Limiting Coronavirus Exposure for Complex and Palliative Pediatric Patients through Prescription Medication Advocacy

Limiting Coronavirus Exposure for Complex and Palliative Pediatric Patients through Prescription MedicationAdvocacy Kuck, Cheryl, MD, FAAP;Harwood, Lori, BSNRN;Auricchio, Lisa;Williams, Elizabeth, BSIE, MBABackground: At Dayton Children's Hospital (DCH), complex and palliative care patients are served by acombined program DCH defines palliative care patients as having life-limiting or life-threatening conditionsand complex care as having three or more chronic conditions, significant functional disability, and highutilization of medical services Both palliative and complex care patients are at higher risk for morbidity andmortality from COVID-19 infection and thus should limit public exposure by themselves and their familymembers Many of these patients have multiple medications and use prescription supplies as well Prescriptions must be refilled every 30 days During the start of the COVID-19 shelter-in-place orders, the DCHComplex and Palliative Care Team undertook an advocacy project with the DCH retail pharmacy andCareSource, Ohio's largest Medicaid insurer, to convert patients' medications from a 30- to a 60-day supply, thereby reducing public exposure for these patients and their families Description: In March 2020, thegovernor of Ohio instituted shelter-in-place orders for Ohio and severely limited ambulatory clinic visits toDCH The Complex and Palliative Care Team began calling its families using the standardized documentationin Figure 1 as a guide Of 58 patients, 10 were interested in and eligible for the project (involving over 150orders) Eligibility required prescriptions be filled at the DCH retail pharmacy and insured through CareSource Once interest and eligibility were confirmed, the following steps were undertaken • Consultation with eachpatient's subspecialists to ensure alignment and agreement of medications and dosages • Advocacy withCareSource to convert approvals from 30- to 60-day supplies In many cases, approvals needed individualoverrides • Close communication with DCH pharmacy to create a specific process for these prescriptions toensure they would be approved by insurance, filled, and delivered for curbside pickup without delays orinconveniences to these fragile families and patients • Synchronization of all medications for an individualpatient so all prescriptions could be picked up on the same day • Reconciliation of the entire medicationrecord Conclusion: Advocacy actions taken by the Complex and Palliative Care Team were an effective way ofpreventing unneeded public exposure for one of the most complex and fragile patient populations at DCH Families expressed their appreciation not only for the time saved and the ability to protect their children;butrecognition of the complexity of their daily lives It allowed our team to fulfill DCH's mission of optimal careand raise morale during a difficult time The framework created in this advocacy project can be used for otherprojects in the future (Figure Presented)