Conventional therapy techniques are no longer good enough. The implementation of healthcare reform through the Affordable Care Act has resulted in an increased focus on avoidable hospital readmissions.  Hospitals are currently incurring penalties for 30-day readmissions for pneumonia, acute myocardial infarction and heart failure.  This will expand in fiscal year 2015 to include COPD and Total Knee Arthroplasty/Total Hip Arthroplasty.  

Furthermore, over the next few years similar plans are being put into place that will also penalize the skilled nursing facility for avoidable readmissions.  As such, to distinguish oneself as a desirable downstream provider, one must effectively manage these high risk patient’s care.

Discharge planning has always been viewed as a routine method to address this issue. As such, a quality discharge planning process will set itself apart by easing the transition to home for the patient and family, while simultaneously creating value and efficiency for a healthcare organization. One major component to a safe transition is effective medication management. About a third of hospitalizations are related to adverse drug effects that are related to patients mistakenly taking their medication. A strong medication management program, starting at admission, which demonstrates a standardized approach to assessing, training and making recommendations, is imperative for a smooth transition.

Medications are for the nursing department to address, correct?  Yes, nursing is primarily responsible for the teaching, administration and dispensing of medication in your facility.  However, medication management is a critical component of a patient’s ADL performance requiring the rehabilitation team to address physical and/or cognitive limitations.  Assessing and addressing fine motor manipulation, ability to read and comprehend medication labels and comprehension of instructions are some of the skilled activities therapist should address.  Others may include recommendations for compensatory techniques including blister packs, automated home medication dispensing systems or other adaptive devices.  It does not just include oral medications but also patient’s ability to manage injectable medications for conditions like diabetes.

Implementing an effective medication management program doesn’t stop there.  An interdisciplinary approach involving nursing and physician services is necessary to ensure proper carry-over.  This can then be expanded to include families and home care agencies to optimize the transition home.  Similar to post acute care providers as a whole, rehabilitation staff will be judged based on their ability to assist with ensuring a smooth transition home.  Medication management is an under addressed ADL skill that is needed to make such a transition an optimal one.

David Siegelman is the Director of Rehabilitation services at the Hebrew Home of Riverdale.