(1345) Design and Implementation of a Telehealth Transitions of Care Support Program for an Acute Care Facility in the United States Virgin Islands

Objectives: The aim of this project is to implement a sustainable process that leverages telehealth services to supports the medical center’s mission of continuity of care and reducing the number of preventable medication related hospital readmission for its patients.As a Joint Commission accredited facility, that serves as a facility for quality healthcare services in Saint Thomas, United States Virgin Islands, neighboring regions, and the 1.2 million visitors yearly. The growing need of the medical center for a seamless patient transition, access to medication, and adherence education, led to the interest in a collaboration with Howard University College of Pharmacy. The university’s telehealth center will be used as a support center for ensuring continuity of care post discharge. The aim of this project is implement a sustainable process that supports the medical center’s mission of continuity of care for its patients post discharge.

Methods: The pharmacy led transitions of care service begins with a thorough medication reconciliation within 24 hours of the patient being admitted to the hospital. Next, the patient access department will provide the patient with forms for enrollment in Meds 2 Bed program, and obtain consent for the Telehealth services that will be provided by Howard University College of Pharmacy staff. Copies of these forms are then faxed to both the Schneider inpatient pharmacy and Howard University to notify team of enrollment. 48 hours prior to discharge, the Schneider pharmacist will conduct a review of the patient's medication therapy and resolve all medication related issues. 24 hours prior to discharge, the Schneider pharmacist will conduct education at the bedside that will include, medication continuation, changes in administration or doses, and discontinuations. The Schneider pharmacist will ensure that all discharge medication prescriptions are sent to the outpatient pharmacy. The outpatient pharmacy will fill and deliver all discharge medications at the bedside prior to the patient leaving the hospital. Within three to five days following discharge, the patient will receive a call from the Howard University Telehealth Center to reinforce medication and disease states educations and continue adherence coaching to avoid preventable medication related causes of readmission within 30 days.
Data will be collected on the number of medication therapy problems that are being identified after discharge, resolution rate of these problems, and the 30 day readmission rate in the patients who completed the service.

Results: N/A

Conclusions: N/A