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New Pharmacy Services: One Medical Center’s Story

NEW YORK UNIVERSITY (NYU) Langone Medical Center is investing in pharmacists in a big way. Since hiring Thomas O’Brien, Pharm.D., as senior director of pharmacy in July 2008, the 812-bed institution has increased the number of staff pharmacists significantly, bringing the total number to about 60. The medical center has also added pharmacists to medical rounding teams in internal medicine, infectious diseases, critical care, psychiatry, the emergency department (ED), pediatrics/NICU TPN, geriatrics, and hematology/oncology.

Pharmacists at New York University Langone Medical Center have been added to a number of rounding teams.

Hired out of retirement to build a world-class pharmacy for the center and start a pharmacy residency program at NYU, O’Brien (formerly director of pharmacy services for Strong Health at the University of Rochester Medical Center, Rochester, N.Y., and Bassett Medical Center, Cooperstown, N.Y.) was given wide latitude by hospital administrators to enhance pharmacy services.

The primary reason behind the institution’s major commitment to pharmacy is self-evident, according to O’Brien.“Pharmacists assure rational drug therapy,” he said, pointing to the vast number of new drugs on the market as well as the cost-effectiveness of including pharmacists on rounding teams to help avert medication errors, maintain formulary compliance, and help decrease length of stay.

“Pharmacists are viewed as an invaluable resource, and a number of subspecialties have made requests to expand the program,” said Irene Kreuscher, vice president of professional services, NYU Hospitals Center, of having pharmacists round with medical teams. “To me, such recognition by other disciplines is an indisputable measure of success.”

Rising Importance of Pharmacists

In recent years, the issue of medication management has gained visibility as a key component in keeping patients safe. The Joint Commission (TJC) emphasized its importance in 2004 as a way to reduce preventable medication errors.

Thomas O’Brien, Pharm.D.

For years, ASHP has advocated for the involvement and leadership of pharmacists in the medication-use process, advocacy that is
clearly making an impact at TJC, according to O’Brien.

“During our TJC survey in December 2009, one of the surveyors asked, ‘Why aren’t there pharmacists on every medical team?’ That question could only have been prompted by ASHP’s advocacy on behalf of institutional pharmacists,” O’Brien said.

At Langone, medical staff are heeding that advice. “Physicians at the attending, fellow, resident, and intern levels have provided positive feedback,” said Robert Press, M.D., Ph.D., chief medical officer. “They truly value having a clinical pharmacist collaborate with them in patient care.”

Pharmacists at the center are also documenting how they are helping to improve care, according to John Papadopoulos, Pharm.D., FCCM, BCNSP, director of pharmacotherapy, and Movses Hovsepian, M.S., assistant director of clinical pharmacy services, division of pharmacotherapy and clinical pharmacy services.

For the 13 months that ended in January 2010, the center’s division of pharmacotherapy, for example, intervened nearly 8,000 times to optimize drug therapy, improve IV-to-PO step-down, and provide medication reconciliation, among other things.

Remaking the Pharmacy

The first thing O’Brien realized when he got to Langone was that the institution wasn’t making the best use of its pharmacists. The hospital had been paying $1.8 million a year in overtime for pharmacists.

Moreover, pharmacists were not involved in direct patient care, even though evidence supported the need for it. “There were pharmacists here for 25 years who never left the basement,” said O’Brien.

Langone began the process of change by investing more in human and technology resources. A software system that places a monetary value on clinical interventions was installed, as well as barcode technology to safely process unit-dose medicines and perform other duties.

“We utilize an intervention tracking software that collects our clinical pharmacists’ interventions and converts the intervention numbers to hard and soft dollar savings, which are significant,” Press noted, adding that the total savings for a recent 13-month period was more than $800,000.

Hospital pharmacy staff also saw their duties reshuffled.

“We had to get to where the patients were,” O’Brien said, noting that pharmacotherapy specialists were added to medical rounding teams throughout the hospital, including the ED.

Kanika Ballani, Pharm.D., PGY1 pharmacy resident, consults with John Papadopoulos, Pharm.D., FCCM , BCN SP, pharmacy residency program director and director of pharmacotherapy.

“The ED is a very vulnerable place,” said O’Brien, adding that “when a patient enters, they may be unable to give you their name, soit’s even more unlikely that they can relate anallergy to penicillin or other medications.”

Additionally, NYU Langone Medical Center accepted its first class of PGY1 pharmacy residents in 2009 and will be adding exciting technologies in the new Department of Pharmacy, including a pharmacy robot, a robotic “mini-warehouse,” and a USP 797—compliant clean room.

The changes have brought about real change in patient outcomes, according to Press.

“Collectively, we have seen an increase in patient specific interventions that we believe has led to a positive patient impact,” Press said. “We have seen our ‘perfect care’ numbers increase, possibly due to the collaborative patient care provided by our clinical pharmacists.”

The ability of pharmacists to optimize medication therapies, prevent errors, and increase medication cost efficiencies isn’t a surprise to O’Brien. Educating other health care providers, administrators, and the public to those capabilities is the real challenge.

“Pharmacy needs to continue to evolve as an intellectual, clinical discipline,” O’Brien stressed. “Pharmacy’s value to health care is not measured simply by how many prescriptions we can fill in an hour.”