Day 2: Transitions of Care

Today's main theme was making the transition from hospital inpatient to home outpatient as smooth and beneficial to the patient as possible. There are many times patients go from a hospital bed to discharge with a stack of prescriptions and quite possibly not be able to fill their medications right away due to the state they are in. In addition, he or she may not receive adequate counseling from the community pharmacist because of time issues and lack of knowledge of what happened within the hospital.

UNC Hospitals is therefore trying to improve the issue by launching Carolina Care at Home. Today I shadowed the transitions technician who took me step-by-step through the process. Right now it's still very new; the program launched October 2011 and is slowly being incorporated into various acute adult units, including cardiac intensive care unit, solid organ transplant unit, and hematology/oncology (the newest unit).

Every morning, the technician goes through the list of patients in the units and looks at the prescription insurance the patients have. Currently, the program is not going to enroll self-pay (no insurance) and Medicaid-covered patients. Another goal of the program is to create some revenue for the hospital, because most of the patients that get prescriptions at the hospital are helped with Medical Assistance Programs. By getting fills that are reimbursed by third party payers, it helps the hospital pharmacies too.

Once she has a list of patients with insurance, we go to the floor and see who on the list will be getting discharged. If a patient is getting discharged, we talk to the nurse and ask if he/she will be going home with new medication prescriptions. If so, we speak with the patient.

We got to talk to one patient. She asked him if he would like to fill his first fill (30 days) at the hospital; we would have them delivered to his room and billed by the discharge pharmacist and he would pay his normal copay. The refills would be sent to his home community pharmacy. He accepted enrollment in the program and we talked to the discharge pharmacist about the prescriptions that were being sent to him.

The ultimate goal of Carolina Care at home is to be incorporated into the whole hospital and enrolling 30 patients a day into the program. I feel this was a great experience to see a brand new initiative being implemented in the hospital. Transitions of care is a very crucial part of a patient's overall health!

On deck for tomorrow: Oncology Pharmacy