The Pharmacist's Role in Patient Discharge Planning

A pilot study to explore the pharmacist's role in discharge planning revealed a significant need for pharmacy involvement. This relates to several areas of concern, including the patient's understanding of medications to be taken and their contraindications and precautions; continuation of therapy after discharge; and overall relationship of the pharmacist, nurse, and physician in the clinical setting. During the study, the pharmacist met three times a week in discharge planning conferences with the physician, nurse and social worker. The needs of each patient were, evaluated from the standpoint of the patient's post hospital care. Following the conferences, the physician wrote discharge orders. From this point, the pharmacist filled the orders after reviewing the medications and the patient's chart and consulting the physician when indicated. In a final interview with the patient, the pharmacist instructed, the patient regarding the correct use of the medications and plans for continuation, if indicated. Evaluation of the pharmacist's contribution was made after counseling 156 patients who received discharge medications during this two-month study. Several of the more interesting case studies are presented from among the complete record of patients interviewed. Follow-up of the patient group over a six-month period showed a slight, but statistically insignificant, decrease in readmission rate.