(P60) Evaluating Afterhours Calls From Post-Acute Care for Admission Medication Verification

Introduction/Objective: The purpose of this pilot is to evaluate the usefulness of after-hours calls to covering clinicians for post-acute care (PAC) admission order verification. Our health system in northern New Jersey supports 8 PAC facilities in 3 counties. A team of 9 physicians and 2 APRNs participate in the after-hours call coverage. A significant portion of these calls pertain to admission medication verification and are addressed by clinicians who do not provide clinical care at the facility and are not involved in these patients' recent hospitalization. As per informal observations, most of the admission medications are transcribed and accepted without changes to the hospital discharge medication list. This retrospective chart review was done to support our hypothesis that most of these medication verification calls do not result in any change to medication orders.

Design/Methodology : This pilot study was conducted in one PAC facility covered by our health system. This facility is like the seven others we cover in terms of demographics, staffing, and patient characteristics. The charts of the first 50 after-hours admissions between 07/01/22 to 09/30/22 were reviewed. After-hours calls are calls to covering clinicians on weekdays between 5 PM to 9 AM and on weekends between 5 PM Friday to 9 AM on Monday. Hospital discharge medications were compared with admission medications orders for each admission. The admission orders were categorized as accepted with or without modification. Orders accepted with modification were reviewed to see if they entailed medication initiation, discontinuation, or addition of parameters.

Results: Only 18% (n=9) of the afterhours admissions had medications modified after discussion with the covering clinician. Out of these, three entailed medication initiation and six medication discontinuations. The reasons for medication discontinuation included- route of administration (intravenous narcotic), unavailability of drug and need for more information on indication for use. Common reasons for initiating medications included- home medication that was stopped at hospital, optimization of blood pressure (BP) control, and treatment of nausea.

Conclusion/Discussion : The results of this pilot study indicate that a considerable number (82%, n=41) of after-hours calls for medication verification do not result in any order modification. Most of the medication changes (except for the BP optimization and treatment of nausea which could have been addressed as an acute change in condition call) in this pilot were noncritical and could have been addressed effectively during the admission assessment the following day. These findings support the rationale that with advent of effective electronic health records and communication tools between hospitals and PACs, the archaic practice of placing phone calls to covering clinician's after-hours for admission medications review needs to be revisited.