ASHP InterSections ASHP InterSections

September 23, 2011

Cleveland Clinic Hospitals Lead Way on Quality-of-Care Measures

Filed under: Current Issue,End Notes,Provider Status — Tags: , , , , , , , , — jmilford @ 11:10 am

STARTING IN OCTOBER 2012, Medicare will reimburse hospitals based on quality-of-care measures, including how closely hospitals follow best clinical practices and how satisfied patients are with their care. “All institutions now have a heightened awareness of the need to perform better because of Medicare’s pay-for-performance reimbursement that’s coming,” said Michael Hoying, R.Ph., M.S., director of pharmacy for Fairview-Lutheran Hospitals, part of the Cleveland Clinic Hospital System. A New Opportunity for Pharmacists  Among the factors that Medicare will consider in its incentive calculus will be drug-related process-of-care measures for patients with congestive heart failure (CHF)—specifically, the percentage of patients with CHF evaluated for left ventricular systolic (LVS) function and the percent of CHF patients with LVS dysfunction who received an ACE inhibitor or an AR blocker. A year ago, Fairview-Lutheran’s respective scores for this patient population hovered around 93 percent and 86 percent, both below national averages.

Michael Hoying, R.Ph., M.S.

Hoying recognized an opportunity for pharmacists to improve the scores and reach organizational goals of 100 percent compliance. “The pharmacy was not consistently involved with heart failure measures, and we saw that we could do a better job of identifying patients who needed their CHF core measures reviewed.”

In August 2010, Fairview-Lutheran’s night-shift pharmacist began a nightly review of a computer-generated data pool, looking for all patients admitted to the hospital that day with a primary or secondary diagnosis of CHF. For patients with CHF whose most recent echocardiograms showed ejection fractions of less than 40 percent and who had received either an ACE inhibitor or AR blocker, the treatment is documented in the electronic medical record (EMR).For those who had not received drug therapy, the pharmacist checks the EMR to determine if there are valid reasons for why it has not been ordered. If none are found, the patient’s record moves to a follow-up list. Patients for whom a new echocardiogram had been ordered are also placed on the follow-up list.The next morning, a pharmacist reviews the follow-up list and obtains either a medication order for appropriate treatment or documentation of a medication variance. A cardiology nurse practitioner who is part of the daily clinical staff coordinates the final resolution to ensure that the core measures have been met.

“Where we faltered in the past was documenting why an ACE inhibitor wasn’t on board,” said Hoying. “That’s where the pharmacists have really filled a role and made sure that there’s either a good reason why the therapy wasn’t ordered, or have tracked down the physician to get the order if there’s no reason why the patient shouldn’t be receiving the drug.”

Over the next few months, the number of CHF patients screened monthly quadrupled. Fairview-Lutheran reached—and has maintained—100 percent compliance with core CHF measures by the last quarter of 2010.

“At first, managing the list was a little overwhelming,” noted Erin Barnett, Pharm.D., clinical specialist II at Fairview-Lutheran, “but soon we were able to easily integrate the new procedures.”

Connecting Patients and Pharmacists

Last March, Hoying turned to another factor that will weigh heavily in the Medicare incentive calculations: the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey. HCAHPS is the first national, standardized, publicly reported survey of patients’ perceptions of their hospital care. The results will count for 30 percent of the Medicare reimbursement score. For the two survey questions about how well patients were informed about new medicines during their stay, Fairview-Lutheran scored poorly.

Hoying initiated a pilot program on one 36-bed unit that increased the number of direct encounters between pharmacists and patients. The goal: improving communications about new drugs.

Prior to pharmacist involvement, overall communication about medications for the unit ranked in the 17th percentile among comparably sized hospitals. For describing what a new medicine was for, it ranked in the 55th percentile, and for describing possible side effects, it ranked near the bottom, in the 2nd percentile.

By the second quarter of 2011, the unit had jumped to the 96th percentile for overall communication about medications, and to the 99th and 90th percentiles, respectively, for the other two measures.

“We’ve had a huge impact,” said Hoying. “I plan to use the data to make the case for greater resources and to start a residency program, which would allow us to expand our coverage to other units.” He’s already added two pharmacists to his staff.

“The story at Fairview-Lutheran demonstrates how pharmacists can really improve patient outcomes as well as their hospital’s ranking,” said David Chen, R.Ph., M.B.A., director of ASHP’s Pharmacy Practice Sections and Section of Pharmacy Practice Managers. “This shows how much they can make a difference.”

