ASHP InterSections ASHP InterSections

March 6, 2020

Pharmacist-led Initiative Cuts Post-Operative Opioid Use

Pharmacists at Riverside discuss patient pain control in daily interdisciplinary rounds with providers, nurses, and therapists.

PHARMACISTS AT RIVERSIDE HEALTH SYSTEM in Newport News, Va., are at the helm of an innovative paradigm shift in post-operative pain management. Historically, most joint replacement patients who sought to eliminate post-operative pain presumed opioids would be the cornerstone their pain control strategy. In 2017, Riverside’s pharmacy team rolled out a new  initiative aimed at reducing the amount of opioids prescribed for post-operative pain. The results have been nothing short of remarkable.

Multiple pain interventions

According to Cynthia Williams, Pharm.D., B.S., FASHP, two essential elements make the opioid reduction initiative a success: managing patient expectations regarding post-operative pain and provider use of multimodal analgesia (MMA).

“Unlike opioid-based regimens, MMA relies on non-opioid treatments, such as acetaminophen, non-steroidal anti-inflammatory drugs, neuropathic pain medications, and muscle relaxants, thus reducing the use of opioids,” Dr. Williams said. She is vice president and chief pharmacy officer at Riverside Health System and led the initiative along with a multidisciplinary team.

Cynthia Williams, Pharm.D., B.S., FASHP

Riverside’s “Joint University”

Dr. Williams, an ASHP member for over 20 years, said the efforts to change how Riverside’s total joint replacement patients think about post-operative pain begins well in advance of the procedure during conversations between patients and providers, and through group education sessions known as the “Joint University.”

“Joint University is our structured program that gives joint replacement patients, their caregivers, and families a chance to learn about all of the aspects and steps of total joint replacement surgery, from the pre-operative period to post-discharge home health care,” explained Dr. Williams.

While the Joint University was in place before this opioid reduction initiative was rolled out, Ms. Williams and her colleagues revised the educational materials to emphasize the need to balance post-operative pain control with safety and physical recovery.

The educational materials are reviewed with a nurse, who explains to patients that eliminating post-operative pain is unrealistic, may slow recovery, and place patients at risk of misuse and complications. “Chipping away at the commonly held patient expectation that there should be no pain post-operatively has been challenging, but the educational initiative has been effective,” said Dr. Williams.

Pharmacists take the lead

While addressing patient expectations, the Riverside team has also been encouraging providers to use MMA regimens, explained Katherine Koehl, Pharm.D., system director of clinical pharmacy services at Riverside Health System, and an ASHP member since 2006.

She said pharmacists have played a key role in achieving this shift in practice, through presentations at grand rounds, at provider retreats, and in one-on-one discussions with physicians, she noted. Pharmacists have also helped revise order sets to “make it easier for providers to do the right thing, which is to use fewer opioids,” Dr. Koehl said.

“Physicians can still order opioids, but the revised order sets for total joint replacement now default to include MMA components and require providers to take additional steps to prescribe opioids,” said Dr. Koehl. We’ve driven clinical practice by how we built our order sets, she added, pointing to a 95% adoption rate of MMA for total joint replacement surgeries.

Juanita Baer, Pharm.D.

Morning rounds

Ensuring joint replacement surgery patients are managed with MMA is a priority for Juanita Baer, Pharm.D., who is Riverside Health System’s surgical team lead for pharmacy.

“When I do my morning rounds, if a patient has high levels of pain, I’ll glance down at their chart and make sure that if they are receiving an opioid, they’re also being given multimodal components when appropriate, because pain medications work much better together than individually,” Dr. Baer said.

Indeed, she said having multiple components in place has led to less opioid use and is helping patients progress more rapidly in their physical therapy and through to discharge and rehabilitation. “By combining several different classes of drugs, we can find that individual optimal pain level where the patient is comfortable enough to sleep, while also being able to stand up safely and participate in physical therapy,” she said.

