Leveraging the Outpatient Pharmacy to Reduce Medication Waste in Pediatric Asthma Hospitalizations
BACKGROUND AND OBJECTIVE: Previous local quality improvement focused on discharging patients with inhaled corticosteroids (ICS) “in-hand” decreased healthcare reutilization after hospitalization for an asthma exacerbation. However, as a result of these new processes, some patients admitted for an asthma exacerbation received more than one ICS inhaler during their admission, contributing to medication waste and potential patient confusion regarding their discharge medication regimen. We sought to decrease this waste.
METHODS: We conducted a quality improvement project to reduce the prescribing of multiple ICS inhalers to patients at a large academic children’s hospital. Our primary outcome measure was the monthly percentage of patients admitted with an asthma exacerbation who were administered more than one ICS inhaler. A secondary outcome measure evaluated the reliability of the new process of using the hospital-based outpatient pharmacy to supply ICS “in-hand” and verify insurance coverage. After the process map review, we hypothesized a delay in the initial ICS treatment decision would allow for both a finalized discharge medication plan and a standardized process to verify outpatient insurance coverage. |
RESULTS: The mean percentage of patients receiving more than one ICS inhaler decreased from our baseline of 7.4% to 0.7%. Verification of outpatient prescription insurance coverage via the outpatient pharmacy increased from 0.7% to 50%. The average inpatient cost (average wholesale price) for ICS decreased by 62% to $90.25.
CONCLUSIONS: Our process change to use the outpatient pharmacy to dispense and verify insurance coverage for ICS medication was associated with a reduction in medication waste during admission for an asthma exacerbation.
© 2020 Society of Hospital Medicine
CONCLUSIONS
Implementation of a new process for ordering ICS that emphasized delaying treatment until all necessary information was available and using an outpatient pharmacy to confirm insurance formulary coverage reduced the waste associated with more than one ICS being prescribed during a single admission.
Acknowledgments
The authors thank Sally Pope, MPH and Dr. Michael Carlisle, MD for their contribution to the quality improvement project. Thank you to Drs. Karen McDowell, MD and Carolyn Kercsmar, MD for advisement of our quality improvement project.
The authors appreciate the following individuals for their invaluable contributions. Dr. Hoefgen conceptualized and designed the study, was a member of the primary improvement team, carried out initial analysis, drafted the initial manuscript, and reviewed and revised the manuscript. Drs. Jones and Torres Garcia, and Mr. Hare were members of the primary improvement team who contributed to the design of the quality improvement study and interventions, ongoing data interpretation, and critically reviewed the manuscript. Dr. Courter contributed to the conceptualization and designed the study, was a member of the primary improvement team, designed data collection instruments, and critically reviewed and revised the manuscript. Dr. Simmons conceptualized and designed the study, critically reviewed the manuscript for important intellectual content, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Disclaimer
The information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the BHPR, HRSA, DHHS, or the U.S. Government.
