Impact of Pharmacy Services Using Telemedicine and Clinical Decision Support in Skilled Nursing Facilities
The aims of the project were to: (1) Evaluate the effect of pharmacist-led medication management service using patient-centered telemedicine on adverse drug events (ADE) for residents receiving high-risk drugs, and (2) Evaluate patient reported outcomes.
Clinical decision support alerts were developed to inform consultant pharmacists of inappropriate prescribing and monitoring of high-risk drugs for the prevention of ADEs. Patient-centered medication reconciliations/reviews were conducted on admission to the skilled nursing facility (SNF) when high-risk drugs were prescribed and medication regimen reviews (MRRs) occurred during the residents’ SNF stay with the prompt of a clinical decision support alert. Consultant pharmacists provided structured feedback and recommendations to the resident’s attending physician.
Our quality improvement project used a cluster randomized stepped wedged design and was conducted in four SNFs within the health system. Upon intervention completion, a review of medical records was conducted to identify ADEs. Surveys regarding consultant pharmacist interactions were administered to residents during usual care and intervention periods.
Pharmacists provided a total of 772 recommendations for medication reconciliation and MRRs with a 57% physician acceptance rate. For the intervention, there was a 92% lesser incidence of ADEs than usual care. SNF residents rated pharmacist services more positively after the intervention and were more receptive to the use of telemedicine.
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