Expanding the program

Since the initial effort on elective total joints, Riverside has moved the focus to Enhanced Recovery After Surgery (ERAS) implementation in several specialty areas, including total colectomy and neurosurgery. One of the components of ERAS is the minimization of opioids, with a focus on multimodal pain management.

In early 2019, Riverside embarked on rapid performance improvement focused on ERAS implementation in colectomy surgery. “During the process, which included provider engagement from anesthesia and surgeons, the focus was placed on opioid-sparing treatment by utilizing multimodal pain management pre-operatively, the use of surgical blocks during the procedure, and the continuation of scheduled non-opioid medications post-operatively,” said Dr. Williams.

Katherine Koehl, Pharm.D.

Based on chart review, patients were successfully managed on limited or no opioid therapy and reported management pain levels. When opioids were needed for break-through pain, the oral route was utilized, which is a component of ERAS pathways, she added.

Leveraging the success of colorectal ERAS implementation, a neurosurgery project was launched in Summer 2019 and is showing early success, noted Dr. Williams.

Optimizing pain management

While there is now near-complete adoption of MMA regimens in Riverside’s total joint replacement, colectomy, and neurosurgery patient populations, Dr. Koehl said there was some initial resistance.

Perhaps the greatest reluctance, which was seen among both providers and patients, was that acetaminophen was thought of as a “low-value pain medication,” despite the evidence showing “it can be very powerful,” said Dr. Koehl. Some nurses were also initially apprehensive about spending more time administering the multiple medications included in an MMA regimen.

However, with education from pharmacists, providers and nurses ultimately placed the welfare of patients and others affected by the opioid epidemic over any hesitation, said Dr. Koehl.

“At the end of the day, we all want to minimize exposure to opioids and prevent large quantities of these drugs from getting into the community, and optimizing post-operative pain management is one way we have achieved this,” she said.

 

By David Wild

 

# # #

November 28, 2018

Clinical Privileging Paves the Way for Expanded Pharmacy Services

This opinion column was authored by ASHP member and InterSections guest columnist Ryan Mills, Pharm.D., M.B.A, M.H.A., BCPS. Dr. Mills is the Pharmacy Manager at Novant Health Kernersville Medical Center and Novant Health Clemmons Medical Center in North Carolina. He is a passionate pharmacy leader who believes that bringing pharmacists to the forefront of patient care will have a significant impact on chronic disease management and population health issues.

 

Ryan Mills, Pharm.D., M.B.A, M.H.A., BCPS

HEALTH SYSTEMS TODAY STRUGGLE WITH RISING COSTS and lower reimbursement coupled with expectations for greater safety and quality of care. Failing to adapt to these changes and position your pharmacy enterprise for the future will result in fates similar to those of  Blockbuster and Kodak. As hospitals and health systems shift toward a value-based reimbursement model, we must promote a progressive pharmacy practice model with pharmacists working together with providers in collaborative practice agreements.

 

Leveraging Pharmacists’ Expertise

My colleague, Matthew Gibson, Pharm.D., M.S., BCPS, is the Clinical Pharmacy Manager for Ambulatory Services at Novant Health. He has many years of experience with implementing collaborative practice agreements, pharmacist credentialing, and expanding pharmacy services. His pharmacy team delivers the highest-quality clinical care to our patients throughout the continuum of care.

It takes more than interprofessional collaboration throughout the patient’s hospital stay to improve patient care. Pharmacists need to be officially recognized for their expertise. North Carolina state medical and pharmacy boards have recognized pharmacists as practitioners since 1998, under the designation of clinical pharmacist practitioners (CPPs). Like other midlevel providers, CPPs enter into collaborative practice agreements with physicians, whereby the physician grants authority to the pharmacist to provide specific patient care services. The North Carolina Board of Pharmacy requires a protocol agreement between the supervising physician and CPP. This agreement details the CPP’s scope regarding disease state, medication therapy, and monitoring privileges.

