All too often in the current healthcare climate, patients are transferred from hospitals to long-term care facilities only to be readmitted back to the hospital. Why do hospital readmissions continue to occur time and time again? The straightforward answer is poor continuity of care. In this blog, we explore some of the reasons behind hospital readmissions, and how LTC pharmacy services can help prevent them.
Case study: pneumonia patient without LTC services
A 72-year-old female patient presents to a hospital emergency department with signs and symptoms of pneumonia. Due to the severity of the patient’s symptoms, the patient is admitted to the hospital. Upon admission, a healthcare professional conducts a medication reconciliation and notes the patient is on warfarin therapy. The healthcare professional contacts the patient’s caregiver and obtains the patient’s warfarin dose and recent international normalized ratio (INR), which is within the therapeutic range. However, due to the patient’s new medications, which include an antibiotic, the patient’s warfarin dose has to be lowered to prevent a possible drug interaction or adverse event from occurring. After several days the patient begins to regain her strength and recover from her illness, and is transferred to a long-term care facility. Unfortunately, the patient’s warfarin dose is never further assessed or evaluated. Within weeks, the patient suffers a stroke and has to be readmitted to the same hospital.
Hospital transfers to LTC facilities
For any number of reasons, when patients transfer from hospitals to long-term care facilities, often essential details such as medications, test results, and lab values are overlooked or just missed, creating a massive gap in healthcare. This gap in healthcare, as highlighted in the above case study, can lead to hospital readmissions, which can be devastating to patient’s overall health, well-being, and quality of life. Simply put, a hospital readmission can mean the difference between positive and negative healthcare outcomes. For some patients, it can potentially mean the difference between life and death. So how can hospital readmissions be prevented or, at least, reduced in number? The answer may lie in long-term care pharmacy, also referred to as LTC pharmacy and long-term care pharmacy services.
What do LTC pharmacists do?
Long-term care pharmacy providers can offer many services that can help prevent hospital readmissions. Collectively referred to as LTC pharmacy services, these services often include medication reconciliations, medication monitoring, order verification, healthcare support and medication packaging. Together they can improve patient care and healthcare outcomes. The bulk of the services mentioned above are carried out by long-term care pharmacists. That said, often when patients or even some healthcare professionals consider the impact of LTC pharmacy services or the role of the long-term care pharmacist, they often ask the following questions: “What do long-term care pharmacists do?” and “How can long-term care pharmacists help prevent hospital readmissions?”
To best answer those questions, let’s revisit the case study presented above. This time, the scenario in the case study will include LTC pharmacy services to highlight how they can impact patient care and help prevent hospital readmissions:
Case study revisited: pneumonia patient with LTC services
A 72-year-old female patient presents to a hospital emergency department with signs and symptoms of pneumonia. Due to the severity of the patient’s symptoms, the patient is admitted into the hospital. Upon admission, a healthcare professional conducts a medication reconciliation and notes the patient is on warfarin therapy. The healthcare professional contacts the patient’s caregiver and obtains the patient’s warfarin dose and recent INR, which is within the therapeutic range. However, due to the patient’s new medications, which include an antibiotic, the patient’s warfarin dose has to be lowered to prevent a possible drug interaction or adverse event from occurring. After several days the patient begins to regain her strength and recover from her illness. Eventually, the patient’s nurse informs her that she will be transferred to an LTC facility. The patient is confused and asks the nurse, “What is an LTC facility?” The nurse informs the patient that an LTC facility is a long-term care facility and goes on to provide the patient with further details. The nurse also tells the patient that the LTC facility she will be transferred to works with a long-term care pharmacy. After the patient gets moved to the LTC facility, a long-term care pharmacist reviews the patient’s information and medications. The pharmacist observes that the patient is on warfarin therapy and immediately contacts the patient’s physician and recommends that an INR be ordered for the patient. The INR is ordered and reported to be sub-therapeutic. The pharmacist follows up with the patient and notes the sub-therapeutic INR. Once again the pharmacist contacts the patient’s physician and this time recommends a warfarin dose adjustment. The patient’s warfarin dose is adjusted and subsequent INR levels are within therapeutic range. With her medications evaluated efficiently, the patient adjusts to her new surroundings and makes a full recovery with no additional hospital admissions.
Benefits of LTC pharmacy
The impact of long-term care pharmacy services and, specifically, the long-term care pharmacist, is evident in the second version of the case study. The long-term care pharmacist directly impacted the patient’s healthcare by reviewing the patient’s history, identifying potential continuity of care issues with the patient’s warfarin therapy and making the necessary recommendations to avoid an adverse event and/or hospital readmission from occurring. Assisting in patient transitions to LTC facilities is often a focal point of long-term care pharmacies and long-term care pharmacists. They often make it their goal to ensure patient transitions occur as smoothly and as safely as possible, providing support to maximize the process.
Trends in long-term care pharmacy
Luckily, the services and potential of long-term care pharmacies are becoming more apparent. More and more, stakeholders within the healthcare system are recognizing the importance of long-term care pharmacies and encouraging their growth and emergence as a vital component to the betterment of patient care. As a result, trends in long-term care predict the need for long-term care pharmacies and pharmacists will continue to increase in the future. For that reason, coupled with the current fluctuations in hospital and retail pharmacy trends, many pharmacists are moving into the world of long-term care pharmacy.
Potential emerging career path
As more pharmacists move into long-term care pharmacy, many are realizing their true value and potential as healthcare professionals. LTC pharmacists are directly improving patient care by helping prevent hospital readmissions, which can prove invaluable to patient health and overall well-being. Pharmacists are essential to the healthcare process, and they are becoming increasingly important to the continuity of care when patients are transitioned into long-term care facilities. If you are a pharmacist considering a new career path or a graduating pharmacy student looking for meaningful pharmacy opportunities, perhaps it is time to consider whether a career in long-care pharmacy is for you.