Pharmacy Integrated Transition (PIT)

The Pharmacy Integrated Transition (PIT) program is focused on strategies to improve coordination during the transition from hospitals to a skilled nursing facility (SNF) for ongoing rehabilitation. The nature of this care transition makes it susceptible to errors . Medication-related errors during transitions are a major driver of avoidable harm and poor patient and family experience.

Currently, the standard discharge processes currently required by The Joint Commission include hospital staff completing a paper-based discharge summary and a medication reconciliation form. Despite excellent compliance with these “best-practices”, up to 75% of patients admitted to SNFs have at least one medication discrepancy between the SNF admitting orders and the hospital discharge plan.

In 2014, a Washington State collaborative led by the University of Washington and including stakeholders from over 50 SNFs and hospitals ─ the Improving Nursing Facility Outcomes using Real-Time Metrics (INFORM) collaborative ─ was formed to address this and other SNF-related transitional quality of care issues. Following extensive pilot testing, the Agency for Healthcare Quality and Research awarded this team funding to test the PIT program broadly in partnership with 4 Washington Hospitals and up to 16 independent SNFs.

The PIT program was developed to focus on improving the standard transition process to target key gaps contributing to medication errors and evaluate its impact on medication-related problems and patient and caregiver measures of transition quality. The program will include:

  • A structured, synchronous “warm-handoff” between clinical teams at the hospital and the SNF
  • A coordinating transitional University of Washington pharmacist to reconcile, adjust, and monitor medications during and after discharge from the hospital
  • An evaluation of patient and caregiver experience

This program will 1) compare the effectiveness of the Pharmacy Integrated Transitions (PIT) program with the Joint Commission transition process on medication related problems, and 2) compare patient and caregiver-reported care of transition measures between the PIT program and the Joint Commission transition process.