P0553 - Limiting Coronavirus Exposure for Complex and Palliative Pediatric Patients through Prescription Medication Advocacy

Limiting Coronavirus Exposure for Complex and Palliative Pediatric Patients through Prescription Medication Advocacy

Kuck, Cheryl, MD, FAAP; Harwood, Lori, BSNRN; Auricchio, Lisa; Williams, Elizabeth, BSIE, MBA

Background: At Dayton Children’s Hospital (DCH), complex and palliative care patients are served by a combined program. DCH defines palliative care patients as having life-limiting or life-threatening conditions and complex care as having three or more chronic conditions, significant functional disability, and high utilization of medical services. Both palliative and complex care patients are at higher risk for morbidity and mortality from COVID-19 infection and thus should limit public exposure by themselves and their family members. Many of these patients have multiple medications and use prescription supplies as well. Prescriptions must be refilled every 30 days. During the start of the COVID-19 shelter-in-place orders, the DCH Complex and Palliative Care Team undertook an advocacy project with the DCH retail pharmacy and CareSource, Ohio’s largest Medicaid insurer, to convert patients’ medications from a 30- to a 60-day supply, thereby reducing public exposure for these patients and their families.

Description: In March 2020, the governor of Ohio instituted shelter-in-place orders for Ohio and severely limited ambulatory clinic visits to DCH. The Complex and Palliative Care Team began calling its families using the standardized documentation in Figure 1 as a guide. Of 58 patients, 10 were interested in and eligible for the project (involving over 150 orders). Eligibility required prescriptions be filled at the DCH retail pharmacy and insured through CareSource. Once interest and eligibility were confirmed, the following steps were undertaken.
• Consultation with each patient’s subspecialists to ensure alignment and agreement of medications and dosages.
• Advocacy with CareSource to convert approvals from 30- to 60-day supplies. In many cases, approvals needed individual overrides.
• Close communication with DCH pharmacy to create a specific process for these prescriptions to ensure they would be approved by insurance, filled, and delivered for curbside pickup without delays or inconveniences to these fragile families and patients.
• Synchronization of all medications for an individual patient so all prescriptions could be picked up on the same day.
• Reconciliation of the entire medication record.

Conclusion: Advocacy actions taken by the Complex and Palliative Care Team were an effective way of preventing unneeded public exposure for one of the most complex and fragile patient populations at DCH. Families expressed their appreciation not only for the time saved and the ability to protect their children; but recognition of the complexity of their daily lives. It allowed our team to fulfill DCH's mission of optimal care and raise morale during a difficult time. The framework created in this advocacy project can be used for other projects in the future.