 

Know Your Medical Staff Bylaws

At Novant Health, Dr. Gibson has partnered with physician leadership to successfully add CPPs to the medical staff bylaws. This means CPPs are now considered advanced practice clinicians, which is the same designation as nurse practitioners and physicians assistants. At a high level, medical staff bylaws describe how the medical staff governs itself. The bylaws explain the rights of the medical staff, the qualifications for medical staff members and advanced practice clinicians, and the necessary steps in the appointment, reappointment, and clinical privileging processes.

Every health system has its own credentialing and privileging process. Our credentialing and privileging process occurs through our central verification and medical staff offices, which determined that our CPPs would complete the same rigor of credentialing, privileging, and oversight process as our medical providers.

North Carolina laws have established a quality assessment schedule for CPPs to meet with their supervising physician on a regular basis to review clinical performance. Since the training of pharmacists has rapidly progressed over the past 10 years resulting in a spectrum of clinical skill sets among pharmacists, we decided to adopt more stringent eligibility requirements than the state, such as Board of Pharmacy Specialties certification and two years’ clinical pharmacy experience.

 

Successful Use of CPPs

Novant Health first used CPPs in the acute care setting to support optimal medication management in the neurology service line and is in the process of expanding into other venues of care, such as medication reconciliation at admission and discharge, emergency department culture review, and high-risk chronic disease state management.

The role of the pharmacist has drastically changed over the years from dispensing and verifying orders to direct patient care in partnership with all other disciplines. Our pharmacists play a crucial role in ensuring that our patients receive the highest-quality care and safest experience possible every time.

One of the most cost-effective investments any health system can make is leveraging its pharmacists in collaborative practice agreements throughout every venue of care to deliver a remarkable experience.

By Ryan Mills, Pharm.D., M.B.A., M.H.A., BCPS

 

August 15, 2016

In an Anticoagulation Clinic, Unrelated Interventions Abound

Melanie Boros, Pharm.D., BCPS, meets with a patient at Cleveland Clinic Akron General's outpatient anticoagulation clinic.

Melanie Boros, Pharm.D., BCPS, meets with a patient at Cleveland Clinic Akron General’s outpatient anticoagulation clinic.

IT’S WELL KNOWN that when pharmacists guide anticoagulation treatment, patient outcomes are better. International normalized ratio (INR) levels are within the target range more of the timei and hemorrhage rates are lowerii, compared to the usual care.

But what about the care pharmacists provide in anticoagulation clinics that is not directly related to the primary purpose of the visit?

A new study published in AJHP found that pharmacists offer significant additional care outside the purview of anticoagulation by helping patients avoid adverse events and receive timely treatment for other health concerns, and by improving their continuity of careiii.

Med Rec Reveals Important Picture of Patient Health

Michael Hicho, Pharm.D., BCPS

Michael Hicho, Pharm.D., BCPS

“Pharmacists, whether they’re in the anticoagulation clinic or in any other setting, can make a significant positive impact on patients’ care if they take advantage of each interaction they have with a patient,” said primary author Michael Hicho, Pharm.D., BCPS, who was a PGY1 pharmacy practice resident at Akron General Medical Center, Akron, Ohio, at the time of the study. Dr. Hicho is currently Inpatient Clinical Manager, Pharmacy Service, at Louis Stokes Cleveland VA Medical Center, Cleveland.

“As our findings show, these interactions may not necessarily always involve starting, stopping, or adjusting a medication but can, for example, include collaboration with other healthcare providers to ensure that patients are receiving appropriate care,” he said.

Dr. Hicho drew these conclusions from a retrospective analysis of records from 5,846 pharmacist encounters with 268 patients treated at the Akron General Medical Center’s pharmacist-managed ambulatory anticoagulation clinic between January 2012 and November 2013. The clinic served patients referred by 30 physicians during the study period.

Dr. Hicho’s team classified interventions not directly related to anticoagulation into six major categories (see TABLE below) and 33 subcategories. They found that pharmacists conducted a striking 2,222 interventions not directly related to patients’ primary reasons for visiting the anticoagulation clinic. Nearly 75% of patients received four or more unrelated interventions and almost 14% received 10 or more of these interventions.

