambulatory KC Other Effective Date: 8/12/2015 Review/Revision Dates: 6/2006; 6/2012; 8/12/2015 Approval by and date: Name Lisa Thornsberry, Nursing Division Director, UK HealthCare Good Samaritan Hospital, Review Team Leader Name Gary L. Johnson, Enterprise Director of Pharmacy Services Name Colleen Swartz, Chief Nurse Executive Name Bernard Boulanger, MD, Chief Medical Officer Name Marcus Randall, MD, Chief, Ambulatory Services Name Anna L. Smith, Chief Administrative Officer Name Michael Karpf, MD, Executive Vice President for Health Affairs Date Policy # A02-030, Discharge Medication Planning, Education, and Procurement 7