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March 28, 2011

Use of Technology Growing, Pharmacists’ Roles Changing

Filed under: End Notes — Tags: , , , , , , , , , , , , , , , , , , , , — editor @ 5:00 pm

OVER THE YEARS, ASHP’s National Survey of Health-System Pharmacy Practice has evolved into a powerful tool to track pharmacy developments. The results of the survey, which monitors both micro- and macrotrends, help highlight changes that can feel almost glacial in pace but that are critical to the profession’s future.

“Although we publish the overarching results of the survey in the American Journal of Health- System Pharmacy (AJHP) each year, the article alone doesn’t capture the trends over longer periods of time,” said Douglas Scheckelhoff, M.S., FASHP, ASHP’s vice president of professional development. “When you stand back and look at the larger picture, you see some startling and exciting changes in the profession.”

The survey, which has its roots in the Mirror to Hospital Pharmacy (published in 1964), was first fielded by ASHP in 1975. What initially began as an occasional survey, occurring once every few years, has become an annual effort at data collection. The new survey will appear in the April 15 issue of AJHP.

Since 1990, the survey has documented three important trends in health-system pharmacy: the influence of The Joint Commission (TJC’s) on national safety standards, the growth of technology in pharmacy practice, and the evolution of roles for pharmacists and pharmacy technicians.

Guiding Pharmacists, Policymakers, Stakeholders

Each year, approximately half of the survey focuses on two of six aspects of the medication-use system: prescribing, transcribing, dispensing, administration, monitoring, and patient education. The other half comprises of standard questions about staffing or current hot topics and evolving issues, such as informatics or the environmental impact of drug disposal.

The consistency of the survey’s questions gives it clout, according to Craig A. Pedersen, Ph.D., Pharm.D., FAPhA, a health care consultant in Mercer Island, Wash., and lead author of the forthcoming practice report in AJHP’s April issue.

“Our methods have been maintained over time, including the weighting and phrasing of the questions, and we’ve had a consistent team of investigators, so the trends are very likely real,” Pedersen said. “This survey is a trusted source of information not only to our profession, but to policymakers and other stakeholders.”

Pharmacists Respond to TJC

In recent years, survey responses have reflected the impact of TJC’s medication safety guidance. For example, after TJC announced national patient safety goals, the number of hospitals in which pharmacists read back verbal orders in detail, including spelling the drug’s name, increased from 30 percent of respondents to more than 83 percent of respondents within five years.

In 2006, 59 percent of hospital pharmacies did not offer after-hours review of orders. Now only 43 percent of hospital pharmacies do not perform after-hours review. There also has been a growth in the number of facilities that have affiliation agreements with other hospitals for order review and remote pharmacy services.

Hospital and health-system pharmacy has changed markedly in the years since ASHP first started surveying pharmacists about their practices. Photos courtesy of ASHP Archives.

“When The Joint Commission gets involved, hospitals step up to the plate with new processes,” said Pedersen. He noted the impact of TJC guidelines on medication reconciliation. “The Commission said we need to perform medication reconciliation, and now everyone is doing that,” he said. “The survey has enabled us to document our progress.”

Expanding Reach of Technology

ASHP’s national survey has captured a second pronounced trend: the growth of technology. In 2010, 34.5 percent of hospitals had adopted bar code medication administration, compared with just 1.5 percent in 2002. In 2010, 18.9 percent of hospitals had adopted computerized prescriber order entry with clinical decision support, compared with 2.7 percent in 2003.

Although seven- and eight-year trends demonstrate growth, longer trends illustrate just how far the use of technology in pharmacy has come, Scheckelhoff said.

“Think about computerization of the hospital pharmacy. In 1982, only 17.6 percent of hospital pharmacies were computerized. Now, virtually all are,” he said. Scheckelhoff noted that the near universal use of automated dispensing cabinets reflects the shift toward unit-dose drug distribution.

“All of these technologies improve efficiency and safety, and we’re able to take the information the survey provides about their use in forming practice models, to make sure these technologies are used to maximum effect,” Scheckelhoff added.

Changing Roles

The growth of technology has positively affected how pharmacists and pharmacy technicians go about their work, according to the survey.

“One could imagine technology replacing people, but we’ve seen the opposite,” said Scheckelhoff. “Technicians are doing more for prepping and distribution of medications, while pharmacists are moving into advanced roles with more direct patient care, such as working in the ER and going on patient care rounds.”

In 1982, pharmacists went on rounds in 13 percent of hospitals. Now, pharmacists go on rounds at 43 percent of hospitals overall and in nearly all hospitals that have 300 beds or more.