Medication reconciliation was the most common intervention not directly related to anticoagulation. During those interactions, pharmacists identified 1,591 medication list discrepancies, including inaccuracies in the medication list for 89% of these instances.

They also found 107 instances in which a patient was taking his or her medication incorrectly and an additional 74 cases in which there was a possibility a patient may have been taking his or her medication incorrectly.

The Continuity of Care Equation

According to Dr. Hicho, pharmacists helped ensure continuity of care by assessing patients’ overall health, sending physicians medical information they collected, recommending primary care physician follow-up, and, in some cases, calling a physician for an immediate onsite visit or urging patients to visit the emergency department.

Amy Rybarczyk, Pharm.D., BCPS

Amy Rybarczyk, Pharm.D., BCPS

Measuring the clinical and financial value of interventions like these is difficult, said co-author Amy Rybarczyk, Pharm.D., BCPS, Pharmacotherapy Specialist in Internal Medicine, Cleveland Clinic Akron General. “At the moment, there is no standardized method for quantifying pharmacist interventions,” said Dr. Rybarczyk, who was Dr. Hicho’s research advisor at the time of the study. “It’s hard to measure the value of ensuring that a patient gets an antibiotic for a diabetic foot infection that is detected by a pharmacist, for example. A tool like that would be beneficial for our profession to have.”

Collaborative Practice Agreement Buoyed by Findings

The team’s results were so impressive that they were included in a letter to the Ohio Legislature in support of House Bill 188, which called for an expansion of pharmacists’ services as part of collaborative practice agreements. The legislation passed in December 2015.

“We believe the comprehensive care provided to patients in our disease state management clinic helped in this effort to expand pharmacists’ clinical services,” explained Dr. Rybarczyk.

“We believe the comprehensive care provided to patients in our disease state management clinic helped in this effort to expand pharmacists’ clinical services.” — Amy Rybarczyk, Pharm.D., BCPS

Co-author Melanie Boros, Pharm.D., BCPS, Pharmacotherapy Specialist in Internal Medicine at Cleveland Clinic Akron General and Dr. Hicho’s research advisor at the time of study, suggested that one of the important takeaway messages is the trust that patients place in their pharmacists. “When we see a patient with a therapeutic INR, and there are no changes that need to be made to his or her anticoagulation regimen, we can still make a significant impact by simply clarifying what their dose of insulin should be or teaching them about appropriate use of nonprescription medicines, for example,” she said, adding that pharmacists are well-positioned to answer patients’ questions and proactively identify other health issues.

“Like our entire department, pharmacists in the clinic have always made it a priority to care for the whole patient,” she emphasized.

–By David Wild

i J Throm Thrombolysis 2011; 32:426-430
ii Pharmacotherapy 195; 15:732-739
iii AJHP Residents Issue 2016; 73 (Supp 3):S80-87


September 25, 2013

HENs Offer Opportunities for Pharmacists to Improve Patient Care

 

Hospital Engagement Networks are bringing together pharmacists, physicians, and nurses to improve patient outcomes in areas such as preventable infections, adverse drug events, and preventable readmissions.

A COLLABORATION BETWEEN ASHP and the American Hospital Association is yielding exciting opportunities for pharmacists to improve patient care across the country.

The two organizations are working together to increase pharmacist participation in Hospital Engagement Networks (HENs), part of the Centers for Medicare & Medicaid Services’ (CMS’s) Partnership for Patients program.

Approximately 3,700 hospitals participate in HENs, choosing among 10 areas in which to improve quality measures, including surgical site infections, adverse drug events, central line-associated bloodstream infections, venous thromboembolism, catheter-associated urinary tract infections, ventilator-associated pneumonia, and preventable readmissions.

The hospitals then share their successes with partnering organizations to help others replicate what they have achieved.

Pharmacists are a Natural Fit

Because so many of the primary goals for HENs involve medication therapy, pharmacists are in a perfect position to help as medication experts on the health care team. And when the American Hospital Association’s Health Research and Educational Trust (HRET) received a CMS grant to create a HEN, approaching ASHP seemed like a no-brainer.

