Site Name
Froedtert Hospital, Milwaukee, WI
Primary Intended Outcomes
- Integration of pharmacy technicians into discharge prescription services with the goal of improving and expanding services provided, including: timely discharge prescription processing, bedside medication delivery, promotion of patient access to medications through prior authorization assistance, resolution of third party adjudication issues, and provision of medication through the drug repository program;
- Assist decentralized pharmacists and other members of the interdisciplinary health care team in ensuring safe and effective care transitions and patient satisfaction throughout the discharge process.
Site Description
Froedtert Hospital is a 550-bed academic medical center located in Milwaukee, affiliated with the Medical College of Wisconsin. Froedtert is a Level 1 Trauma Center, comprehensive stroke center, and major specialty referral center, with over 40 specialties and sub-specialties. Froedtert Hospital has more than 5,000 staff members on campus, including over 800 faculty physician FTEs and 330 resident physician FTEs from the Medical College of Wisconsin, 1800 registered nurse FTEs, and approximately 90 pharmacist FTEs. It is a Nursing Magnet Hospital and Center for Excellence in stroke, epilepsy, adult Ventricular Assist Device (VAD) destination therapy, and hereditary hemorrhagic telangiectasia (HHT).
The Froedtert Hospital Department of Pharmacy consists of approximately 220 FTEs across the continuum of care. The department utilizes an integrated, decentralized inpatient pharmacy practice model with 20 pharmacist AM teams and 12 pharmacist PM teams during weekdays and 16 pharmacist AM teams during weekends and holidays. There are four outpatient pharmacies located on the Froedtert Hospital campus, including our 92nd Street Pharmacy, Specialty Clinics Pharmacy, Cancer Center Pharmacy, and Eye Institute Pharmacy. The 92nd Street Pharmacy houses the discharge pharmacy services. Ambulatory clinical pharmacy services are provided by pharmacists in the Anticoagulation and Medication Therapy, GI/Hepatology, Endocrine/Metabolic, Internal Medicine, Transplant, Infectious Disease, Cardiology, Rheumatology, Pulmonary, Cancer Center, and Sickle Cell Clinics.
Advanced Role Description
Upon patient admission to Froedtert Hospital, a pharmacist or extender conducts a medication history. During medication history collection, the pharmacist, or extender, provides information regarding our discharge prescription services and asks if the patient is interested in using these services upon discharge. The patient’s response is documented in the electronic medical record and the pharmacist, or extender, will also check that the patient’s prescription insurance cards are on file and mention that the patient will need a method of payment for prescriptions at time of discharge. Discharge pharmacy technicians will use this documentation to assist in determining which patients have an initial interest in discharge prescription services. During the course of the hospital stay, both pharmacists and discharge technicians monitor patient profiles for new medication starts that may require patient assistance, including prior authorization assistance, third party insurance adjudication, or provision of medication through the drug repository program. Discharge technicians are also able to help promote and facilitate patient enrollment in our mail order pharmacy services.
When time permits, discharge pharmacy technicians also round to patient care units to get an idea of upcoming discharges for that day, run test claims, and promote discharge prescription services to patients. When a patient is interested in using discharge prescription services, the discharge technician will ensure that prescription insurance information is on file and document patient interest in filling at Froedtert in the electronic medical record. Additional responsibilities include facilitating and prioritizing prescription processing and delivery to patients, assisting other discharge technicians in processing and inputting prescriptions, and resolving adjudication issues that arise, i.e., need for prior authorization.
Outpatient Pharmacy Discharge Workflow
Intake/Reception: Discharge pharmacy technicians receive prescriptions via the tube system from decentralized inpatient pharmacists. Prescriptions are sent down with routing slip that provides logistical information including expected discharge and delivery time.
Data Entry: Discharge technicians obtain insurance information if needed, add patient demographics, insurance information, and prescription data into the outpatient pharmacy prescription processing system. Technicians then submit the claims to third party insurance for processing, which will determine co-pay and whether or not adjudication issues may exist. If adjudication issues exist, the technician will contact the pharmacist and begin the resolution process.
Patient Contact: Technician calls patient with information on co-pay amount and any insurance adjudication issues. Technician will also verify patient payment type.
Product Dispensing: Discharge technicians help fill non-narcotic prescriptions in the discharge product dispensing area of the pharmacy. Prescription orders are placed in blue bins to differentiate them from other orders. Discharge orders are given priority throughout the product dispensing process. Schedule II narcotics are filled by 92nd Street Pharmacy technicians.
