Evaluation and optimization of a clinical pharmacist driven transitions of care model for malignant hematology

Lucas S Wind; Thomas G Knight; Jessica J Auten; Jill S Bates; Leonardo Marucci; Crista J Creedle; Matthew C Foster; Benyam Muluneh

doi:10.1177/1078155220916516

Evaluation and optimization of a clinical pharmacist driven transitions of care model for malignant hematology

J Oncol Pharm Pract. 2021 Mar;27(2):283-287. doi: 10.1177/1078155220916516. Epub 2020 Apr 14.

Authors

Lucas S Wind^{1

2}, Thomas G Knight³, Jessica J Auten^{1

2}, Jill S Bates^{1

2}, Leonardo Marucci⁴, Crista J Creedle⁵, Matthew C Foster^{4

6}, Benyam Muluneh^{1

2}

Affiliations

¹ Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA.
² University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA.
³ Levine Cancer Institute, Atrium Health, Charlotte, NC, USA.
⁴ Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
⁵ Division of Nursing, University of North Carolina Medical Center, Chapel Hill, NC, USA.
⁶ Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.

PMID: 32290764
DOI: 10.1177/1078155220916516

Abstract

To implement and optimize a pilot transitions of care model for scheduled chemotherapy admissions in patients with hematologic malignancies at our institution.Methodology: We utilized the plan-do-study-act (PDSA) quality improvement technique to prospectively measure success of interventions related to improving transitions of care processes that occurred in multiple stages including development of standardized operating procedures, electronic medical record documentation, and education to the malignant hematology multidisciplinary group. Chart review was performed retrospectively for at least nine patients per PDSA cycle. Areas of intervention addressed and measured regarding communication between the ambulatory care and acute care settings included: admission purpose, processes related to insurance benefits investigations for specialty medications required in the post-discharge setting, and plan for growth factors, prophylactic antimicrobials, and follow-up.Results and conclusions: We included 28 patients and performed a total of three PDSA cycles demonstrating specific improvements in: communication regarding status of benefits investigations performed for specialty medications prior to admission, resolution of these benefits investigations at various time points, improvement in efficient use of the electronic medical record for chemotherapy orders, and patient instructions for appropriate use of prophylactic antimicrobials. Although improvement was noted initially with prescribing of discharge antiemetics and antimicrobials, regression to baseline was noted with the third PDSA cycle.

Keywords: Malignant hematology; plan-do-study-act; transitions of care.

MeSH terms

Communication
Documentation
Electronic Health Records
Female
Hematologic Neoplasms / drug therapy*
Humans
Insurance Benefits*
Insurance, Health*
Male
Medication Systems, Hospital
Middle Aged
Patient Admission / standards
Patient Care Planning / standards
Patient Education as Topic
Patient Transfer / organization & administration
Patient Transfer / standards*
Pharmacists / organization & administration
Quality Improvement*
Retrospective Studies