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Discharge Planning Advisor: CHF readmissions decline as med needs addressed
Medication Mission’ improves quality of life
A discovery that came out of a congestive heart failure (CHF) project led to a "Medication Mission" that is improving quality of life and reducing readmission rates for patients at St. Joseph Health Center in Warren, OH.
While looking at factors surrounding the treatment and readmission of CHF patients, case managers realized "there was a compliance issue around being unable to afford the medications" the condition requires, says Mary Spano, RN, BA, manager for case management services.
"We decided to work on [the medication issue] as a way of increasing the overall quality of the CHF program," adds Valerie Mihalik, RN, CCRN, performance improvement coordinator.
The 30-day readmission rate for the first patients to benefit from the Medication Mission went from 12% to zero, she notes.
The CHF project began in July 2001, Mihalik explains. "We developed an entire program from beginning to end, which included standing order sets for admission as well as discharge and nursing protocol for the care of CHF patients — how often nurses assess patients, take vital signs, weigh patients, what they teach. We even had a unit specified for heart failure patients, with finely educated nurses who were experienced in that area."
"The thing that kept glaring at us," she adds, "is that the big problem was that patients could not afford their medications."
A large number of pensioners in the Warren area have lost health care benefits as a result of the large steel companies for which they had worked going out of business, Mihalik notes. "As a result, we’re seeing a lot more patients who are underinsured or uninsured, especially for pharmaceutical benefits."
Caregivers would get wonderful feedback from patients on the treatment and education they received, she adds, but the conversation often would end with, "Don’t bother filling that [prescription] out. I have $600 a month to live on, and the [medications] cost $600."
As hospital staff began to look at what could be done to address the problem, Mihalik says, "we got a lot of inspiration from the mission of our organization, which was founded by the Humility of Mary Sisters. Our mission statement from the sisters is to extend the healing ministry of Jesus to the poor and underserved.’ We also looked at the example of Mother Theresa."
The CHF program’s physician advocate is a cardiologist who had worked with Mother Theresa and who is very passionate about helping the underserved, she notes.
With that inspiration, funding from the St. Joseph Development Foundation, and the cooperation of Trumbull County’s SCOPE (Senior Citizens Opportunity for Personal Endeavor) Center, the health center began its Medication Mission program, Spano says.
"In conjunction with [the county], we hired and underwrite the salary of a prescription assistant, who makes every effort to see [participating] patients while they are in the hospital," she continues. That person begins the process of qualifying the patients to receive help from the pharmaceutical companies’ indigent funding program, and facilitates that. It takes about six weeks to get those medications once the paperwork is set up."
"What we started doing," Mihalik says, "is providing a 30-day supply with one refill of CHF medication, and then added [other drugs] as we found we could afford it. We added all cardiac medications, including blood pressure meds, then diabetic medications — including glucometers and testing strips — because a lot of our patients have multiple things going on."
Now, she adds, a recipient might be a mother who needs antibiotics for a sick child.
Patients initially were given a 60-day prescription, notes case manager Tammy Rienzi, RN, but it soon became apparent that most patients were receiving the pharmaceutical company benefit before all the drugs were taken. To save costs, she adds, program administrators went to the 30-day prescription, with one refill.
The multidisciplinary committee that meets every other month to oversee the program recently discussed adding pulmonary medications, including those for chronic lung disease, to the list of drugs the medical center provides, Rienzi notes.
The idea, Spano explains, is to "create a bridge" so that there is no interruption in medications between when the patient leaves the hospital and when the pharmaceutical funding program kicks in.
Once the transition is made into that program, which is administered through the senior center, the benefit opens up to include any of the medications the patient needs, not just those "bridged" by the hospital, she points out.
The hospital directs its funds toward providing key medications, such as angiotensin-converting enzyme inhibitors and beta-blockers, without which the patient will end up back in the hospital, Mihalik notes.
"If the patient is without the oral medications that will lower cholesterol or help calcium loss for six weeks, they can get by," she says.
Before the medication program was instituted in February 2002, the hospital had been averaging a 14% 30-day readmission rate for its CHF patients, she says, "which is about the national average."
Now, Mihalik adds, the 30-day readmission rate for those who have been helped by the program is zero, and 68% of the patients helped had no readmissions for 204 days.
Patient screening is thorough
There is an extensive process in place to ensure that the patients who are most in need are served by the program, Spano says.
"They are identified by a case manager or by any staff nurse or physician. Then, because we are a religious-based hospital, someone from the pastoral care department talks to the patient.
"From the case management perspective," she adds, "we also check to see that the patient has no [prescription drug] benefits or that they are exhausted. We have to be prudent with the dollars we have available."
In addition, Mihalik says, a clinical pharmacist reviews the patient’s medications to make sure they’re appropriate, that there are no contraindications, and to determine whether substitutions can be made.
"At first," Spano notes, "we thought people might take advantage and come back for free medications, but that’s not the case at all. Once they get in the [pharmaceutical indigent funding] program, their needs are being met and they don’t return with the same needs."
In fact, adds Rienzi, she actually has patients who are offered the benefit and say, "I have access to some money. Give it to somebody else who really needs it."
The best of all job perks
One of the perks of her job, she notes, is being able to go to patients and tell them the hospital will supply their drugs for free for 60 days. "It’s the most wonderful thing to see them just light up."
[For more information, contact:
• Mary Spano, RN, BA, Manager for Case Management Services, St. Joseph Health Center, Warren, OH. Telephone: (330) 841-4000. E-mail: Mary_ Spano@hims.org.
• Valerie Mihalik, RN, CCRN, Performance Improvement Coordinator, St. Joseph Health Center, Warren, OH. Telephone: (330) 841-4000. E-mail: Valerie_Mihalik@hims.org.
• Tammy Rienzi, RN, Case Manager, St. Joseph Health Center, Warren, OH. Telephone: (330) 841-4000. E-mail: Tammy_Rienzi@hims.org.]