An interventional study of Structured hand-off and Medication reconciliation during transitional period in Care Transition, sponsored by University of Washington. Completed at 1 site in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-11-24.
Sponsored by University of Washington · Not applicable, Interventional, and Health services research
The Pharmacy Integrated Transitions (PIT) program, utilizes a crossover randomized control design to evaluate the impact of a clinical pharmacist in decreasing medication related problems during a patient's transition from hospital to skilled nursing facility (SNF).
Standard hospital discharge processes (e.g. as recommended by the Joint Commission Center for Transforming Healthcare), include hospital staff completing a paper-based discharge summary and medication reconciliation form. To reduce the likelihood of medication-related problems during care transitions, the Pharmacy Integrated Transitions (PIT) program aims to improve the standard transition process by adding a coordinating transitional pharmacist to provide a structured synchronous "warm-handoff" between clinical teams at the hospital and the Skilled Nursing Facility, in addition to reconciling, adjusting, and monitoring medications during and after discharge from the hospital.
University of Washington is the lead sponsor of 1,397 studies on the registry; 225 are open to participants now.
Of its 154 completed or terminated interventional studies of FDA-regulated products, 132 (86%) have results posted.
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Exclusion Criteria:
A clinical pharmacist will be provided as a patient discharges from one of four University of Washington (UW) medical centers to one of 14 post acute skilled nursing facilities randomized to the intervention arm. The coordinating transitional pharmacist will conduct (1) a comprehensive medication review including medication reconciliation, adjustment, and monitoring during the transitional period from hospital to SNF, 2) a structured handoff between clinical teams at the hospital and SNF.
Other: Structured hand-off · Other: Medication reconciliation during transitional period · Other: Transitional medication monitoring · Other: Teleconsultation
Patient will transition from one of four University of Washington (UW) medical centers to one of 14 post-acute skilled nursing facilities randomized to the control arm. Patients will receive the standard discharge process.
Use of standardized checklist to provide synchronous or asynchronous handoff that conveys medication recommendations to the SNF clinical teams
Also known as: Standardized Checklist
Comprehensive medication reconciliation conducted during transitional period between hospital and SNF, focused on SNF-specific requirements for medication delivery (e.g., stop dates, titration instructions)
Review of medication orders during first 7 days of SNF admittance to address barriers to translation of medication orders and appropriate medication delivery
Ad hoc consultation to provide additional clarification to SNF clinical teams
Medication Related Problems
Number of medication related problems experienced by patients within 30 days post hospital discharge.
Time frame: 30 days post hospital discharge
Death
Number of deaths experienced by patients within each cohort
Time frame: 30 Days post hospital discharge
Readmissions
Number of readmissions within 30 days of index hospital discharge
Time frame: 30 Days
Plan to share: No — IPD will not be shared with other researchers
This study is completed, as verified in Nov 2025. You cannot join it, but the record below documents what was studied.
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University of Washington