What Is a Meds-to-Beds Program? Inside Harris Health System’s Bedside Delivery Model
A meds-to-beds program delivers a patient’s discharge prescriptions to their hospital bedside, filled by the health system’s own pharmacy and paired with in-person counseling, so the patient goes home with medication in hand instead of an errand to run while unwell.
Public health systems often serve as a ‘safety net’ for their patients, and Harris Health System in Houston, Texas, is no different. Its meds-to-beds program now enrolls more than 90% of discharged patients.
NRC Health helps health systems measure and improve the full patient experience, from the bedside to the follow-up. Explore NRC Health’s Patient Experience solutions →
What Exactly is a Meds-to-Beds Program?
A meds-to-beds program fills a patient’s discharge prescriptions at the hospital’s own pharmacy and hand-delivers them to the bedside before the patient leaves, along with a counseling session from the pharmacy team.
It goes by other names, such as bedside delivery or discharge prescription delivery, but the medicine and the instructions arrive together, at the bedside, before discharge.
The difference from the usual process is small to describe and large in effect.
Normally, a patient is discharged with a script and a task: get to a pharmacy, wait in line, ask questions if they think to.
Meds-to-beds removes the task.
The patient leaves already holding the medication and already shown how to take it. A prescription a patient never fills is just a note in a chart, and the days right after discharge are exactly when a missed medication turns into a return trip.
Why Do Health Systems Launch Meds-to-Beds Programs?
Health systems launch meds-to-beds programs for three reasons: medication adherence, readmission reduction, and HCAHPS performance.
Adherence comes first because it drives the other two.
A patient who leaves with medication in hand and a clear understanding of how to take it is far likelier to take it than one sent to fend for themselves at a retail counter.
That, in turn, supports recovery, and it’s why readmission reduction is a stated goal of nearly every meds-to-beds program. And because the program touches the discharge experience directly, it shows up in the HCAHPS domains for Care Transitions and Communication About Medicines.
For a public system, the motive runs deeper than metrics.
“We are the safety net for the patients of Harris County. When they come to our hospital, they’re ours for acute care, specialty care, and primary care. So, it’s our responsibility to ensure the highest level of quality across the continuum of care.” — David Riddle, Administrative Director of Patient Experience, Harris Health
How Harris Health Built its Meds-to-Beds Program
Harris Health didn’t launch its program all at once. It built it in stages across late 2020 and into 2021:
- September 2020: Pilot on selected units at Lyndon B. Johnson Hospital
- November 2020: Expanded hospital-wide
- January 2021: Implemented at Ben Taub Hospital, supported by another Harris Health System pharmacy about 10 minutes away
Getting there took more than the pharmacy. Harris Health pulled in pharmacists, physician representatives, nursing representatives, patient experience representatives, and IT. That last group managed the Epic builds and workflows the program runs on, a software workstream in its own right rather than an afterthought.
The program also launched into the worst possible conditions, and used them.
“When we launched, this was also during a peak with the COVID pandemic. We thought this was also a way to make sure patients got what they needed, so they didn’t have to go to the pharmacy. It’s been a successful program; we have over 90% of discharged patients enrolled.” — Sara Dwivedi, Pharmacy Operations Manager, Harris Health Ben Taub Hospital
How the Bedside Counseling Session Works
The counseling session is where a meds-to-beds program earns its outcomes, and it’s the part that can’t be automated. At Harris Health, a pharmacist sits with the patient, opens the bag, and works through the medications one at a time.
“Pharmacists sit down with the patient, take each medication out of the bag, show them the pills, read the instructions, and discuss the most common side effects they may experience with the medications.”
— Sara Dwivedi
The method behind it is teach-back, an AHRQ-recommended technique for confirming a patient actually understood rather than nodding along. The pharmacist asks the patient to explain the plan back in their own words.
“We use a teach-back method, so we’ll say, ‘I know that was a lot of information, and I want to make sure you understand how to take this medication properly. Can you teach me how you’re going to use this?'”
