Increasing Medication Core Measures Compliance Utilizing Unit-Based Clinical Pharmacists

Purpose: Core Measures (CM) are outcomes derived from a set of quality indicators defined by the Centers for Medicare and Medicaid Services.  Compliance increases optimal patient outcomes, failure to comply results in decreased quality of care and decreased reimbursement.  There are 12 medication-related measures.  Our purpose was to utilize unit-based clinical pharmacists (UBCPs) to assess and document medication-related CM in patients admitted for acute myocardial infarction (AMI), community-acquired pneumonia (CAP), congestive heart failure (CHF), and stroke.  Our goal was to sustain 100% medication-related compliance in the AMI group and attain 100% compliance in all other disease states post implementation of the UBCPs. 

Methods: The UBCPs prospectively reviewed charts for patients admitted with diagnoses corresponding to the CM disease states from April 2011-May 2012.  Patients were identified via e-mail notification generated by our institution’s performance improvement analyst, during patient care rounds, and through the pharmacy clinical surveillance program (Sentri 7®). Prescribers who did not order an indicated medication were notified.  If a medication was not administered due to a contraindication, this was documented by the UBCPs in the medical record.

Results: The UBCPs reviewed 2,267 patients. Two hundred six recommendations were made for medication compliance and 161 contraindications were documented.  Monthly compliance rates were compared both pre and post implementation of the UBCP intervention.  In the pre-intervention period (January 2010 –March 2011), 100% compliance was achieved only in the AMI group and in none of the remaining disease states.  In the post-intervention period, compliance rates were sustained at 100% for AMI for 12/13 months and increased to 100% for 12/13 months for CHF; 7/13 months for CAP, and 2/5 months for stroke. 

Conclusion: Utilizing UBCPs to assess patients and intervene on medication-related CM successfully attained 100% compliance in CHF, CAP, and stroke, and sustained 100% compliance in AMI patients.