Consider How to Support Hospital-at-Home Care

More healthcare systems will offer "hospital-at-home" care...as the COVID-19 pandemic puts pressure on inpatient capacity.

Think of it as inpatient services for moderate acuity patients who can be safely treated and monitored in their home.

Data suggest hospital-at-home delivers quality care...reduces overall cost and length of stay...and improves patient satisfaction.

Anticipate hospital-at-home will blend in-person and remote care. CMS requires at least 2 in-person visits per day by a nurse or paramedic...and virtual care may be added, such as remote rounding.

Be ready to discuss your pharmacy's role.

Start with operations. For example, some hospitals may outsource med dispensing to long-term care or infusion pharmacies.

Others may create kits or lockboxes stocked with standard meds for specific conditions...or develop a "virtual patient care unit" and use inpatient processes (cart fill, etc) to dispense Rxs.

Check your state laws and regulations. For instance, you may be required to label meds as outpatient Rxs.

Develop policies for med delivery and administration at home.

In some cases, paramedics deliver and administer meds during in-person visits...or patients may self-administer oral meds. And nurses may confirm and document all meds on the MAR remotely.

Clarify home med use. For example, if using a home med, consider a process where pharmacy verifies it...and ensures there is an active order. Suggest storing home meds without active orders separately.

Ensure that policies address controlled substance use, such as daily inventory during in-person visits...and virtual witnesses for waste.

Also extend your clinical services to hospital-at-home. Work with IT to pull these patients into your monitoring lists for antibiotic stewardship, anticoagulation monitoring, IV to PO, etc.

And develop a system to provide patient education...such as using phone or video visits for discharge education.

Use our FAQ, Considerations for Hospital-at-Home Care, for more on CMS criteria, clinical services, etc.

Key References

  • Ann Intern Med. 2020 Jan 21;172(2):77-85
  • Cochrane Database Syst Rev. 2016 Sep 1;9(9):CD007491
  • J Am Pharm Assoc (2003). 2021 May-Jun;61(3):e143-e151
  • Can Pharm J (Ott). 2021 Sep 24. doi: 10.1177/17151635211045951
  • https://www.ashp.org/advocacy-and-issues/key-issues/hospital-at-home (10-27-21)
Hospital Pharmacist's Letter. November 2021, No. 371122



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