Palliative Care Pharmacist Interventions Surrounding Medication Prescribing Across Care Transitions (IMPACT) (RP306)

Outcomes. 1. Describe the process of palliative care pharmacist integration into a transitions of care setting for palliative care oncology population 2. Discuss impact of a pharmacist-led transitions of care program for patient care Importance. In our palliative care clinic embedded in our outpatient cancer center, no transitions of care process exists. Pharmacist-led transitions of care programs have shown a reduction in medication errors, 30-day hospital readmissions, improved medication reconciliation, and patients' understanding of appropriate use of medications. The Palliative Care Pharmacist IMPACT Program aims to improve continuity of care for our oncology patients, ensure access to discharge medications, and provide comprehensive medication reconciliation for a medically complex patient population with high readmission risk. Objective(s). The primary objective of this project is to evaluate the feasibility of this program. Secondary outcome is a description of palliative care provider satisfaction with this program. Method(s). PC Pharmacist called "high-risk" patients within 72 hours of hospital discharge for comprehensive medication review and symptom assessment. "High risk" defined as 2 of the 4 criteria: highest readmission risk, intermediate or high mortality risk, needing 90 or more oral morphine equivalents, or 10 or more medications on home medications list. Over a 3-month period, data collected included number of patients enrolled in this program, medication-related problems identified and resolved, quantifying medication reconciliation discrepancies identified and resolved, and provider satisfaction. Results. Forty-three patients were seen by a clinical pharmacist. An average of 14.9 medication reconciliation discrepancies per patient were identified and resolved. 76 drug therapy problems (DTPs) were identified, and recommendations were made to the patient or provider for resolution; the most common DTPs were compliance or dose too low involving opioids, bowel regimens, antiemetics, and nonopioid analgesics. 100% of palliative care providers strongly agreed the IMPACT Program improved quality of care for our patients. Conclusion(s). The IMPACT Program is feasible and effective in reducing medication-related errors in the palliative care oncology population. Impact. Plan to increase resources to ensure sustainability of the program and research program impact on readmissions.