Timely Delivery of Discharge Medications to Patients' Bedsides: A Patient-centered Quality Improvement Project

Abstract

Introduction: Patients who are unable to fill prescriptions after discharge are at risk of hospital readmission. Ensuring that patients have prescriptions in hand at the time of discharge is a critical component of a safe and effective discharge process. Using a "Meds to Beds" program, we aimed to increase the percentage of patients discharged from Holtz Children's Hospital with medications in hand from 49% to 80%, reduce turnaround time (TAT) from electronic prescription signature to bedside delivery from 4.9 hours (±2.6 hours) to 2 hours, and increase caregiver satisfaction.

Methods: We formed a multidisciplinary team and implemented 4 patient-centered interventions through iterative plan-do-study-act cycles. Statistical process control charts were used to understand the impact of the interventions over 10 months. Hospital length of stay and discharges before 2:00 pm were used as balancing measures. We measured caregiver satisfaction using a telephone survey administered by pediatric residents within 7 days after discharge.

Results: The mean percentage of patients discharged with medications in hand increased to 76%. TAT decreased to 3.5 hours (±1.8 hours). Length of stay did not significantly increase, whereas the percentage of patients discharged before 2:00 pm did. Caregivers of patients who had prescriptions delivered to their bedside reported high levels of satisfaction.

Conclusions: Using a "Meds to Beds" program, we increased the percentage of patients discharged with medications in hand, decreased TAT with reduced variability, and achieved high levels of caregiver satisfaction. Importantly, there was a shift in the culture of the institution toward improved medication access for patients.

Fig. 1.

Ishikawa diagram (root cause analysis). DEA, Drug Enforcement Administration; SMART, Specific Measurable Attainable Realistic Timely.

Fig. 2.

Key driver diagram.

Fig. 3.

Statistical process control (p-chart) displaying the biweekly percentage of patients discharged with medications in hand. A baseline of 47% is observed. After 4 PDSA cycles, the mean went up to 76%. LCL indicates lower control limit (3 SDs below the mean); UCL, upper control limit (3 SDs above the mean).

Fig. 4.

Run chart of the mean TAT defined as the time from prescription signature to prescription delivery to the bedside. Median TAT is 3.6 hours.

Fig. 5.

Statistical process control (X-chart) measuring the mean LOS. An increase from 2.7 to 2.9 days was observed. LCL indicates lower control limit (3 SDs below the mean); UCL, upper control limit (3 SDs above the mean).

Fig. 6.

Statistical process control (p-chart) displaying the biweekly percentage of patients being discharged from the hospital before 2:00 pm. A baseline of 28% is observed. After 4 PDSA cycles, the mean went up to 48%. LCL indicates lower control limit (3 SDs below the mean); UCL, upper control limit (3 SDs above the mean).