SHM Converge Scientific Abstract ePoster Gallery-A Centralized Approach for Post-Discharge Medication Review and Education

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The document describes a centralized medication review and education program launched by Stanford Health Care’s Clinical Advice Service (CAS) to support patients shortly after hospital discharge. Because medication communication strongly affects patient experience and medication-related readmissions, CAS nurses began offering comprehensive phone-based medication reviews within 24–48 hours after discharge.<br /><br />From September to December 2021, 3,231 patients were offered this service and all agreed to participate. Most patients (2,700; 83%) had no medication-related concerns after review. However, 370 patients (11%) needed clarification about medication indication, dose, frequency, side effects, drug interactions, or discrepancies between their home medications and new discharge medications. Common discrepancies involved anticoagulants, diuretics, and antibiotics. Another 60 patients (2%) requested refills, and 2 patients reported side effects.<br /><br />Some issues were resolved directly by CAS nurses, while others were escalated to the discharging physician or outpatient provider. Fewer than 5% of issues required escalation to the discharging service. The program was supported by about 1.0 FTE CAS nurse per day. Patient satisfaction remained above 95%, and the authors believe the approach likely prevented adverse events and medical errors.<br /><br />Overall, the initiative shows that a centralized, nurse-led post-discharge medication review can improve patient education, resolve medication problems, support safer transitions of care, increase satisfaction, and potentially reduce readmissions.

Asset Subtitle

Nidhi Rohatgi

Meta Tag

Author List Alicia Yuen, Alpa Vyas, Chito Pascual, Eric Lee G. Escobedo-Wu, Fouzel Dhebar, Joan Slagle, Nidhi Rohatgi, Wendy Espitia

Category Innovations

Concept Post-Discharge Medication Review

Concept Medication-Related Issue

Concept Patient Education

Concept Patient Safety

Concept Readmission Prevention

Distinguished Non-Finalist

Presenter Organization Stanford University School of Medicine

Presenting Author Nidhi Rohatgi

Track Transitions of Care

Keywords

medication review

post-discharge care

patient education

nurse-led program

medication reconciliation

hospital discharge

adverse events prevention

clinical advice service

patient satisfaction

readmission reduction

Post-Discharge Medication Review

Medication-Related Issue

Patient Education

Patient Safety

Readmission Prevention