The HRET HEN is focused on identifying solutions that are already reducing health care-acquired conditions and disseminating them to other hospitals and health care providers, according to David G. Schulke, HRET’s vice president of research programs in Washington, D.C.

“It was natural to reach out to ASHP because many readmissions are attributable to breakdowns in drug therapy, and pharmacists are well-trained and have tremendous knowledge in that area,” Schulke said. “I’ve worked with pharmacists and ASHP for many years, and HRET wanted to see if we could use that existing relationship to knit pharmacists into the HEN’s implementation teams.”

Beverly L. Black, MHSA, CAE

Beverly L. Black, MHSA, CAE

ASHP then turned to its strong network of state affiliates to reach members who might be interested in participating.

“Depending on what a state affiliate is focusing on, they may be able to recruit pharmacists to get involved,” said Beverly L. Black, MHSA, CAE, ASHP’s director of affiliate relations. She added that pharmacists attend workshops as presenters or participants, work within their health systems to design and implement quality improvement programs as part of the HEN, and forge strong partnerships among state health-system pharmacy groups and state hospital associations.

“These relationships are important because we are common stakeholders in ensuring that patients receive optimal therapy.”

Narrowing the Focus

Developing initiatives relevant to a hospital’s or health system’s needs, measuring outcomes, and sharing information with other providers in the network are major facets of the HRET HEN.

At Purdue University’s Center for Medication Safety Advancement in Indiana, pharmacists collaborated with the Indiana Hospital Association to create the Indiana Medication Safety Alliance. Last November, the Alliance hosted a conference about medication safety, ADEs and readmissions. Now the group has its own website, provides ongoing coaching, and hosts conference calls every other month or so.

The group initially focused on two measures, successful anticoagulation with warfarin and avoidance of hypoglycemia among insulin users, but has since whittled its efforts down to improving anticoagulation.

John B. Hertig, Pharm.D., M.S.

John B. Hertig, Pharm.D., M.S.

Narrowing the focus was essential because the HEN’s guidance offers so many possible areas for improvement, said John B. Hertig, Pharm.D., M.S., the Center’s associate director.

“The HRET HEN’s Encyclopedia of Measures contains more than 100 distinct measures. So, zeroing in on warfarin was a strategic decision because the HEN was looking at patient harm with regard to ADEs and the hospitals in Indiana were reporting [issues with anticoagulation] more than anything else,” Hertig said.

At the University of Arkansas for Medical Sciences in Little Rock, the focus is on reducing readmissions for heart failure patients.

“When Medicaid announced penalties for pneumonia, acute myocardial infarction, and heart failure, we decided to take a look at how that would affect us,” said Niki Carver, Pharm.D., assistant director of pharmacy.

“After working on medication reconciliation for years, I wondered if there was a way the pharmacy could be notified when heart failure patients were admitted so the pharmacy could obtain medication histories for those patients.”

Carver knew such an effort would have an impact on the pharmacy’s workload, so she created an elective rotation for fourth-year pharmacy students that tasks them with obtaining medication histories and assisting in quality improvement efforts. Thus far, reductions in monthly readmission rates for patients with congestive heart failure have ranged from 1.67 to 4.43 percent.

Pharmacists at The Johns Hopkins Hospital are working to improve HCAHPS scores related to educating patients about their medicines. Above, a pharmacist talks to a patient about how to properly use an insulin pen.

Above left, Leigh Efird, Pharm.D., BCPS, clinical pharmacy specialist, The Johns Hopkins Hospital, teaches a patient how to properly use an insulin pen.

Working Smarter, Not Harder

The Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) served as a catalyst for involving pharmacists in the HRET HEN at The Johns Hopkins Hospital in Baltimore, where their goal is to improve HCAHPS scores for medication-related questions.

“When we partnered with the Maryland Hospital Association, they knew we were working on issues related to HCAHPS,” said Meghan Davlin Swarthout, Pharm.D., MBA, BCPS, division director, ambulatory and care transitions.

“We were able to take actionable steps toward our goals and share information with other hospitals about our successes.”