The load varies. One patient goes home on a single medication; the next goes home on fifteen. “It’s a lot of information at once, but we work with them to make sure they understand everything,” Dwivedi says. Every bottle carries a phone number: “We include a phone number on the bottle that they can call if they have questions, and we encourage them to reach out to us if they come up with a question once they are home.”
The time this takes is not incidental to the program; it is the program. Dwivedi recalls a patient who started crying at the end of a session that ran 25 minutes: “Everyone here has been so great and so patient with me. I feel so blessed. Thank you.”
What to Measure
Public health systems often serve as a ‘safety net’ for their patients, and Harris Health System in Houston, Texas, is no different.
A meds-to-beds program is only as good as what it tracks. Harris Health measures seven things:
- Number of patients enrolled
- Number of patients discharged with meds
- Number of enrolled patients with prescription education
- Number of prescriptions dispensed
- Prescription turn-around time
- HCAHPS “Care Transitions” survey scores
- “Communication about Meds” survey scores
The first four describe reach; the fifth describes speed; the last two describe whether patients felt the difference. Here is what those numbers looked like in Harris Health’s own reporting.
Program reach (year to date, March 2022)
| Metric | Result |
|---|---|
| Discharged patients enrolled | 90% |
| Enrolled patients who received prescription education | 95% |
| Prescriptions dispensed (YTD) | ~5,600–6,000 |
| Primary fall-out reasons | Discharge to a facility; after-hours discharge |
Prescription turnaround time
| Month | Turnaround |
|---|---|
| Oct 2021 | 43 min |
| Nov 2021 | 37 min |
| Dec 2021 | 42 min |
| Jan 2022 | 36 min |
| Feb 2022 | 37 min |
| Mar 2022 | 52 min |
Goal: under 60 minutes. Met every month for six consecutive months.
Results at Harris Health
By early 2022, Harris Health was enrolling more than 90% of discharged patients, educating 95% of them, and filling prescriptions in under an hour every month for six months running. It also met a majority of its HCAHPS patient experience goals, measured against an internal threshold of greater than 80%, equal to or above the NRC Health 70th-percentile benchmark for the questions it tracked.
The turnaround data is the kind of number that only exists if someone decides to watch it.
“NRC Health gave us that critical metric to monitor and share. If you don’t have that, you don’t really know how you’re doing. So it’s really important to be data-driven and to have that feedback.”
— Sally Sims, Director of Pharmacy, Ben Taub Hospital
For the people running the program, the point of all of it is what happens after the patient leaves.
“Before this, a patient might be discharged with a prescription, but it’s up to them to go out and fill their medications. That’s huge if we can send them out with a clear understanding of what their medicine is for and a supply to start taking. It helps support their recovery and keeps them from returning to our emergency centers or being readmitted to the hospital, so it’s a win-win all around.”
— David Riddle
What Harris Health Would Tell Another Health System
Three lessons run through the Harris Health experience, and none of them are about software.
First, it’s a cross-functional build, not a pharmacy project. Pharmacy runs it, but pharmacy alone can’t launch it: nursing, physicians, patient experience, and IT all shaped the workflow before the first bag was delivered.
Second, the counseling is the program. The delivery gets the medicine to the bedside; the teach-back conversation is what changes whether the patient takes it correctly at home. A system that funds the logistics but rushes the counseling has bought the packaging, not the outcome.
Third, plan for the fall-out cases. The patients who don’t get enrolled are the predictable ones: discharged to another facility, or discharged after pharmacy hours. Knowing that in advance lets you design around it instead of discovering it in your numbers.
“Making sure that all of our staff conducts their counseling sessions this way is really how I think we’ve been very successful with the program. It’s a team effort; you can’t accomplish something like this when it’s one group.”
— Sara Dwivedi
Thinking about a program like this at your system? A meds-to-beds program stands or falls on the counseling and the follow-through, the parts hardest to see without measuring them. NRC Health’s patient experience platform helps health systems do exactly that, from the bedside through discharge and the days after.
