Panelists Discuss Medication and Care Transitions

By Maria Anderson

wesolowskicis2James Poullard, Vice President of Pharmacy and Laboratory Services for Kindred, led a reaction panel on Medication Management and Polypharmacy, following Justin Kullgren's, PharmD, CPE presentation on the subject. In addition to Kullgren, panelists included Sally Brooks, MD, Chief Medical Officer for RehabCare, Kim Ramos, RN, Care Transitions Manager for the Hospital Division and Jill Wesolowski, RPh, PharmD, Clinical Staff Pharmacist for Kindred Hospitals of Cleveland.

Poullard started the panel by defining its purpose, which was "to assemble a panel of professionals who are in the trenches, to help us deal with these challenges of transitioning patients from our short-term acute care referral sources to our LTACs, and then preparing those individuals for discharge to nursing homes or to home care settings, and discussing really what their experiences have been."

cisramos1Ramos began by talking about the care transitions program and their work to help make patient transition to the next level of care as seamless as possible for everyone involved. This is in order to reduce preventable hospital readmissions, mis-medications on the day of discharge, and to help educate on what's next. Specifically, she discussed the transition home and the importance of educating not only the patients, but the home care providers, and providing them with all of the information to manage the patient safely. When asked what her biggest barrier has been to doing that successfully, Ramos stated, "Safe, effective communication from provider-to-provider. Or lack of hand-off and lack of standardization of care."

kullgren3cisKullgren continued the discussion by touching on the importance of keeping goals and prognosis in mind, and not discontinuing medications during transition to hospice until key information is identified. He provided an example of a Down Syndrome patient who suffered from seizures, and had all of her medications discontinued during her transition to hospice, putting her at a high level risk for seizures. The patient was quickly put back on her medications, bridged with other medications. Kullgren concluded that, "it is important to keep in mind that we're still caring for them. We're still aggressively caring for patients in hospice, with a different focus."

mictroublescis1Wesolowski got a little help from Kullgren when she experienced some technical difficulty, then shared some of the complications she sees when receiving medication lists on admission and preparing them for discharge, and how the care transitions team in Cleveland has worked to overcome those challenges. Wesolowski cited a lack of access to important information to answer the many questions they have when they receive a medication list on admission. In the Cleveland market, they are "trying to pay it forward" by engaging the pharmacist on the discharge level, in order to provide as much information as possible to the next facility, and that, "it has been nice to have the care transitions team facilitate getting that information."

brookscis1Dr. Brooks encouraged audience members to "feel empowered" to raise issues and communicate any observed patient behaviors that could be attributed to medications to physicians and nurses. She discussed that the interplay of cognitive function, the physiological reserve and the medications caused a dilemma regardless of the care setting, giving the example of a patient with a fracture and the importance of managing their pain, but needing to keep in mind additional medical concerns such as hypertension and diabetes.

The panel then took a few questions from audience members before concluding for the afternoon.