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Quality Improvement (Original Research)

Session: Improving medication management in TBI inpatient rehabilitation: A quality improvement project

Improving Medication Management in TBI Inpatient Rehabilitation: A Quality Improvement Project

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 9
Has Audio

    Poster Presenter(s)

  • Carsen Cash, MD

    Resident Physician
    Vanderbilt University Medical Center PM&R Program
    Nashville, Tennessee

    • Co-Author(s)

  • Jack E. Kilgore, III, MD

    Resident Physician
    Vanderbilt University Medical Center
    Nashville, Tennessee

  • SH

    Samantha Houser, MD

    Resident physician
    Vanderbilt University Medical Center PM&R Program
    Nashville, Tennessee

  • Joshua Geller, MD

    Resident
    Vanderbilt University Medical Center PM&R Program
    Nashville, Tennessee

  • JJ

    Jacob Jeffers, MD

    Physician
    Mary Free Bed Rehabilitation Hospital
    Ada, Michigan

Disclosure(s):
Jack E. Kilgore, MD, III: No financial relationships to disclose
Joshua Geller, MD: No financial relationships to disclose
Background and/or Objectives: Patients with traumatic brain injury (TBI) are reported to have high rates of polypharmacy, with many of these medications being psychotropic or pain medications. Polypharmacy increases morbidity via drug-drug interactions and falls in a population often using deep vein thrombosis (DVT) prophylaxis and anticoagulants. The general rehabilitation population is also at risk for these issues. Pre-intervention retrospective review of our patient population confirmed polypharmacy as an issue. We sought to reduce polypharmacy in patients on the TBI inpatient rehabilitation team by instituting pharmacy-physician team table rounds to review each patient’s medication list using plan-do-study-act (PDSA) analysis.

Design: Quality improvement project with pre-intervention data and 2 PDSA cycles of post-intervention data.

Setting : Inpatient rehabilitation

Participants : All patients on the traumatic brain injury team (including non-brain injury patients)

Interventions: Weekly pharmacy table rounds (involving a pharmacist and members of the physician team) to discuss all patients' medication lists

Main Outcome Measures: Total medication changes and changes to sedating, antimicrobial, and anticoagulant medications

Results: 36 total medication changes were made during the pharmacy rounds in PDSA cycle 1, which was a 31% increase from the changes made in the baseline data. Specifically, 3 changes to anti-thrombotic medications (200% increase from pre-intervention data), 1 change was made to add a stop date to an antibiotic course which was prescribed indefinitely, and 15 changes were made to sedating medications (25% increase). PDSA cycle 2 involved addition of feet ambulated by each patient, which turned out to be rarely recorded after analysis. Twenty medication changes were documented during the month, but only nine (45%) changes were related to sedating medications, and no changes were made to anti-thrombotic or antimicrobial medications.

Conclusions: Weekly pharmacy rounding does increase the number of intentional medication changes, decreasing sedating medications and reducing polypharmacy. Next steps could be tracking falls data and extending to other subpopulations in inpatient rehabilitation.