Preventing Medication-Related Problems in Care Transitions to Skilled Nursing Facilities

Not Applicable

Active, not recruiting

• Conditions: Care Transition
• Interventions: Other: Structured hand-off; Other: Medication reconciliation during transitional period; Other: Transitional medication monitoring; Other: Teleconsultation

• Registration Number: NCT05241951
• Lead Sponsor: University of Washington

Brief Summary

The Pharmacy Integrated Transitions (PIT) program, utilizes a crossover randomized control design to evaluate the impact of a clinical pharmacist in decreasing medication related problems during a patient's transition from hospital to skilled nursing facility (SNF).

Detailed Description

Standard hospital discharge processes (e.g. as recommended by the Joint Commission Center for Transforming Healthcare), include hospital staff completing a paper-based discharge summary and medication reconciliation form. To reduce the likelihood of medication-related problems during care transitions, the Pharmacy Integrated Transitions (PIT) program aims to improve the standard transition process by adding a coordinating transitional pharmacist to provide a structured synchronous "warm-handoff" between clinical teams at the hospital and the Skilled Nursing Facility, in addition to reconciling, adjusting, and monitoring medications during and after discharge from the hospital.

Study Timeline

• Study First Submitted: 2022-01-28
• Study Start: 2022-01-31
• Study First Submitted QC: 2022-02-11
• Study First Posted: 2022-02-16
• Status Verified: 2024-05
• Last Update Submitted: 2024-05-20
• Last Update Posted: 2024-05-22
• Primary Completion: 2024-07-31
• Study Completion: 2025-07-31

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 5760

Inclusion Criteria

• 18 years of age and older
• patients receiving inpatient care at University of Washington Mountlake, University of Washington Northwest, Harborview, and Valley Medical Center hospitals to one of 14 collaborating SNF's on a day when the PIT program pharmacist is conducting the intervention

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Exclusion Criteria

• Under 18 years of age
• patients with a discharge on hospice care
• patients discharged on days that the pharmacist is not conducting the intervention

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: CROSSOVER

Arm && Interventions

Group	Intervention	Description
Clinical Pharmacist in Transition of Care	Structured hand-off	A clinical pharmacist will be provided as a patient discharges from one of four University of Washington (UW) medical centers to one of 14 post acute skilled nursing facilities randomized to the intervention arm. The coordinating transitional pharmacist will conduct (1) a comprehensive medication review including medication reconciliation, adjustment, and monitoring during the transitional period from hospital to SNF, 2) a structured handoff between clinical teams at the hospital and SNF.
Clinical Pharmacist in Transition of Care	Teleconsultation	A clinical pharmacist will be provided as a patient discharges from one of four University of Washington (UW) medical centers to one of 14 post acute skilled nursing facilities randomized to the intervention arm. The coordinating transitional pharmacist will conduct (1) a comprehensive medication review including medication reconciliation, adjustment, and monitoring during the transitional period from hospital to SNF, 2) a structured handoff between clinical teams at the hospital and SNF.
Clinical Pharmacist in Transition of Care	Medication reconciliation during transitional period	A clinical pharmacist will be provided as a patient discharges from one of four University of Washington (UW) medical centers to one of 14 post acute skilled nursing facilities randomized to the intervention arm. The coordinating transitional pharmacist will conduct (1) a comprehensive medication review including medication reconciliation, adjustment, and monitoring during the transitional period from hospital to SNF, 2) a structured handoff between clinical teams at the hospital and SNF.
Clinical Pharmacist in Transition of Care	Transitional medication monitoring	A clinical pharmacist will be provided as a patient discharges from one of four University of Washington (UW) medical centers to one of 14 post acute skilled nursing facilities randomized to the intervention arm. The coordinating transitional pharmacist will conduct (1) a comprehensive medication review including medication reconciliation, adjustment, and monitoring during the transitional period from hospital to SNF, 2) a structured handoff between clinical teams at the hospital and SNF.

Primary Outcome Measures

Name	Time	Method
Medication Related Problems	30 days post hospital discharge	Number of medication related problems experienced by patients within 30 days post hospital discharge.

Secondary Outcome Measures

Name	Time	Method
Readmissions	30 Days	Number of readmissions within 30 days of index hospital discharge
Death	30 Days post hospital discharge	Number of deaths experienced by patients within each cohort

Trial Locations

Locations (1)

University of Washington Health System; 🇺🇸 Seattle, Washington, United States