Impact of Targeted Medication Counselling during Discharge: Erie Shores HealthCare Experience

Author(s): Munira Sultana, Antoinette Chandler, Thomas Koltko, Ann Petrlich, Deepa Chawla, Jacob Weibe, Muhammad Ahnaf Ahsan, Matt Bessey

Addition, omission, and changes in medication dosage are common in patients during their hospital stay. One in five patients experienced an adverse event after hospital discharge, of which more than two-thirds were related to suboptimal medication counselling before their hospital discharge. Pharmacist-led targeted medication counselling could improve medication adherence, ultimately patient safety. Erie Shores HealthCare (ESHC) is a small, remote hospital serving at a 130% capacity since the pandemic era. We implemented a pharmacist-led medication counselling initiative that includes a paper-based medication list, a discussion on dosage, therapy changes (new, stopped, or changed), an explanation of indications and potential adverse drug reactions, and the importance of adherence, starting in January 2024. We aimed to evaluate the impact of such an intervention on our patient population. We conducted a series of telephone follow-ups with patients randomly after discharge (on days 7, 15, and 30) to learn about their experiences. The patient satisfaction rate with the intervention was overwhelming (92%). The hospital's readmission rate, both before and after the intervention, was also reduced, reflecting the potential success of the project. However, a more robust evaluation with a more extended implementation period may yield evidence of the project's success.