Prescription Verification: 92nd Street pharmacists complete prescription pre-verification and verification per usual procedures.
Delivery: Discharge technicians call patients to inform them of upcoming delivery and also communicate this information to the decentralized pharmacists. Technician will ensure that all insurance issues (if any) have been resolved and/or are being followed up on.
Pick Up: If a patient chooses to pick up their discharge medications following discharge, the medications are bagged together and hung in the discharge prescription waiting area.
End of Day: Prior to closing the pharmacy, discharge technicians will check for discharge orders hanging in the discharge prescription waiting area and call patient/decentralized pharmacist to verify pick up.
Prior Authorization Workflow
Discharge technicians print out patient lists from the electronic medical record for assigned units. Technicians will then touch base with the pharmacist and flow coordinators on the units and round with each patient about using Froedtert discharge prescription services using the prior authorization scripting. Technicians then obtain prescriptions from pharmacists and process prescriptions, determining whether or not a prior authorization is required. If a prior authorization is required, the discharge technician will page the provider to begin prior authorization facilitation. All steps of the process and outcomes will be documented in the electronic medical record.
Discharge Technician Staffing Model
92nd Street Pharmacy Hours
Monday-Friday: 7:30 a.m.–7:00 p.m.
Weekends and Holidays: 10:00 a.m.–5:00 p.m.
Monday and Tuesday
8:00 a.m.–4:30 p.m. Discharge pharmacy technician 1
8:00 a.m.–4:30 p.m. Discharge pharmacy triage technician
10:30 a.m.–7:00 p.m. Discharge pharmacy technician 2
Wednesday, Thursday and Friday
8:00 a.m.–4:30 p.m. Discharge pharmacy technician 1
8:00 a.m.–4:30 p.m. Discharge pharmacy triage technician
9:30 a.m.–6:00 p.m. Discharge pharmacy technician 2
10:30 a.m.–7:00 p.m. Discharge pharmacy technician 3
Weekends and Holidays
8:45 a.m.–5:15 p.m. Discharge pharmacy technician
Regulatory and/or Legal Requirements
The role of the discharge pharmacy technician, under the supervision of Froedtert pharmacists, is in compliance with the rules and statutes of the State of Wisconsin.
Per the Wisconsin Administrative Code Book:
A pharmacist may delegate technical dispensing functions to a pharmacy technician, but only under the general supervision of the pharmacist where the delegated functions are performed. Technical dispensing functions include:
- Accepting written or electronic prescription orders of the prescribing practitioner or from the prescribing practitioner’s agent.
- Accepting original oral prescription orders from the prescribing practitioner or prescribing practitioner’s agent, if the conversation is recorded and listened to and verified by the pharmacist prior to dispensing.
- Obtaining and entering patient or prescription data into the patient information system.
- Preparing a prescription label.
- Retrieving medication from stock, counting or measuring medication, and placing the medication in its final container.
- Affixing a prescription label to its final container.
- Placing ancillary information on the prescription label.
- Prepackaging and labeling drugs for dispensing by a pharmacist.
- Other technical functions that do not require the professional judgment of a pharmacist.
- Transferring the prescription to the patient or agent of the patient, provided that the pharmacist has first provided a patient consultation.
Revenue and Expense Parameters
Discharge pharmacy technician positions are justified based on revenues generated from an increase in outpatient prescription volume and overall cost-avoidance as part of overall discharge pharmacy services. Approval for 3.0 technician FTEs was granted by hospital leadership following pilot implementation of Project PRIMED (Pharmacist Reconciliation and Medication Education at Discharge.)1 This allowed for hospital-wide implementation of discharge prescription services.
Outcome Measures
- Discharge prescription processing time, fill time, verification time, delivery time, and overall turnaround time (TAT);
- Patient wait time in pharmacy;
- Discharge prescription capture and revenue generation;
- Patient, nursing, and pharmacy staff satisfaction.
Lessons Learned
- Important to overcome patient misconceptions about the services offered at the outpatient pharmacies (i.e., co-pays and drug prices will be higher, wait times will be longer);
- Discuss discharge prescription services with patient during admission medication histories and mention that patients will need a method of payment for their prescriptions at the time of discharge;
- Proactively verify that prescription insurance card is on file;
- Have the floor pharmacist review the prescriptions for accuracy prior to sending down to the pharmacy;
- Provide patients and floor staff with realistic promise times.
References
1 Smith, E, Fleming, R, Karpinski, T, et al. Project PRIMED (Pharmacist Reconciliation and Medication Education at Discharge). ASHP Best Practices Award in Health-System Pharmacy, 2011.
