Newswise — LOS ANGELES (January 21, 2019)—Cedars-Sinai pharmacists are helping make clinical care safer and more effective as more patients with complex medical needs require a variety of increasingly complicated medication therapies. 

"Frequent medical breakthroughs mean that more of the patients we see are taking a myriad of medications for a wide range of diseases," said Rita Shane, PharmD, chief pharmacy officer and professor of medicine at Cedars-Sinai. "We ensure that a patient's treatment plan is carried out the way it was intended. It's an expansion of the role of a pharmacist in a community practice that people are familiar with."

Cedars-Sinai pharmacists are tasked with ensuring patients receive the medications they need safely and effectively and stick to their regimens once they return home while not taking unnecessary drugs. When patients fail to take prescribed medications—or don't use them the right way—they risk return trips to the hospital and cost the U.S. healthcare system more than $100 billion a year, according to a 2005 study in The New England Journal of Medicine. Older hospital patients are most susceptible to drug-related problems that can lead to readmissions or even death.

To help these individuals get the right medications and take them correctly after discharge, Cedars-Sinai has embedded pharmacists in the care teams treating certain high-risk patients. Medication lists are double-checked by a pharmacist for errors prior to discharge, and patients are sent home with their prescription drugs after being counseled on how to take them properly. Early data show that the transitions of care pharmacy program reduced 30-day readmissions for these patients by 14.5% percent while eliminating prescription errors caused by providers.

Some of the initiatives in Cedars-Sinai's innovative pharmacy practice include:   

  • Medication Education—Pharmacists teach patients at high-risk of being readmitted to the hospital about their medications and ask patients to explain their drug regimens in their own words. Pharmacists also counsel patients at their hospital bedsides or call them within 72 hours of being discharged to check that patients are taking their medications as prescribed.
  • Reducing Errors—Pharmacists and pharmacist technicians stationed in the medical center's Emergency Department take medication histories for high-risk patients, reducing prescribing errors. Other high-risk hospital patients also have their medication lists evaluated to help avoid unnecessary readmissions. This Cedars-Sinai innovation was tested, and research proved this approach to be effective, which led to a new California law that went into effect this year. Inpatient pharmacists evaluate all orders for medications to avoid drug-to-drug interactions and to ensure that dosages are safe based upon each patient's underlying diseases or conditions.
  • Curbing Unnecessary Antibiotic Use—Pharmacists trained in treating infectious diseases monitor antibiotic use by accompanying physicians on patient rounds. Inpatient pharmacists routinely evaluate and monitor antibiotics to catch early signs of antibiotic resistance.
  • Medication Delivery—Patients can request that their discharge prescription medications be delivered to their room before they leave the hospital. A pharmacist completes a comprehensive review of the patient's medical and medication history and, if needed, offers information about financial assistance. This ensures a smooth transition back home. 

High-Cost Drugs—As drug costs skyrocket, Cedars-Sinai's inpatient pharmacy is reducing the amount of money spent on certain high-cost medications. Pharmacists work closely with physicians and the latest medical evidence to determine when a high-cost drug is essential or when a generic drug or an alternative approach would work equally well.

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The New England Journal of Medicine