Montefiore Medical Center - Bronx, NY

Discharge-Focused Medication to Bedside Program

Submitted by Steven Tuckman, BS Pharm, MBA and Constance Browne, PharmD, BCACP

Site Description

Montefiore Medical Center is the University Hospital for Albert Einstein College of Medicine and a part of the Montefiore Health System. The Montefiore Community Pharmacy at CHAM is located within the lobby of the hospital. The pharmacy is owned by the Medical Center.

Med to Beds Service Description

Medication to Bedside (M2B) is a service we provide to our patients on discharge. It is considered a concierge service, wherein prescriptions are sent to our outpatient pharmacy either 1 or 2 days prior to discharge and are filled and delivered to patients’ bedside on day of discharge. The patients can opt-in to choose our pharmacy via a software (GetWell Network) hooked up to their bedroom television. The opt-in information is automatically sent to our pharmacy by email where our team will contact the patient and introduce ourselves. They will have the chance to ask any questions before delivery to bedside.

Once discharge date and time has been finalized between pharmacy and medical provider, the prescriptions are filled and rung through the POS and delivered. The delivery is completed by a pharmacist who will provide teaching instructions to the patient/caregiver. Payments if any are arranged via telephone for credit card. Cash payment would be received on delivery. We service the children’s hospital and the cardiology floor of the main hospital with M2B. The M2B service is available during hours when we have at least 2 staff pharmacists on duty, allowing 1 pharmacist to go to the floor for teaching. When there is insufficient staff, a hospital associate or other acceptable person will get the medications directly from the pharmacy. There is good support from the medical team in the hospital, as we have a unified goal of reducing 30-day readmissions. Important to implementation is provider buy-in.

Policies and Procedures

All new providers are informed of the M2B services at their beginners’ orientation, enhancing program participation. The program also meets Joint Commission requirements because all meds delivered to bedside must be stored with patients’ personal belongings. The delivery bag is sealed with a label that states, “do not use while in hospital.” If the medication is for a refrigerated item, the family will come to the pharmacy to pick them up on their way out of the hospital. Since medication consulting services are not a covered benefit with any of our insurance plans, pharmacist-provided education is documented through a “yes” or “no” indication at Point of Sale.

Additional Tools

No dashboard for meds to beds identification is currently in place, however, this is part of the organization’s future considerations.

Patient Population Target

All patients of the Children’s Hospital at Montefiore are targeted for M2B. Patients admitted for PCI in the main hospital with NSTEMI, STEMI, HLD, etc. are also potential targets.

Financial Considerations

We are financed by the hospital, but our service is not restricted to just M2B. We provide outpatient services to all who enter our doors from outside, and to several nearby clinics in and around the hospital.

Patient Assistance

The Medical Center has a policy that addresses patients’ need for financial support. The determination is made by the Department of Social Services. Should a patient qualify, medication is provided through Compassionate Care. Patients with the means to pay for their medication are expected to pay for it.

The Medical Center has recently implemented a service to help patients with high copays or no coverage in finding Financial Assistance. There is no data yet to determine its effectiveness.

For prescriptions that require prior authorization, the pharmacy staff notifies the provider.

Key Stakeholders and Operational Considerations

The M2B program has been operational since 2017. The pharmacy was built with M2B capability as part of the business plan. Senior administration approved the plan. Once ready for implementation, pharmacy leadership met with CHAM nursing leadership and the chief medical residents to develop the process by which the service would happen. The GetWell Network is a tool of the Department of Social Services, so they were included in the program’s development. There are four inpatient floors in the Children’s Hospital, and the service was rolled out unit by unit. Regarding discharge delays, we are in constant communication with the providers arranging and planning discharge.

Outcomes & Measures

To reduce 30-day re-admission and improve patient satisfaction scores. Charts are used to determine the percentage of scripts sent to our pharmacy vs outside pharmacy on discharge.

Key Elements of Success

It is important to have provider buy-in for success. They must also be persistent in seeking patient buy-in, as some patients still prefer to use their home pharmacy.

Lessons Learned

Winning elements – patient and provider satisfaction and less medication failures because patients leave with medication in hand without worry of prior authorization, price, etc., moreover, medication teaching is provided in detail by a pharmacist using teach-back method. Providers within the organization have also been the biggest champions to the success of the program.

Biggest challenge – This also continues to be a challenge – after medication gets delivered to floor, the medication gets changed or is discontinued. Sometimes the patient’s clinical status will change causing discharge to be postponed to another day. Also, sick calls will interfere with the process due to limited staff. To cope with the change, the organization is considering changing the bedside delivery time table until the patient’s car services has been called. However, this can be prohibitive as it leaves a smaller window for delivery.

Future Goals

The organization hopes to expand the pharmacy and house all medications that would be needed to carry on this service. Plans of incorporating a biosafety cabinet for hazardous preparations and sterile compounding are currently being considered.