Background: Bedside medication delivery (BMD) and teaching by pharmacy is gaining popularity as an important component of safe hospital discharge. Having medications in hand at time of discharge and education with home medications has been shown to reduce medication administration errors and decrease readmission rates in pediatric patients with asthma. As part of Project IMPACT (Improving Pediatric Patient-Centered Care Transitions), a care collaborative formed to improve hospital to home transitions, our goal was to institute BMD to improve discharge transitions for patients with asthma. However, due to the burden of coordinating delivery times with pharmacy and limited pharmacy staff, unintended consequences of enacting the program could be delay in discharge and nursing dissatisfaction. Nursing plays an important role in the discharge process and in integrating quality improvement initiatives into standard workflow. For these reasons, nursing feedback is essential in directing improvement of the service. The goals of this study were to gain nursing perceptions of BMD and to assess for possible delays in discharge.
Methods: An independent pharmacy provided BMD to asthma patients between 2-17 years of age who were admitted to the hospital medicine service from 2/2017 to 11/2017. Beginning in 6/2017, surveys were given to each discharging nurse by the pharmacist after completion of BMD. Consent was implied by completion of the survey. The 5-question survey combined yes/no, open ended and Likert scale questions to assess nursing perceptions of the BMD service, including satisfaction, delays in discharge, increased patient/caregiver knowledge of medication, ease of communication with pharmacy, and likelihood of recommending the service. The anonymous surveys were collected over a 6-month period. Data are reported as proportions.
Results: A total of 61 surveys were collected. 59 (97%) rated overall satisfaction with BMD as 4 or 5 on a 5-point Likert scale, with 5 being “extremely satisfied.” Regarding delay of discharge, 51 (84%) reported no delay, 3 (4.9%) 0-15 min delay, 3 (4.9%) 16-30 min delay, 2 (3.3%) 31-59 min delay and 1 (1.6%) >2-hour delay. The service was felt to increase patient/caregiver knowledge of medication administration 89% of the time. Ease of communication was rated as 4 or 5 on a 5-point Likert scale, with 5 being “extremely easy”, 72% of the time. 100% of respondents would recommend the service to patients and co-workers.
Conclusions: In general, nurses were very satisfied and would recommend BMD, even in the rare occurrences where discharge was delayed. Delays in discharge of more than 30 minutes were perceived to be rare. Further work is needed to improve ease of nursing communication with the pharmacy.