Swarthout said that the hospital has increased its “Always” HCAHPS score from the 48th percentile in the second quarter of FY2013 to the 84th percentile in the fourth quarter for the survey question, “When I left the hospital, I clearly understood the purpose for taking each of my medications.”

Swarthout also stressed the value of sharing information within the network. “Sometimes the goals for quality and safety can be overwhelming. HENs bring in the expertise of your peers, and they can help you target your biggest problems,” she said.

Carver noted that HENs eliminate redundancy. “You hear what other hospitals have done, take what you need for your institution, make changes that fit your setting and implement them, instead of starting something from scratch.”

Pharmacist involvement in the HRET HEN is still fairly sporadic. For example, in a statewide workshop of roughly 250 attendees that Swarthout attended, only about 10 participants were pharmacists. Yet despite the relatively small number of pharmacists there, they made an impact: Once the other participants heard what the pharmacists had to say about safe medication use, many indicated they would promote better use of pharmacists’ skill within their own institutions.

ASHP is hopeful that by encouraging affiliate members to participate in the state-level HENS, other health systems will likewise more fully understand the valuable role that pharmacists play in ensuring patient safety and optimal health outcomes.

“We believe that if more pharmacists knew the benefits of participating in the HENs network, they would be more interested in participating,” Swarthout said. “We all have days when it feels like we’re not making any improvements, and that can be discouraging. But when you hear other people in the HEN talk about the same things, you realize you are not alone. You come away with ideas and external motivation.”

Showcasing Pharmacists’ Skills

HENs are also an excellent way to advance the profession, according to Hertig.

“It’s an opportunity for pharmacists to showcase their skills and abilities as members of interdisciplinary teams,” he said. “But it’s also in line with ASHP’s Pharmacy Practice Model Initiative in that it helps pharmacists work at the top of their licenses. What better avenue to show the impact we can have than a federal program where we work with nurses, physicians, and other professionals?”

Shekhar Mehta, Pharm.D., M.S.

Shekhar Mehta, Pharm.D., M.S.

Shekhar Mehta, Pharm.D., M.S., ASHP’s director of clinical guidelines and quality improvement, agreed.

“ASHP is primarily concerned with patient care, medication-use safety, and ensuring that pharmacists are part of a collaborative care team. So, this initiative supports all those goals,” he said.

“Pharmacists are also the most knowledgeable members of the team when it comes to medication use, and that’s a big issue in health care reform in improving the quality of care and lowering readmissions.”

Ultimately, patients are the ones who benefit most, said Carver.

“Skeptics will say that it’s more work for pharmacists, and it is. But if you’re in hospital pharmacy, you’re in it to improve patient care. And the outcomes you will see with this program are astounding.”

—Terri D’Arrigo

Editor’s Note: Interested in getting involved with an HRET HEN program? Send an email to affiliates@ashp.org, and we’ll put you in touch with the right resources within your state.

 

August 8, 2013

Leadership: Central to Pharmacy Practice Advancement

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

EFFECTIVE, FOCUSED LEADERSHIP AND EXECUTIVE PRESENCE are essential to driving pharmacy practice advancement, thus optimizing patient care. ASHP and the ASHP Foundation are committed to supporting pharmacists in their professional and leadership development journey to achieve this goal.

Leadership in clinical practice and effectively working collaboratively on interprofessional teams are what drives practice change. And, through a number of initiatives, ASHP and the Foundation are dedicated to assisting pharmacists across the complete spectrum of their career… from student, to new practitioner, to emerging clinical and administrative practice leaders, and, ultimately, as experienced leaders.

No other pharmacy organization has the depth and level of commitment to your practice leadership development that ASHP does. Please let me review with you this level of commitment and showcase examples of leadership development opportunities that ASHP and the Foundation are offering our members.

Pharmacy Leadership Academy

The Pharmacy Leadership Academy (PLA) has been in existence for five years, and nearly 400 practitioners have completed this transformational leadership development program. The Academy is helping to launch talented new clinical practice leaders and assisting other established leaders in reaching new heights in their careers.

