Safe Practice 18, titled “Pharmacist Leadership Structures and Systems,” is one of 34 guidelines for organizations that have proved effective in reducing adverse health care events. The practice is explicit in its support for pharmacy leadership, stating: “Pharmacy leaders should have an active role on the administrative leadership team that reflects their authority and accountability for medication management systems performance across the organization.”
Recognizing Pharmacists’ Patient-Care Role
Safe Practice 18 is an important new recognition of the health-system pharmacist’s role in reducing medical errors through medication management, according to Hayley Burgess, Pharm.D., BCPP, director of performance improvement measures, standards, and practices at the Texas Medical Institute of Technology in Austin.
“Pharmacists are good at implementing change, and someone has to go in and identify the gaps where people are getting hurt. This is what we are all well-trained to do,” said Burgess, who helped write the new practice standard.
Safe Practice 18 is also a call to action for pharmacists to step up and take on larger leadership roles in areas like information technology within their own organizations, Burgess noted. “Pharmacists have the potential to be great leaders, but we haven’t always given ourselves enough credit for that in the past.”
The new practice, according to Burgess, gives pharmacists a road map for a safe medication program, based on the framework of strong leadership, a culture of safety, teamwork, and identifying and mitigating potential harm to patients.
Safe Practice 18 augments the four practices issued by the NQF in 2006, which covered standardized medication labeling and packing, high-alert medications, unit dose medications, and the pharmacist’s role in coordinating both of these kinds of medications.
The Value of Pharmacists
With Safe Practice 18, NQF is acknowledging the value of pharmacist involvement not only on the frontline delivery of safe patient care but also on the organizational level. That’s because pharmacist involvement at all levels has been shown to significantly improve patient outcomes, prevent harm, and reduce costs, said Mary Andrawis, Pharm.D., M.P.H., ASHP’s director of clinical guidelines and quality improvement.
“This recognition means that pharmacists should be expected to take on enhanced roles and responsibilities within their organizations,” she said, adding that there are three areas critical to enhancing the leadership potential of pharmacists:
1. Provider status: Pharmacists need to be recognized as health care providers for the purpose of liability and billing. ASHP has been aggressively advocating in Congress for the enactment of provider status for pharmacists.
2. Organizational decision making: Pharmacy leaders should be involved with integral system decisions.
3. Direct communication: The organization’s leadership team should have pharmacists engage directly with its board of directors.
Burgess believes that defining the skills to become a great leader is a critical, but difficult, step. “Our teams will follow leaders who have core values and behaviors that drive patient safety and organizational performance improvement,” she said.
Another critical step, according to Wayne Bohenek, Pharm.D., M.S., FASHP, vice president of care transformation at Catholic Healthcare Partners in Cincinnati, is to begin assessing individual facilities to reveal opportunities for improvement.
“Pharmacy is the only discipline called out by the NQF, which is a great honor,” he said. “But it’s only a first step. We need to find ways to take these concepts and operationalize them.”
As an example, Bohenek points to the NQF’s call for pharmacy leaders to communicate regularly and directly with hospital board members. To understand any barriers to that process, he suggests that pharmacists develop assessment tools similar to those of ASHP’s 2015 Initiative.
“For example, how many pharmacy directors have made a presentation to their facility’s board of directors?” he said, adding that the data could reveal the priority the board places on medication management and pharmacists’ patient-care role.
Hospital pharmacists who have already stepped into leadership roles can offer additional insights into how to partner with executives in meeting patient-care goals.
Take, for example, Darin Smith, Pharm.D., BCPS, who has served in his roles as director of pharmacy and director of performance improvement at Norman Regional Health System in Norman, Oklahoma, for more than two years.
Smith updates the health-system’s board monthly on health and safety issues facing the system’s three hospitals. He said his transition was made easier by the trust that the medical staff already had in the pharmacy department.
“They recognized the good work we had already done on quality initiatives,” he said. “When I look at all the work that needs to be done on safety, a good portion is medication-related. If pharmacists don’t step up and jump into these roles, other people will. And they don’t understand the intricacies of the systems like we do. Pharmacy leadership truly is the wave of the future.”