Potentially preventable medication-related hospitalizations: A clinical pharmacist approach to assessment, categorization, and quality improvement.

OBJECTIVES: The primary objective of this report is to describe a quality improvement practice designed to identify and categorize potentially preventable medication-related hospital admissions. The secondary objective is to present data collected from this practice and describe how it was used to improve a pharmacist intervention focused on reducing medication-related readmissions.

SETTING: This practice was developed as part of the quality improvement system supporting a pharmacist-led care transition model that was implemented across rural and urban counties in Hawaii.

PRACTICE DESCRIPTION: Pharmacists systematically assessed readmissions of the high-risk patients who were enrolled in the care transition model to determine the reasons for the admission and whether each was potentially preventable and medication related. This information was then used to improve the care transition model.

PRACTICE INNOVATION: This admission categorization system is the first based on best practice in pharmaceutical care and identifies indication, effectiveness, safety, and adherence problems, as well as subcategories within each of those domains.

EVALUATION: This quality improvement practice was applied to 401 readmissions. A chi-square test was used to determine if there were differences between urban and more rural areas regarding percentage of readmissions that were potentially preventable and medication related.

RESULTS: Twenty-six percent of the readmissions were determined to be potentially preventable and medication related. The most common categories were nonadherence due to patient choice (23.8%), untreated condition for which medication is indicated (13.3%), dose too high (10.5%), and dose too low (10.5%). The percentage of readmissions that were potentially preventable and medication related was significantly higher in more rural areas (30%) compared with urban areas (17%). There were no significant rural-urban differences by major category of potentially preventable medication-related admissions.

CONCLUSION: This systematic and actionable approach to reviewing and categorizing potentially preventable medication-related admissions can facilitate improvement in care and document the value of pharmacists serving in patient care roles.