Philip J. Schneider, M.S., FASHP, clinical professor and associate dean at the University of Arizona College of Pharmacy in Phoenix, notes the increase in pharmacists’ responsibilities.

“Pharmacists are being delegated responsibility for prescribing or making changes in drug therapy without necessarily having to get physician approval, and we think that’s important,” Schneider said.

“The survey has shown us that there is a shift away from labor-intensive activities and toward pharmacist empowerment in terms of drug therapy management,” he said. “It’s clear that this is a vision for a lot of pharmacists, and it shows how hospitals are increasingly making better use of their pharmacists’ time to achieve that vision.”

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December 26, 2010

Mentorship Program Helps Pharmacists Improve VTE Prevention

Filed under: End Notes — Tags: , , , , , , , , , , , , , , , , , — admin @ 12:38 pm

The team at Sharp Grossmont Hospital in La Mesa, Calif., has put the suggestions of VTE Initiative faculty member Gregory A. Maynard, M.D., to good use.

DESPITE THE FACT that venous thromboembolism (VTE) is the most preventable cause of death in hospitalized patients, and that evidence-based guidelines for mechanical and pharmacological prophylaxis are widely available, VTE is still a significant cause of morbidity and mortality among patients at risk. Studies have shown that the incidence of VTE is about one in 1,000, with more than 250,000 patients hospitalized annually with the condition.1

Recognizing the great need for VTE interventions, ASHP Advantage recently developed the Institutional Impact VTE Mentored Quality Initiative.2 Through the program, physician-pharmacist faculty teams provide on-site evaluations of health systems’ VTE preventions practices and offer site-specific recommendations to help each system meet its quality-improvement goals.

Mentorship and Support

True to the initiative’s name, faculty members go beyond a consulting role and instead mentor each facility’s staff members, said Stuart T. Haines, Pharm.D., BCPS, BC-ADM, professor and pharmacotherapy specialist, University of Maryland School of Pharmacy, Baltimore, and clinical specialist, West Palm Beach VA Medical Center, West Palm Beach, Fla. “VTE prophylaxis is one of the bread-and-butter things pharmacists do, but this particular project is far more intensive for the selected sites,” he said. “We have regular contact with them, and although we analyze what they are doing and offer suggestions for how it can be better, we also support them as colleagues and help them communicate their efforts to peers.”

Indeed, faculty members for the initiative were chosen because of their collegial efforts and reputations, according to Kristi N. Hofer, Pharm.D., ASHP Advantage’s director of scientific projects. “In choosing mentors, we focused on their expertise,” she said. “These faculty have either been involved in VTE prophylaxis at their own hospitals, have experience with similar programs, or are known for sharing their knowledge.”

Tailored Partnerships

Each participating hospital has different needs, and the recommendations they receive vary as much as the hospitals themselves. At the suggestion of initiative faculty, the focus at Baylor Medical Center in Waxahachie, Tex., is shifting from a “two-bucket” system, in which a patient is considered either low or high risk, to a “three-bucket” system that includes moderate risk, said Donna Drain, Pharm.D., clinical pharmacist.

Initiative faculty also prompted Waxahachie’s staff to revisit its risk- assessment procedures.

“The mentors were intuitive about that,” said Drain. “For years, we concentrated risk assessment within a few hours of admission, but the mentors asked us how we reassess when a patient changes level of care, like from surgery to ICU. It was an ‘aha’ moment.”

A third suggestion was to home in on the quality of VTE prophylaxis, as opposed to the quantity.

“That hit home with me,” Drain said. “As clinical pharmacists, we can get caught up on numbers. We’ll say that we are providing prophylaxis 72, 80, or 90 percent of the time, but we aren’t stepping back and saying, ‘Are we caring for Mr. Green? Are we there for Mrs. Jones?’”

At West Virginia University Hospitals, mentor recommendations swung in the other direction.

“We’d been sharing our VTE efforts with nursing units, but trying to attribute outcomes back to different units was difficult,” said Frank Briggs, Pharm.D., CACP, director, Center for Quality Outcomes. “Now, rather than look at which unit did what, we look instead at the percentage of patients who receive pharmacological prophylaxis.”

The focus changed as a result of mentor review, Briggs added. “We saw that we were overrelying on mechanical prophylaxis,” he said. “[The mentors] really drilled down into that and got us to look at ways of improving pharmacologic prophylaxis. We found that if you want to drive pharmacologic prophylaxis, then you have to report its use.”