At the Foundation’s ASHP Summer Meeting Donor Breakfast, I heard three pharmacists speak about their life-changing PLA experiences. I was touched and thrilled to hear their heartfelt stories of professional success, and I suggest that you read their inspiring messages and view the video on the Foundation’s website.

What impressed me about the graduates’ messages was their self-confidence, poise, passion, and full commitment to their patients and to leading our profession to new heights. This month, 68 pharmacists began the year-long, distance-based PLA program. They are poised to reach new heights in practice leadership.

If you are interested in catapulting your career, I encourage you to consider enrolling in the next class. In addition, directors and chief pharmacy officers should also identify members of their staff who are primed for success and enroll them in the 2014 class.

leadersINNOVATION Masters Series

ASHP and the Foundation also offer the leadersINNOVATION Masters Series, which consists of two, six-week distance-learning programs: “Developing Transformational Leadership Skills” and “Designing Transformational Change: Strategy and Tactics.”

This leadership development series is an excellent option for pharmacists who may not be able to fulfill a year-long commitment, or who seek a program before the start of the next PLA class. The leadersINNOVATION Masters Series begins August 18. Courses position practitioners to deal effectively with rapid changes in the health care environment and to position pharmacy for the type of transformational change that can expand and advance pharmacy practice.

The series is ideally suited for an emerging leader, a recent pharmacy resident graduate, or for an established leader needing guidance on how to move pharmacy practice to the next level. It also may be exactly what you need for your own professional development or what you have been seeking for one or more of your staff.

leadersEDGE Webinar Series

The new leadersEDGE Webinar Series is another leadership development program that will be launched by the Center for Health-System Pharmacy Leadership in September 2013.

This 90-minute program will address major, cutting-edge leadership challenges facing pharmacy practitioners in health systems. The first program will address the current state of the “Business of Pharmacy.” Webinar faculty will focus on the critical capability and capacity necessary to transform practice. It is the perfect program for pharmacists interested in staying in front of major leadership issues facing our profession.

Opportunities for Students, Residents

At ASHP, we believe that our student pharmacists and pharmacy residents are the lifeblood of our profession.

Pharmacy students face a competitive environment when they graduate and are looking for opportunities to develop and ultimately showcase their leadership talents. ASHP has a host of opportunities through the Student Societies of Health-System Pharmacy, Leadership Speakers BureauASHP Student Leadership Award ProgramStudent Leadership Development Workshops, and the national Clinical Skills Competition.

The future of our profession is in the hands of our pharmacy students and pharmacy residents. ASHP remains committed to providing leadership opportunities for them, including the Visiting Leaders Program, which has been developed explicitly for pharmacy residents.

Showcasing ASHP’s Many Leadership Offerings

During my many years working in hospitals and health systems, I relied upon ASHP, as my professional organization, to assist me in that journey at all steps along the way. It was a challenge for me to keep up with the many offerings of ASHP, and I know many of you face the same challenge.

That is why, at this critical juncture, I am taking the time to showcase ASHP’s commitment to our leadership development programs. Please take the time to share this message, and have your colleagues or your staff members review these fantastic program opportunities.

Feel free to share your thoughts with me about your leadership development needs, and remember that focused and effective leadership is central to pharmacy practice advancement at the bedside, in the pharmacy, in the clinic, and in the administrative office.

July 15, 2013

West Penn Clinic Successfully Treating Underserved Patients

Pharmacists at West Penn are a key part of the transition-of-care team as indigent patients move from inpatient care to care at the Health and Wellness Clinic.

PITTSBURGH KNOWS A THING OR TWO about comebacks. The Rust Belt capital suffered big losses when the steel industry collapsed in the 1980s, but returned to prosperity with a diversified economy. The West Penn Hospital also faced its own budgetary crisis a few years ago, after peaking in patient volume in 2008.

