Ecumen Awarded Grant To Reduce Hospital Readmissions Through Improved Medication Management For Seniors

Ecumen has been awarded a $1.7 million grant from the Minnesota Department of Human Services (DHS) to improve medication management by the elderly as a way to reduce hospital readmissions.

The new medication management program will be based on a successful pilot project started last year at Ecumen Lakeshore in Duluth, Minn., in partnership with Thrifty White Pharmacy, which was developed to ensure patients being discharged fully understand their medications and how to take them at home.  The pilot program received the Aging Services of Minnesota’s “Leading Change Innovation Award” earlier this year.   Under the DHS Performance Improvement (PIPP) grant, 9 Ecumen rehabilitation centers will implement the model program and measure results over the next three years.

“Taking medications as prescribed after leaving a care center can be a significant challenge for the elderly, especially when they are taking multiple drugs,” said Shelley Matthes, RN, director of quality improvement at Ecumen.  “We’re focusing on ways to expand the collaboration between patients and pharmacists to make sure people know when and how to take their medications and what to do if they have problems.” 

As part of the discharge process, a nurse will do an evaluation to make sure patients can read and understand their medication labels and can open the bottles before they go home. Then a nurse holds a meeting with the patients and their families to discuss any issues and initiates an interactive web-based session with a registered Thrifty White pharmacist. The pharmacist then explains to the patient and family how to take all the prescribed medications and answers questions. 

The patient receives an action plan for medication management before discharge and a 30-day supply of medication through Thrifty White.  Then the pharmacist follows up in three days for a check-in and does another follow-up in three weeks.

“Just making sure that patients fully understand the basics of their medications and how to take them reduces readmissions,” said Matthes, who cites studies showing that about 40 percent of seniors take five or more medications.  “Often people are so glad to be going home that they have trouble focusing on anything else.  The detailed discharge procedure, the pharmacy education and the pharmacist’s follow-up all work to minimize mistakes or lapses in memory.”

The nine Minnesota Ecumen communities participating in the program are Ecumen Detroit Lakes in Detroit Lakes; Ecumen Bethany Community in Alexandria; Ecumen North Branch in North Branch; Ecumen Parmly LifePointes in Chisago City; Ecumen Scenic Shores in Two Harbors; Ecumen Litchfield in Litchfield; Ecumen Pathstone Living in Mankato; and Ecumen-managed Grand Village in Grand Rapids and St. Mark’s Living in Austin.