VTE Initiative faculty member Gregory A. Maynard, M.D., M.S., FHM, chief, Division of Hospital Medicine, University of California, San Diego

Identifying Communication Gaps

The team at Sharp Grossmont Hospital in La Mesa, Calif., is incorporating suggestions from initiative faculty members Gregory A. Maynard, M.D., M.S., FHM, chief, Division of Hospital Medicine, University of California, San Diego, and Zachary A. Stacy, Pharm.D., BCPS, associate professor of pharmacy practice, St. Louis College of Pharmacy, into efforts to revamp its ordering system.

“After meeting with Dr. Maynard and Dr. Stacy, we found that we may have undermined our efforts at VTE prevention by utilizing a complicated point-based system,” said Electa Stern, Pharm.D., pharmacy clinical supervisor. “We also failed to associate the list of risk factors with the preferred pharmacological options.”

Maynard also shared a real-time measurement tool that utilizes a color-coded dashboard: Patients who have no VTE prophylaxis are in the red zone, those with only mechanical prophylaxis are in the yellow zone, and those who have pharmacological prophylaxis are in the green zone.

%%sidebar%%Stern said that the first priority is to minimize the number of patients in the red zone. A standardized nursing procedure will allow nurses to start mechanical prophylaxis in at-risk patients found to be without any prophylaxis. The new tool consolidates risk into two pools, low versus moderate/high, as well as defines risk factors to help prescribers choose appropriate therapy.

Stern notes the practicality of the advice her team has received. “These are simple ideas” she said, “but that’s why they are so exciting: They should be easy
to implement.”

1. Goldhaber SZ. Pulmonary embolism.N Engl J Med. 1998;339:93–104.
2. An educational grant from Ortho-McNeil, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc., administered by Ortho-McNeil Janssen Scientific Affairs, LLC., allows hospitals to participate in the program for free.

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September 28, 2010

Fauquier Health Reveals the True Meaning of Teamwork

Filed under: End Notes — Tags: , , , , , , , , , , — editor @ 10:28 am

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.%%sidebar%%

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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June 1, 2010

Pharmacists Adopt Simple Tobacco-Cessation Tools

Filed under: End Notes — Tags: , , , , , , , , , , , , , , , , , , — admin @ 2:20 am

ROUGHLY ONE IN FIVE ADULTS in the U.S. uses tobacco products, according to the Centers for Disease Control and Prevention. That figure represents a tremendous opportunity for pharmacists to provide tobacco cessation counseling that can save lives, an opportunity not lost on the profession as a whole.

Karen S. Hudmon, Dr.Ph.

Indeed, roughly 85 percent of pharmacy schools train their students in techniques to help patients stop using tobacco products through Rx for Change, a shared curriculum being disseminated by the University of California-San Francisco Schools of Pharmacy and Medicine and promoted by the ASHP-supported Pharmacy Partnership for Tobacco Cessation (PPTC).

Initiating the Discussion
One of the most useful techniques featured in Rx for Change is a brief intervention called Ask-Advise-Refer (AAR). Using this intervention, pharmacists can ask patients about tobacco use, advise them to quit, and refer them to 1-800-QUIT NOW, a national quitline that connects to counselors located in each patient’s state.

“In many cases, it’s unrealistic for pharmacists to provide comprehensive counseling, from start to finish, so we are also promoting an approach where the pharmacist is the initiator of the quitting process,” said Frank M. Vitale, M.A., national director of PPTC and senior lecturer, pharmaceutical sciences, University of Pittsburgh School of Pharmacy.

“Most people have no idea how to quit,” Vitale adds. “They don’t understand that it’s more than just making yourself stop. So, pharmacists’ referring is a huge intervention because it gets people thinking about actual steps to take.”

Hospital and health-system pharmacists have unique opportunities to help change the tobacco-related behaviors of patients within their care, according to Karen S. Hudmon, associate professor in the Department of Pharmacy Practice at Purdue University, Indianapolis. Hudmon, along with her colleagues at UCSF, developed the Rx for Change curriculum.

“Any pharmacist who has contact with the patient has an opportunity,” she said. “Tobacco use should be addressed with all patients, including, but not limited to, cardiac patients, pulmonary patients, cancer patients, pregnant women, patients with mental illness, and patients undergoing surgery.”

Hudmon noted that hearing about tobacco cessation from a pharmacist reinforces what physicians have already tried to impart. “Studies show that people are more likely to quit when they hear the message through multiple providers,” she said.

A Touchy Subject
One of the challenges of using AAR is getting through the first step—asking a patient if he or she smokes or uses tobacco.

