When patient history is limited, medication management tools fill in the gaps
By Lisa Lowery Deal, PharmD, FASHP, BCACP, BSN, Director of Pharmacy, SUN Behavioral Delaware, recent honorable mention for DrFirst’s 2022 Healthiverse Heroes Award
Across the country, behavioral health resources are being stretched thin as the COVID-19 pandemic’s effect on mental health leads to an unprecedented surge in demand for services while the opioid epidemic continues to intensify at an alarming rate. At SUN Behavioral Delaware’s 99-bed psychiatric hospital, we are seeing the impact of these crises first-hand, with hundreds of new patients seeking mental health services to address issues of loss, anxiety, thought disorders, and addiction.
Yet even as our patient volumes grow, we have successfully reduced readmissions in part due to the application of new technologies that streamline processes and allow us to gather the essential information we need to make informed care decisions and deliver the highest quality of care. At a time when demand is particularly high and resources are limited, these tools have allowed us to quickly gain deep insights into patients’ medication histories, empowering staff to make clinical decisions that improve patient safety and drive better medication adherence.
Improving care and efficiencies with electronic documentation and medication management tools
In 2018, SUN Behavioral Delaware made the strategic decision to transition 100% of our clinical documentation to an electronic health record (EHR) system. Though EHR adoption rates in other medical specialties hover around 95%, only about 61% of behavioral health providers and psychiatrists have embraced EHRs, according to the most recent CDC nationwide EHR survey.
Our organization, however, felt the implementation of the right automation tools was vital for the delivery of high-quality patient care and for improving staff efficiencies. After an evaluation process, we selected WellSky Specialty Care for Behavioral Health, which integrates DrFirst’s e-prescribing and medication management platform Rcopia, which includes patient medication history.
Our clinical staff now has access to medication history data within the EHR, which is particularly critical when treating behavioral health patients. Due to intoxication or acute psychosis, it’s not uncommon for patients to present in the emergency room and be unable or unwilling to communicate their medical history. This lack of information creates a huge challenge for physicians, nurses, and pharmacists who need this essential information to deliver care safely and effectively. Without vital data about patients’ underlying conditions, medical histories, prescribed medications, allergies, comorbidities, and more, treatment can be delayed, sometimes leading to unnecessary costs and poorer outcomes.
Because staff can easily access medication history data, they can uncover key facts using limited information on patients who are unable to communicate. Performing a simple search of the patient’s name in our EHR’s e-prescribing module, for example, provides staff with a patient’s prescription history, allergies, and insights to medication adherence. The ability to quickly rule out allergies and identify the prescriptions patients are taking can have a huge impact as it allows caregivers to safely administer drugs to stabilize patients without fear of an adverse reaction. Once patients are stabilized, many can communicate more clearly, which helps us understand the issues contributing to the current hospital visit.
Using technology to close medication information gaps has even helped our team identify patients who have been reported as missing by their families. In one instance, a medication history inquiry revealed a patient typically had prescriptions filled by a pharmacy several states away. Our staff took this clue and dug deeper. Eventually, we learned the patient was listed as a missing person in their local community. Our team was able to contact a family member who traveled to our facility to be reunited with the patient.
Digital solutions support long-term health and reduce readmissions
Perhaps most importantly, our use of technology has enabled staff to positively impact patients’ ongoing, long-term wellness. For example, we can identify prescription fill patterns and trends that indicate a patient may be struggling to adhere to a prescribed treatment plan. According to BMC Research, medication non-compliance is the leading cause of re-hospitalization among the mentally ill. I see firsthand that it is also one of the most common reasons for relapse in substance use disorder patients. Patients may veer off their prescribed treatment plans for a variety of reasons, including drug costs, concerns about side effects, or simple forgetfulness.
To promote medication adherence, we launched an initiative using data from our EHR’s medication management module to identify patients who have histories of missing or skipping doses of their prescribed oral medications—which can lead to decompensation, or deterioration of mental health. When appropriate, we then work to transition these patients to long-acting injectables that provide 28 days of therapy in a single dose. This frees patients from the burden of remembering to take multiple doses of an oral medication and decreases lapses in treatment. We also use the corresponding drug lapse and hospitalization data from the EHR to secure pre-authorization from the payer for the long-lasting injectable.
The results of this initiative have been remarkable. To date, this simple change in prescription therapy has improved medication adherence, which in turn has helped us reduce our hospital readmission rates.
Empowering patients with digital connections
In our next phase of digitization, we will extend the power of technology directly to our patients. We’re working with WellSky to build a SUN Behavioral Delaware-branded mobile app that will connect patients with providers, peer groups, and mentors to support mental wellness between appointments and reduce relapses.
In an environment where the demand for behavioral health services has never been higher, healthcare providers must leverage digital tools that improve efficiency and help us do what’s right for our patients. While those in our care struggle with serious challenges, there’s no better feeling than helping someone who has been acutely ill break through a mental health episode and reach a healthier state.