Medication Management Through Collaborative Practice for Children With Medical Complexity: A Prospective Case Series

Medication Management Through Collaborative Practice for Children With Medical Complexity: A Prospective Case Series

Quinn J; Bodenstab HM; Wo E; Parrish RH

Journal of Pediatric Pharmacology and Therapeutics

2024

child; adult; female; human; major clinical study; male; newborn; cerebral palsy; epilepsy; chronic disease; neurology; economics; paracetamol; congenital malformation; hospital readmission; clinical practice; nervous system; adolescent; dysphagia; infant; Article; emergency ward; drug therapy; adverse drug reaction; blood pressure; pharmacist; length of stay; multiple chronic conditions; diphenhydramine; diazepam; metoclopramide; salbutamol; bradycardia; hypotension; asthma; cost control; Current Procedural Terminology; health care facility; adverse drug reactions; cerebral blindness; children with disability; collaborative practice; drug information; drug-related side effects; ipratropium bromide; long-term care; medication management; medication therapy management; pediatric long term care facility; pharmaceutical

OBJECTIVE Care coordination for children and youth with special health care needs and medical complexity (CYSHCN-CMC), especially medication management, is difficult for providers, parents/caregivers, and patients. This report describes the creation of a clinical pharmacotherapy practice in a pediatric long-term care facility (pLTCF), application of standard operating procedures to guide comprehensive medication management (CMM), and establishment of a collaborative practice agreement (CPA) to guide drug therapy. METHODS In a prospective case series, 102 patients characterized as CYSHCN-CMC were included in this pLTCF quality improvement project during a 9-month period. RESULTS Pharmacists identified, prevented, or resolved 1355 drug therapy problems (DTP) with an average of 13 interventions per patient. The patients averaged 9.5 complex chronic medical conditions with a median length of stay of 2815 days (7.7 years). The most common medications discontinued due to pharmacist assessment and recommendation included diphenhydramine, albuterol, sodium phosphate enema, ipratropium, and metoclopramide. The average number of medications per patient was reduced from 23 to 20. A pharmacoeconomic analysis of 244 of the interventions revealed a monthly direct cost savings of $44,304 ($434 per patient per month) and monthly cost avoidance of $48,835 ($479 per patient per month). Twenty-eight ED visits/admissions and 61 clinic and urgent care visits were avoided. Hospital readmissions were reduced by 44%. Pharmacist recommendations had a 98% acceptance rate. CONCLUSIONS Use of a CPA to conduct CMM in CYSHCN-CMC decreased medication burden, resolved, and prevented adverse events, reduced health care-related costs, reduced hospital readmissions and was well-accepted and implemented collaboratively with pLTCF providers. ABBREVIATIONS ADR, adverse drug reaction; AlOH-MgOH, aluminum hydroxide-magnesium hydroxide; CMC, children with medical complexity; CMM, comprehensive medication management; CPA, collaborative practice agreement; CPT, current procedural terminology; CTCAE, Common Terminology Criteria for Adverse Events; CYSHCN-CMC, children and youth with special health care needs and medical complexity; DTP, drug therapy problems; ED, emergency department; MRCI, Medication Regimen Complexity Index; NaK-phosphate, sodium and potassium phosphate; NaPhos-enema, sodium phosphate enema; PHIS, Pediatric Health Information System; pLTCF, pediatric long-term care facility. © Pediatric Pharmacy Association. All rights reserved.

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