“In clinics, nurses tend to ask because it’s a routine part of their job,” said Alan J. Zillich, Pharm.D., associate professor in the Department of Pharmacy Practice at Purdue and research scientist at the Roudebush Veterans Administration Medical Center in Indianapolis. “But it’s not something that pharmacists have traditionally done, so there isn’t necessarily a routine for incorporating it into our patient interactions.”

Sometimes, the ability to conduct outreach comes down to a simple matter of personal comfort. “There’s a reluctance particular to community pharmacy when it comes to asking people about their tobacco use,” said Zillich. “But if you don’t ask, you can’t help patients quit.”

The approach should always be respectful of the patient, said Hudmon. “Before asking questions about smoking or imparting advice, ask for permission to do so. ‘Do you mind if I ask you a few questions?’ and ‘May I tell you what concerns me [about your smoking]?’ ”

Vitale added that pharmacists often have a ready-made reason for asking: namely, drug interactions. “In training students and clinicians, we provide them with a list of medications known to interact with smoking,” he said. “If a patient is taking a medication that is on the list, that’s a perfect opportunity to start the conversation.”

Vitale, who has counseled more than 15,000 patients about smoking cessation, said that he finds a common theme among tobacco users. “You discover very quickly that most smokers hate it and want to stop,” he said. “But many have that little voice that wants them to find an excuse to continue. If you, as a health professional, don’t say anything, you could be providing them with that excuse to continue.”

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April 9, 2010

Preventing DVT Helps Patients and Bottom Lines

Filed under: End Notes — Tags: , , , , , , , , , , , , , , — admin @ 11:34 am

PHARMACISTS LYNDA THOMAS, Pharm.D., CACP, and Michael Palladino, Pharm.D., are part of a new wave of clinical specialists who oversee patients’ anticoagulation therapy post surgery.

Michael Palladino, Pharm.D., inpatient anticoagulation coordinator of the Jefferson Center for Vascular Diseases, speaks with a patient about the importance of DVT prevention.

They help ensure that orthopedic surgery patients don’t develop deep vein thrombosis (DVT), a potentially dangerous and often preventable condition common among orthopedic surgery patients. The best defense against DVT, anticoagulant therapy also comes with inherent risks. Leaders at Thomas Jefferson University (TJU) Hospital in Philadelphia see pharmacists as best equipped to keep patients safe post surgery.

“Warfarin is one of the top 10 drugs for medical errors,” noted Thomson, inpatient anticoagulation coordinator of the Jefferson

Center for Vascular Diseases, Thomas Jefferson University (TJU) Hospital in Philadelphia. TJU Hospital performs some 3,000 joint surgeries each year.

A New Wave

The pharmacists at TJU help to ensure that a new wave of clinical specialists who oversee patients’ anticoagulation therapy post surgery and help to ensure patients discharged on warfarin and other blood thinners transition safely home. Preventing adverse events and readmissions are key parts of their jobs.

“It’s an excellent chance for pharmacists to demonstrate the value and the return on investment from implementing these clinical services,” said Cynthia Reilly, B.S. Pharm., director of ASHP’s Practice Development Division.

Pharmacists Key to Prevention

Palladino, who is coordinator of the center’s orthopedic anticoagulation program, and Thomson focus on patient and family education around high-risk medications such  as warfarin and other bloodthinners. Their efforts helped TJU meet recent Joint Commission requirements around patient education for anticoagulant therapy.

In working with patients directly, “we’re first asking questions of the patient to get important information,” Palladino said. He added that pharmacists are best positioned to spot possible risks for each patient and to determine the drug and dose to prescribe to avoid bleeding complications or other risks.

TJU Hospital has instituted a computerized physician-order entry system, with automatic order sets prompting prescribers to assess each surgical patient for bleeding complications before offering appropriate prophylaxis anticoagulant options based on the patient’s risk.

“It’s an educational tool, as well as an order set,” Palladino said.

The pharmacists then work with patients to help them understand their medicines, the importance of follow-up monitoring, adherence, and drug-food interactions, and the potential for adverse drug reactions and drug interactions. Time is also spent calling health plans to advocate for patient needs, such as coverage for certain drugs or equipment.

Pharmacists also oversee proper care transitions for patients, scheduling labs and arranging for home health services. For the latter, pharmacists call each patient twice a week for six weeks post discharge to answer questions and ensure that each patient’s recovery goes smoothly.

“We’re transitioning patients back to the primary care physician,” said Thomson, adding that surgeons appreciate the help.

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