Analysis of Inpatient Hospice Pharmacist Interventions Within a Veterans Affairs Medical Center

Abstract

Clinical pharmacy interventions have been shown to improve medication therapy, prevent undesirable side effects, and improve patients’ clinical outcomes in a number of settings; however, limited data exist to characterize clinical pharmacy specialist (CPS) providers’ interventions in an inpatient hospice Veteran Affairs (VA) setting. The primary objective of this quality improvement (QI) project was to quantify the number and types of pharmacy interventions implemented from the Pharmacists Achieve Results with Medications Documentation (PhARMD) tool for inpatient hospice patient encounters in a VA medical center. A total of 453 interventions during 185 patient care encounters were documented by CPS providers between September 1, 2016, and December 31, 2016. These interventions were documented across 32 unique patients, with an average of 14.2 interventions made per patient during this period. CPS providers frequently intervened to optimize pharmacotherapy for the treatment of pain (42.38%), terminal agitation (5.08%), and nausea (3.97%). Additionally, CPS providers played a significant role in the deprescribing of medication by discontinuing drugs no longer indicated (18.3%). These results substantiate the valuable contribution to patient care that the CPS providers make in optimizing symptom management and deprescribing at end-of-life. Future studies are needed to characterize the potential cost savings of CPS provider services in the inpatient hospice setting.

Keywords:

• Cost avoidance
• hospice
• pharmacist interventions
• pharmacotherapy
• symptom management

Declaration of interest

Dr. Abigail Brooks is a consultant for Axial Healthcare. Sandra DiScala, Spouse of DiScala owns stock in Indivior PLC as part of his retirement portfolio in a Roth IRA account. Danny Basri, Christine Vartan, Michael Silverman, and Jennifer Quellhorst have nothing to disclose. The authors alone are responsible for the content and writing of the article. The views expressed in this article reflect those of the authors and do not represent the views of the Department of Veterans Affairs or of the United States.