(1291) Pharmacist Involvement in Pediatric Cardiac Surgery Patient Transitions of Care: Quality Initiative

Introduction: Pediatric patients with congenital heart disease are at risk for morbidity following discharge and require complex care, which increases the risk of unplanned readmissions. Therefore, a multidisciplinary collaboration among cardiac intensive care, nursing and pharmacy was established. The primary objective was to describe pharmacist impact on medication related readmission rates. Secondary outcomes included: patient satisfaction scores, and further opportunities for pharmacist driven services.

Methods: This is a single-centered retrospective study. Patients < 18 years of age admitted between June 2022 and June 2023 for cardiac surgery or cardiac catheter palliation were included. On weekdays, pharmacists provided patient medication schedules and education. Data collection included: patient age, surgery, discharge medications, medication-related readmission rates, and patient/caregiver satisfaction scores (Likert:1=strongly disagree;2=disagree;3=uncertain;4=agree;5=strongly agree).

Results: A total of 108 patients met eligibility criteria. One-hundred four (96.3%) patients underwent cardiac surgery, and 4 (3.7%) complex cardiac catheter palliation. Age at admission included: 41 (38%) neonates, 48 (44.4%) infants, and 19 (17.6%) children/adolescents. Most frequent surgery was: TOF (11, 10.9%), AVC (10, 9.9%), VSD (8.9%), ASD (7, 6.9%), TGA (6, 5.9%) and Norwood (5, 5%). Of the 108 patients, 101 (93.5%) received a medication scheduled by the pharmacist. Reasons for patients not receiving a schedule included: no new medications (1, 0.9%), no discharge medications (2, 1.9%), or weekend discharge/other (4, 3.7%). Patients required a median (range) of 3 (1-11) medications at discharge. Median patient satisfaction scores for medication discharge readiness were 5 (4-5). There were 0 (0%) medication-related readmissions. Opportunities identified for pharmacist driven services (e.g., collaborative practice) include dose rounding, medication timing, and discharge reconciliation.

Conclusions: Pediatric patients undergoing complex cardiac surgery and catheter palliation require complex medication regimens. The collaboration of pharmacists in the transition of care process benefits pediatric patients to minimize readmission rates, facilitate feasible medication schedules, and positive satisfactions scores.