(Management Case Study) Bringing the Hospital to You: Planning and Implementation of Providing Medication Needs to Acute Hospital at Home Patients

Purpose: According to the CMS waiver, hospitals that meet certain criteria can apply to participate in the Acute Hospital At Home Program.  One of the critical and most challenging needs of successfully providing this service is pharmaceutical care.  This presentation will cover the timeline of the process, detail steps taken to ensure both state and federal compliance in the dispensation of medications and cover lessons learned when implementing this program from a pharmacy prospective.

Methods: When planning for the implementation of this program, inputs from a menagerie of personnel from local and system level pharmacy staff members were needed.  These range from local pharmacy staff all the way up to the Chief Pharmacy Officer.  Pharmacy Informatics was also heavily relied upon when determining how to best proceed using the already established technology in new creative ways.  Leveraging the knowledge of home care pharmacy to provide and administer medications is critical in ensuring a smooth process that pharmacists in the acute care setting often have little experience.  Once a process was best identified, clearly defined policies and procedures needed to be established in order to ensure the reproducibility and overall compliance with the goals of the waiver as well as state and federal laws.

Results: To date, we have treated over 230 patients in just over a year of operating under the CMS waiver.  The average length of stay since the inception was 3.5 days, with a rate of patients being transferred to a traditional inpatient bed of 5.5%.  The represented length of stay constitutes a 0.55 days reduction from the average length of stay represented within the system.  Roles of key pharmacy staff members within the service were clearly defined. Dispensing records and financial tracing were standardized by detailed policies and procedures outlining proper steps to take when providing care. Responsibilities for the procurement and storage of medications within the patient’s home were standardized. Extensive staff input was provided to ensure appropriate implementation of the changes.

Conclusion: When participating in the Acute Hospital at Home Program, providing high quality pharmaceutical services is one of the most challenging aspects of the program.  However, through clearly established policies and procedures, as well as staff input, we are able to meet state and federal requirements allowing patients to recover at home and freeing up hospital resources for more critical patients.