Discharge Counseling for Patients with Heart Failure or Myocardial Infarction: A Best Practices Model Developed by Members of the American College of Clinical Pharmacy's Cardiology Practice and Research Network Based on the Hospital to Home (H2H) Initiative

Abstract

Hospital to Home is a quality-based initiative led by the American College of Cardiology and the Institute for Healthcare Improvement, aimed at reducing 30-day hospital readmission rates for patients with heart failure or myocardial infarction. Several factors have been shown to attribute to early readmission for these conditions including comorbidities, environmental factors, insufficient discharge planning, lack of health literacy, and nonadherence to drug therapy. Pharmacists play a significant role in reducing readmissions by ensuring that appropriate evidence-based pharmacotherapy regimens have been prescribed during hospitalization; monitoring for drug duplications, medication errors, and adverse reactions; and performing medication reconciliation. Studies have demonstrated the role of pharmacists in reducing medication-related visits to the emergency department as well as hospital readmissions, solely by preventing adverse drug events. Although all of these factors impact early readmissions, providing quality counseling to the patient as well as the patients' caregiver(s) at discharge is critical in order to optimize adherence as well as outcomes. In order to accomplish the goal of reducing readmissions, health care providers must partner together across the continuum of care and include pharmacists as pivotal members of the health care team. In this best practice statement, we summarize key components of discharge counseling for patients with heart failure or myocardial infarction including medication use, medication dose and frequency, drug interactions, medications to avoid, common adverse effects, role of the medication in the disease state, signs and symptoms of the disease, diet, the patient's role in self-care (lifestyle modifications), and when patients should seek medical advice.

Hospital pharmacists' perceptions of medication counseling: A focus group study

“…[1][2][3] Medication counselling opportunities are key times for pharmacists to speak to patients about their medications and the changes made to their therapies during their hospital stay. 2,[4][5][6][7] Failure by a hospital pharmacist to communicate effectively with patients may negatively impact a patient's ability to understand medication issues contributing to medication non-adherence. [8][9][10][11] The literature indicates patient benefits with hospital pharmacist involvement in discharge counselling and the practice has been incorporated into national pharmacy professional standards.…”

Examining hospital pharmacists' goals for medication counseling within the communication accommodation theoretical framework

“…[1][2][3][4][5] Failure by a hospital pharmacist to communicate effectively with patients may negatively impact a patient's ability to understand medication issues contributing to poor health outcomes. [6][7][8][9] .…”

Discharge Medication Counseling and its Correlation with Reducing Readmissions for Patients with Chronic Obstructive Pulmonary Disease Exacerbations

“…Several studies have shown pharmacists to play significant roles in reducing medication-related readmissions by preventing adverse drug events. 12,17 In a report by Wiggins et al, pharmacist interventions in patients with heart failure demonstrated improved patient knowledge, reductions in medication discrepancies and errors, fewer hospital readmissions, and lower costs. 12 Although small in nature, this study demonstrates the potential for discharge counseling conducted by a pharmacist to reduce the number of hospital readmissions in the COPD population.…”