Background: Hospitalizations related to opioid use disorder (OUD) are rising, creating opportunities to initiate medications for opioid use disorder (MOUD) and connect patients with outpatient resources.1,2 Despite evidence that MOUD reduces morbidity and mortality, most patients fail to receive evidence-based treatment during hospitalization.3-6 Addiction consultation services are becoming the standard of care to address this [...]

Background: Alcohol use disorder (AUD) is the most prevalent substance use disorder, but most patients with AUD do not receive evidence-based medications for AUD (MAUD), including naltrexone or acamprosate. Inpatient addiction consult services (ACS) may offer an opportunity to start medical treatment for hospitalized patients with AUD, but it is unknown if ACS are associated [...]

Background: In medical care for older patients, the presence of potentially inappropriate medications (PIMs) is associated with increased adverse outcomes [1, 2]. A wide range of medications with anticholinergic properties affects cognitive states of older patients have been regarded as PIMs [1, 3]. We purposed to assess clinical impact of anticholinergic cognitive burden on clinical [...]

Background: Central nervous system medication (CNS med) use among older adults is associated with high morbidity and mortality. This study described patterns of CNS medication use, and identified people most likely to have CNS medications initiated or deprescribed around hospitalization. Methods: Retrospective cohort study using electronic health record data from 3-hospitals. Patients aged 65 years [...]

Background: Duplicate as-needed (referred to hereafter as “PRN”) orders for common indications such as pain, nausea, insomnia, and constipation are frequent in hospitalized patients. Without explicit instructions for circumstances or order of administration, therapeutic duplication can cause confusion for nurses and violates both Join Commission and the Centers for Medicare & Medicaid Services (CMS) guidelines. [...]

Background: Diabetes is an exceedingly common disease encountered by medical trainees, with over 8 million hospitalizations in 2018 listing type 1 or type 2 diabetes as a diagnosis (1). Evidence supports continuing certain oral diabetes medications during admission when safe, reflected in recent consensus statements from professional societies (2,3). Nevertheless, oral medications are often held [...]

Background: Alcohol use disorder (AUD) is a pervasive disease affecting 28.6 million (11.3%) American adults in 2021.1 Medications for AUD (MAUD), including naltrexone, acamprosate, and disulfiram, are effective, yet less than 5% of these patients received treatment.1,2    Inpatient encounters of patients with AUD present a crucial opportunity to initiate MAUD, prompting this quality improvement [...]

Background: Hospital readmissions are an important marker of healthcare quality, reflecting worse patient outcomes and resulting in millions of dollars of penalties annually. Medication nonadherence is an important driver of hospital readmissions, with one significant factor being difficulty obtaining medications after discharge. The difficulty could be due to copays, availability, or transportation to a local [...]

Background: Unimpeded patient flow enhances quality, patient experience and access, while reducing costs. Our hospital has an in house discharge pharmacy, which allows us to send patients home with their imperative medications prior to discharge. About 53% of our discharges were delayed due to discharge medications, which equates to 27.8 hours for the ~30 daily [...]

Background: The hospital discharge process is challenging and opportune for human error. Medication discrepancies continue to be a patient-safety problem, exacerbated with the multiple sources of discharge medication documentation. Medication discrepancies may lead to medication errors and may contribute to adverse drug events with potential subsequent healthcare utilization and cost. Discharge medications can be listed [...]