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Implementing Clinical Pharmacy Services

What lead to the pilot project at Providence in 2004?

In 1994, Roger Woolf, pharmacy director at Virginia Mason Medical Center in Spokane, Washington, and Larry Bettesworth, pharmacy director at Providence Sacred Heart Medical Center in Spokane, were inspired by what they heard about a patient-care-centric pharmacy model at the San Antonio Pharmaceutical Care Conference. I helped Woolf through the conversion from 1994 to 1999 and then helped Bettesworth complete the process from 1999 to 2004.

How were you able to get administration buy-in?

The pharmacy directors were passionate about their desire to implement a patient-centered care model and did their best to educate and convince their administrators of its value. The administrator over pharmacy at Providence Sacred Heart Medical Center, Elaine Couture, supported the development of the large program for several years but asked that the value be measured in 2004, which lead to the use of a documentation program.

What was most surprising about the project?

I was most surprised by how easy it was to gain the resources we needed once we made a solid business case. We also learned how to overcome inertia and manage the change process by involving staff in design and implementation. A change will not work unless staff members feel ownership of the process. We learned that lesson again and again.

When did you expand the pilot to other hospitals?

We knew we were ready when we gained approval for a corporate director of pharmacy clinical services. Data showed that some hospitals could pull through a market share contract or implement a protocol while others could not, and we believed it was related to the level of pharmacy clinical practice. However, it was not until we had a person who was free to travel and work with each hospital to help spread and adopt leading practices that things really took off.

How has patient care been improved?

The best indication we have at this time is the increase in the number of clinical interventions documented. Each intervention is associated with a value that gives it a relative weight of impact on the patient outcome. We track the number of interventions per case and have seen a consistent trend upward. We also are searching for more direct measures, such as reduction of adverse drug events, medication-related legal claims, and length of stay or other clinical outcomes.

If pharmacists are interested in pursuing this project in their own hospitals, what are the top three things they should do?

The top thing I recommend is to start the process by developing a shared vision and need for this change with the staff. You can usually bypass resistance by having the pharmacy director, along with an administrator, meet with staff members, state the absolute necessity for the change, and then task them with developing the plan. Secondly, some may not want or be able to practice in a patient-centered model and may choose to leave. Be prepared to allow them that choice. Finally, you must have clinical leadership resources to succeed. If there is no clinical coordinator or manager, then a program is very unlikely to develop and grow.

What has this project meant to you personally and professionally?

When you convert to a patient-centered model, it’s exciting to see the reactions of pharmacists when they realize the impact this change will have on the care of their patients. In almost every case, pharmacists are convinced that patients are receiving safe, effective medication therapy. But when pharmacists are finally freed from distribution and can round or perform profile reviews, they begin to see all the opportunities that are available to improve medication therapy. Once I experienced that epiphany, my practice changed forever. I have now worked with 28 different hospitals to plan and implement a pharmacy clinical practice model and feel like I am just getting started.