Pharmacist-led discharge service at Mater Dei hospital

Abstract

The provision of a transitional care service enhances the safe transition of patients across various healthcare settings. The aim of this research was to develop and implement a novel, patient-focused, pharmacist delivered transitional care service at the Hospitality Lounge at Mater Dei Hospital. The methodology adopted consisted of a mixed methods approach with concurrent triangulation. Phase I involved an observational phase to familiarise with the activities carried out within the setting. Phase II was characterised by the provision of tailored pharmaceutical services for discharged patients flagged by healthcare professionals to the researcher pharmacist. Phase III piloted an innovative medication reconciliation-based service on a selected patient cohort. A qualitative study using semi-structured interviews gauging the perception of healthcare professionals on the provision of the medication reconciliation service was performed during Phase IV. Ten hours per week for a total of eight weeks of direct observational visits were performed using reflective journaling during Phase I. Three Plan-Do-Study-Act cycles were run to test the framework for the development of the pharmacist-led discharge service provided in Phase II. During 12 months of provision of the discharge service, the pharmacist was contacted 247 times and 679 patients were referred for pharmacist intervention. The pharmacist’s interventions involved ensuring access to medication supply (n=642); tailored patient counselling (n=525) and validation of discharge information by providing a clinical check (n=672). The medication reconciliation service was tested for implementation using a prospective observational study in Phase III. A statistically significant increase in the time taken to obtain the best possible medication discharge list in the study group was observed when the Mann-Whitney test was applied (p-value <0.001). Qualitative data obtained through thematic analysis of interview data with 20 healthcare professionals revealed the barriers and challenges towards formal implementation of medication reconciliation services within the setting. The global findings of this research illustrated that interventions which facilitate seamless care provision ensure safe patient transitions. The successful implementation of the proposed discharge service has highlighted leadership roles pharmacists can take in ensuring holistic patient care.