Implementing hospital pharmacy practice changes

Pearls from the ASHP Midyear

Accountability, bedside discharge counseling, and the Pharmacy Practice Model Initiative (PPMI) were just a few topics spotlighted at the 2012 American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting & Exposition.

From new practitioners to management leaders, pharmacists provided novel strategies for improving patient care and useful “lessons learned.”

Increased accountability

“Clinical pharmacy practice is continually changing, [and] one future goal is that pharmacists will be recognized as privileged providers,” said Trish Hessling, PharmD, Clinical Pharmacist at William S. Middleton Memorial Veterans Hospital in Madison, WI. “As we move toward this, pharmacists are going to be held more accountable for providing a high standard of patient care.”

About a year ago, Hessling and her team implemented a clinical pertinence review process. This process proactively provides insight into the quality of care not only of individual providers, but also of the group. The data collected from this process also validates the pharmacist’s expanded role.

“The key to starting this process is not to reinvent the wheel,” said Hessling. Create a formal policy, educate staff on the purpose of the review, establish a Clinical Pertinence Review Committee, and use the results to make improvements.

After completing the first round of reviews, Hessling and her team found that the vast majority of care provided at the hospital was either optimal or near optimal. In addition, “the process helped us identify an area of practice where performance improvement may be needed,” said Hessling.

Bedside discharge counseling

Sam Calabrese, BSPharm, MBA, Associate Chief Pharmacy Officer at the Cleveland Clinic, highlighted the importance of implementing a bedside medication delivery program prior to patient discharge. After hospital discharge, patients often do not fill their prescriptions due to wait times or monetary reasons, or they may not take their medications correctly due to a lack of discharge counseling or an inability to ask questions. Bedside medication delivery allows patients to “leave the hospital with medications in their hand,” said Calabrese.

Other benefits of a bedside medication delivery program include identifying financial issues up front so problems can be resolved before a patient leaves the hospital, and “having that continuity of care and the medical record being complete” when a pharmacist provides discharge counseling, he said. For Calabrese and his team, it all comes down to the patient experience. “Our results show that patients found this process very important in that they were able to get their prescriptions easier, [there is] less hassle if they are sick, [and] they are ensured that their prescriptions are being filled,” Calabrese said.

Patient bill of rights

Jeff Little, PharmD, MPH, BCPS, Assistant Director of Pharmacy at Children’s Mercy Hospitals and Clinics in Kansas City, MO, discussed the lessons learned from undertaking a PPMI project several months ago.

Before the implementation of the PPMI project, about 60% of patients received decentralized pharmacy services such as rounding, medication review, and medication verification. The goal of the PPMI was to have 100% of patients receive decentralized pharmacy services without adding staff. To accomplish this, Little and his team developed a pharmacy patient bill of rights.

“This [is] essentially what we feel all patients have a right to regarding pharmacy services and medications,” Little said. Little and his team determined that the patient has a right to have only indicated medications ordered and administered, to experience a safe medication process, to receive education about medications, to meet with a pharmacist, and to interact with a knowledgeable and skilled pharmacy workforce.

After implementing PPMI, the hospital ended up with a fully decentralized pharmacy Monday through Friday, and critical care services were decentralized 7 days a week, noted Little. “The patient truly comes first in this type of model,” he said.