A Dedicated Outpatient Pharmacy Improves Access to Discharge Medications in a Pediatric Emergency Department: A Quality Improvement Study

Jason Hyunjoon Choi; Michelle Caruso Barrett; Nicholas Michel; Kamali Bouvay; Hamilton Schwartz; Adam Alexander Vukovic

doi:10.1016/j.annemergmed.2023.12.010

A Dedicated Outpatient Pharmacy Improves Access to Discharge Medications in a Pediatric Emergency Department: A Quality Improvement Study

Ann Emerg Med. 2024 Jan 17:S0196-0644(23)01433-6. doi: 10.1016/j.annemergmed.2023.12.010. Online ahead of print.

Authors

Jason Hyunjoon Choi¹, Michelle Caruso Barrett², Nicholas Michel², Kamali Bouvay³, Hamilton Schwartz³, Adam Alexander Vukovic³

Affiliations

¹ Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX. Electronic address: Jason.Choi@bcm.edu.
² Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
³ Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.

PMID: 38244028
DOI: 10.1016/j.annemergmed.2023.12.010

Abstract

Study objective: Following discharge from a pediatric emergency department (ED) or urgent care, many families do not pick up their prescribed medications. The aim of this quality improvement study was to increase the percentage of patients discharged home with medications in-hand from 6% to 30% within 6 months.

Methods: Due to the planned construction of a new ED, urgent care, and dedicated pharmacy, a multidisciplinary team was formed to increase access to discharge medications. We performed a pilot study in the urgent care to improve the discharge prescription process and expanded its scope to the ED. We evaluated the effect of our interventions on the percentage of patients discharged with medications in-hand through statistical process control charts. Process measures included the percentage of prescriptions electronically prescribed and directed to an on-site pharmacy.

Results: Between June 21, 2021 and March 27, 2022, 7,678 patients were discharged with at least 1 medication in-hand. The percentage of patients discharged with medications in-hand increased from 6.2% to 60.6%. The percentage of prescriptions e-prescribed and directed to an on-site pharmacy increased to 94.6% and 65.6% respectively.

Conclusions: In this study, the availability of a 24-hour on-site pharmacy appears to be the most impactful intervention increasing access to discharge medications for families. Other interventions, such as a pilot study in the urgent care and implementing default electronic prescribing, may have potentiated the effect of the new pharmacy.