Einstein Medical Center Incorporates AHRQ Pill Card in Discharge Process

An AHRQ publication designed to help patients, parents, or anyone who has a hard time keeping track of their medicines is being successfully used to reduce hospital readmissions by Einstein Medical Center, a 772-bed tertiary-care teaching hospital in Philadelphia.

The "How to Create a Pill Card," part of AHRQ's Pharmacy Health Literacy Center, allows users to create an easy-to-read pill card that helps patients keep track of when and how much medicine to take. The card, developed through an AHRQ-funded study, makes counseling easier for pharmacists, and patients appreciate the design and portability of the illustrated medication card.

Deborah Hauser, RPh, MHA, Network Director of Pharmacy at Einstein Medical Center, was asked by hospital administration to reduce both adverse medication events and hospital readmissions for patients discharged from the hospital. Hauser found that limited resources and funding and socioeconomic issues were barriers to preventing readmissions.

To address these barriers, Hauser developed an intervention that incorporated the pill card. Known as "Medication REACH (Reconciliation, Education, Access, Counseling, and Healthy)," the program—launched in 2010—was initially designed for telemetry/cardiovascular patients who were being discharged from the hospital.

Specifically, the program sought to:

• Validate medication reconciliation.
• Deliver patient-centered education.
• Resolve medication access issues during transition.
• Coordinate a comprehensive counseling approach.
• Ensure a healthy compliant patient at home.

Hauser developed a list of commonly used medications and created a library of hundreds of pill images, which are used to develop a pictorial-based, personalized medication card. The card shows the name and image of the medication, what condition the medication is treating, and how and when to take it. Refrigerator magnets and pill organizers are also provided.

Hauser says, "Patient-centered education is central to this program. The pill card is very well received by patients and has made a huge difference in improving the safe use of medications."

As a result of the successful implementation of Medication REACH, a dedicated pharmacist was hired to educate and counsel patients prior to discharge. The discharge process includes an in-person consultation with the pharmacist, a copy of the medication card, and a free pill dispenser/organizer. The pharmacist uses the "teach back" method with patients to confirm their understanding of the information presented. Pharmacists make two followup phone calls to the patient after discharge, one within 72 hours and the second within 30 days, to address questions about their medications.

Hauser says, "The families and patients have responded positively to the materials and to the process." When patients receiving the Medication REACH intervention were compared with patients who were discharged using the traditional method, there was a 50 percent reduction in hospital readmissions with Medication REACH. The 30-day readmission rate was 10.6 percent for the Medication REACH group compared with 21.4 percent for the control group.

Medication REACH has since expanded across the Einstein Healthcare Network. The Network includes several major facilities and many outpatient centers providing a significant level of care to low-income, uninsured, and vulnerable populations.

Hauser has presented Medication REACH to the American Pharmacy Association and the American Society of Health-System Pharmacists (ASHP). The program received recognition as a "Best Practice in Care Transitions" from ASHP and the American Public Health Association, and an achievement award from the Hospital and Healthsystem Association of Pennsylvania.