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Fauquier Health Reveals the True Meaning of Teamwork

Sep 28, 2010

Margaret V. Rowe, Pharm.D., director of pharmacy at Fauquier Health in Warrenton, Va., poses with her staff.

How would you define the ideal pharmacy practice model?

The ideal pharmacy practice model is one where the pharmacist works side by side with other members of the health care team to design optimum drug regimens for patients. This is, of course, supported by a drug distribution system in which the right drug, in the correct dose, is in the hands of the nurse to be administered safely to the correct patient. At Fauquier Health, we have been seeking this ideal since the mid-1990s, when we began to decentralize our pharmacists. Our decentralization showed hospital leadership that pharmacists in a clinical role improve therapeutic outcomes and have a positive impact on reducing drug costs.

How do Fauquier Health pharmacists ensure safe and effective medication therapy?

As valued members of the health care team, our pharmacists are highly involved in all aspects of patient care. Pharmacists are staffed on our major inpatient nursing units Monday through Friday, from 7 a.m. to 3 p.m. While on the units, they participate in patient rounds. Pharmacists are also involved in reviewing and processing medication orders, reviewing patient profiles, and performing a variety of other clinical functions (e.g., pharmacokinetic dosing). After 3 p.m., and on weekends, pharmacists in our central pharmacy assume the patient-care responsibilities. All of these efforts have resulted in improved turnaround times for medications and patient outcomes, reduced medication errors, and better communication with all the members of the health care team.

What services are critical in supporting your new practice model?

The essential components of our clinical pharmacy program include pharmacokinetic dosing, total parenteral nutrition management, antimicrobial stewardship, renal dose adjustment, and clinical consultations with other members of the health care team. Our physical presence on the nursing units, including in the ICU, has also placed us in a prime location to intervene during urgent situations.

Another instrumental component is our team of highly trained and motivated pharmacy technicians. All of our technicians are certified pharmacy technicians (CPhTs). They have a strong understanding of the pharmacy and are valued members of our team.

What technologies have you implemented to help facilitate this change?

In addition to allowing pharmacists to access information and process orders from anywhere in the hospital, our computerized physician order management software allows physicians not only to document their histories, physicals, and consults electronically but also to receive and review labs and X-ray results. Our health care informa- tion system also includes an electronic medication administration record along with an electronic nursing documentation system. In 2012, we plan to begin implementing bedside medication verification. We are very wired for a 97-bed hospital.

What are your measures of success?

One major indicator of our success is the overall reduction in medication errors at our hospital. Three years ago, our medication error rate was 5 percent; currently, our data show us at 2.9 percent. Decreases in drug costs per adjusted patient day and demonstrated decreases in hospital-acquired warfarin ADRs are other indicators of the success of our program. Noticeable improvements in communication and collaboration with other members of the health care team, especially physicians, and an overall reduction in staff turnover rates (pharmacists and pharmacy technicians) are also important indicators of our success.

What are some key considerations for gaining employee buy-in?

Gaining acceptance from the pharmacy department, especially our more senior staff members, was critical. We quickly learned that pharmacists who had not functioned previously in a clinical role needed a different level of coaching and training than more recent graduates, who developed their clinical skills during pharmacy school.

Another approach we found to be extremely successful was implementing an active mentoring program for our staff members. We offered both formal and informal training and educational opportunities to pharmacists and pharmacy technicians.

How did you gain support of hospital administrators, physicians, and nurses?

We piloted our program with one clinical pharmacist stationed on the nursing unit providing targeted therapies on pharmacokinetics and renal dosing. Being physically present on the nursing unit had a positive impact on our relationship with the nursing team. The nursing staff appreciated being able to talk to the pharmacist in person and in real time.

Gaining acceptance from the medical staff, however, took more of a concerted effort. Our clinical pharmacists worked diligently to develop relationships with key members of the medical staff. To win over the more reluctant staff members, cost saving and outcomes data were presented to hospital leadership and during medical staff meetings.

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