Including pharmacists in hospital rounds receives high endorsement
Including pharmacists in hospital rounds receives high endorsement
President Obama speaks of role of PharmDnm
[Editor's note: This is the first part of a series of articles about the major changes underway in hospital pharmacy practice in the 21st century, including a cover story in this issue about how the model of hospital pharmacists participating in patient care teams and rounds is promoted by President Barack Obama as an "island of excellence." Other stories include a look at how one hospital prepared for a transition to a decentralized pharmacy and suggestions on how to prepare staff for the change. In the September issue of Drug Formulary Review, there will be additional stories about how a hospital with long-term planning for transition to clinical pharmacy care has become a model for the industry and how pharmacists may best be part of medical management therapy.]
As the U.S. Congress and President Barack Obama debate and work on changing our country's health care system to provide more universal coverage and better safety and economic outcomes, hospital pharmacists might move further to the foreground of the new patient care team model.
At the American Medical Association (AMA) House of Delegates meeting in mid-June, 2009, Obama said that pharmacists' participation on multidisciplinary rounds is an island of excellence that should become a standard in health care.
"From our standpoint, we're pretty excited the president made these comments," says David Chen, RPh, MBA, director of pharmacy practice section of the American Society of Health-System Pharmacists (ASHP) of Bethesda, MD.
"When you look at ASHP and pharmacy leaders in the community, it's pharmacists in multidisciplinary teams where you've seen the centers for excellence," Chen says. Multidisciplinary teams' excellence includes a group of patient care leaders at the bedside, where each member of the team brings his or her own expertise, he adds.
"For the team to be efficient, you need to have a pharmacist as part of that group," Chen says.
Some hospitals — both large and small — have been moving in the direction of a decentralized model that includes pharmacists on patient care units and in medical teams. This often includes making rounds with physicians, residents, and other health care providers.
For example, The Medical Center of Columbus, GA, which is part of the Columbus Regional Healthcare System, has been moving in this direction for more than 20 years, says Burnis Breland, MS, PharmD, FASHP, director of pharmacy.
The licensed 413-bed acute care, teaching, nonprofit community medical center has a pharmacy staff of nearly 100 full-time employees, including pharmacists and pharmacy technicians.
When Breland became the hospital's director of pharmacy in 1984, he brought with his PharmD training — he was the third person in Mississippi to earn the degree — a desire to build the clinical program.
"We started building a good clinical program that has evolved over the last 20 years," Breland says. "Our structure, practice model is where we have pharmacists in all patient care areas, working collaboratively with physicians, nurses, respiratory therapists, and all clinicians."
The goal is for pharmacists to optimize medication therapy by improving safety, effectiveness, and outcomes, he adds.
"Pharmacists have responsibility for individual patients, and every patient has a pharmacist who is overseeing his drug therapy," Breland says.
The transition to a clinical care role for pharmacists can be difficult for those who were trained before pharmacy schools offered much training in clinical care, and it can be expensive — at least initially — for hospitals. But some hospital pharmacists agree with the president's assessment that this is the way of the future.
"When you look at national patient safety goals, there are so many aspects of those that pharmacists can influence," says Jennifer E. Tryon, PharmD, MS, an assistant director of pharmacy at Oregon Health & Science University hospital and clinic in Portland, OR.
"This is true of CMS [Centers of Medicare & Medicaid Services] core measures, as well," Tryon says.
"The next 20 years could be an era when pharmacists are integrated into the larger health system," says Jon Schommer, PhD, professor in the University of Minnesota College of Pharmacy in Minneapolis, MN. Schommer has researched pharmacist-provided medication therapy management and other aspects of pharmacy and health care.
Pharmacists are needed to resolve drug therapy problems and keep health systems updated on new therapeutic categories, