Improving Medication Use After Discharge
Northern Maine Medical Center
The Centers for Medicare & Medicaid Services (CMS) measures both the quality of hospitals and how satisfied
patients are with their hospital experience. One quality measure that CMS reports on its website is the number
of patients with certain conditions who have unplanned readmissions to the hospital within 30 days. Medicare
financially penalizes hospitals that have higher than expected readmissions.
“Our penalty has never been very large, but we’ve been on that list twice,” said Sue Devoe, quality director at
Northern Maine Medical Center (NMMC) in Fort Kent. “No one wants to be on that list.”
A patient’s confusion surrounding medication prescribed at discharge or his or her failure to fill the prescriptions
can be contributing factors in readmissions. NMMC wanted to improve both patient outcomes and their
experience in the hospital, in part, by focusing on medications that are prescribed after the patient leaves the
hospital.
“When talking about something like readmissions, we do our very best while the patient is with us,” Devoe said.
“We can’t just be worried about what we’re doing in our hospitals anymore.”
Hospitals work with patients to ensure that they understand their discharge instructions, fill their prescriptions
and have a lifestyle that will help them stay out of the hospital. In the last quarter of 2014, NMMC patients
scored their readiness for discharge at 81 percent. By using some of the techniques described below, the
hospital was able to raise the score to 89 percent by the end of the first quarter of 2015.
After they are discharged, medical-surgical patients receive a phone call from a nurse, asking if they have filled
their prescriptions and if they understand any changes made in their medications. NMMC also offers patients
a courtesy visit. If the patient agrees, a floor nurse, usually one who cared for the patient, will stop by the
patient’s house on his or her way to or from work a few days after discharge. Neither insurance nor Medicare
pays for these courtesy visits.
“It’s really supplementing the discharge information,” said Alain Bois, NMMC’s director of nursing. “They go
through the discharge packet, talk about the patient’s condition.” Sometimes the nurse will contact the patient’s
doctor or make an appointment if there seems to be a problem.
Often there’s such a flurry at discharge, with patients thinking more about leaving than about what is being said,
that they are unsure about the instructions they received. Or they have questions that they didn’t have in the
hospital. Patients are more relaxed and better prepared to ask questions in their own homes.
Northern Maine Medical Center
