Written by Kimiko Dunbar
Spoon Feed
Rates of discharge prescriptions sent to the onsite outpatient pharmacy from the pediatric ED can be increased using quality improvement initiatives such as EMR modifications and education.
Where’s the pharmacy again?
The study aimed to increase the percentage of pediatric emergency department (PED) discharge prescriptions sent to an onsite outpatient pharmacy (OOP) from 8.9% to 70% by June 2022. Using a quality improvement (QI) framework, interventions included provider education, electronic medical record modifications, and project champions. These efforts increased OOP prescription rates to a peak of 70.9%, with sustained improvement at 60%. The study team employed some savvy interventions, including expanding the OOP pharmacy hours (7a-11pm daily – including weekends!), defaulting all patient’s primary pharmacy to the OOP during the ED encounter, and printing a map with directions to the pharmacy on every patient’s discharge paperwork. Even with the increase in the number of prescriptions sent to the OOP, the number of unfilled prescriptions at the OOP remained steady at 15%. This study is limited by single-site design and lack of data on prescriptions sent outside of pharmacy hours.
How will this change my practice?
There are lessons here that are broadly applicable. Expansion of OOP hours and an EHR default to the OOP could be effective at other institutions. That being said, I’m pretty impressed with the authors’ ability to expand the OOP hours and imagine that could be a pretty big barrier in a place with less buy-in. Whether discharged from an ED or not, this highlights the importance of communicating with families about their pharmacy preference and the value of sending prescriptions to a peds-specific pharmacy. We’ve all had times where we get a call from the pharmacy long after patient discharge that the med isn’t in stock, or they don’t have the liquid version.
Source
Improving Pediatric Emergency Department Access to Discharge Prescriptions. Hosp Pediatr. 2025 Feb 1;15(2):169-176. doi: 10.1542/hpeds.2024-007979. PMID: 39809300