In 2010, we were forced to significantly downsize and reduce patient care services due to the financial difficulties of our parent organization. After an acquisition and two years of rebuilding and revitalization, we have turned things around with the reopening of a transformed emergency department, an increase in patient beds, technology upgrades, and the biggest transformation yet: the opening of a “new concept” health and wellness clinic in downtown Pittsburgh.

The West Penn Hospital Health and Wellness Clinic, which opened in February 2013, helped us to re-establish our reputation as a cornerstone of medical care in Pittsburgh and the surrounding Bloomfield-Garfield community. Funded 100 percent by proceeds from the hospital’s 340B drug discount program, the clinic provides critical medical services to underinsured and otherwise underserved patients.

Jennifer Davis, Pharm.D.

Jennifer Davis, Pharm.D.

Since its inception, the pharmacy services department has been a driving force behind West Penn’s 340B program.  As the system director for outpatient pharmacy services, I’ve taken the lead in the overall operations of the new clinic. We run the clinic as efficiently as possible, saving time and resources by using existing space and personnel, including on-staff physicians. The funds generated by our 340B program pay for medications that patients might not otherwise be able to afford and for the cost of staffing the clinic.

As a 340B-covered entity, West Penn Hospital contracts with local pharmacies to fill prescriptions using inventory purchased by the hospital at the 340B price. Through this contract pharmacy network, we provide discounted medications to uninsured patients and generate much-needed supplemental revenue from prescriptions covered by insurance.  The revenue, in turn, is used to cover the cost of the downtown Health and Wellness Clinic as well as costs associated with other uncompensated care.

Clinic Grows, Hospital Readmission Shrinks

Physicians at the clinic see uninsured and underserved patients weekly, and we expect to see more patients as word spreads. With funding generated by the 340B program, we help patients offset the costs of their medications. They literally benefit twice from the same 340B savings—patients now have increased access to care and their prescription costs are lower.

As with most hospitals today, readmission is a hot topic at West Penn. Pharmacists at the clinic help keep patients from using the hospital’s emergency department by providing disease management, medicine adjustments, and lab monitoring services. In addition, we receive prescription compliance data from our 340B program administrator to help clinicians monitor the patients who use the program. In February alone, the clinic saw 52 patients. We were also able to hire a full-time receptionist. By year’s end, the clinic hopes to see 800 patients.

Transitioning to Better Care

At the clinic, we are strong advocates for the “transition of care” program, which helps patients use the wellness clinic and Allegheny General Hospital (AGH) Apothecary (one of the hospital’s 340B contract pharmacies) and other local contract pharmacies. This program helps to ensure the coordination and continuity of care as patients transfer between different locations or different levels of care within the same location.

Another service we offer at the clinic is bedside medication counseling at discharge and seeing these patients at the clinic for medication management. AGH Apothecary fills prescriptions as needed. Pharmacists also provide post- hospitalization follow-up for patients who are unable to see their regular doctor.

Key Partners in Setting up the Clinic

With the health and wellness clinic, we have made the best possible use of the hospital’s 340B savings. Starting the clinic, however, took planning, resourcefulness, hard work, and a partnership with a contact pharmacy administrator, Wellpartner, to manage the program.

Wellpartner has expertise in creating custom 340B retail pharmacy networks that include both chains and independents.  Our network is well balanced with the right geographical coverage, which helps increase 340B program utilization.

The hospital first implemented its 340B contract pharmacy program in 2011, after a local pharmacist noted that uninsured and underinsured patients from the hospital’s Joslin Diabetes Center could no longer pay for their medications. Currently, West Penn’s 340B program uses 29 contract pharmacies, filling more than 8,800 prescriptions in 2012.

I also credit the hospital’s C-suite for helping to get the clinic started. They were huge champions for us, and I believe that with strong C-suite support any hospital can implement such a program.

The economy has caused plenty of setbacks for us and for people in need throughout our service area.  But the West Penn Hospital Health and Wellness Clinic proves that with hard work and ingenuity, positive results are possible, even in the worst of times.

–By Jennifer Davis, Pharm.D., Director of Outpatient Pharmacy Services, West Penn Health System, Pittsburgh

 

 

 

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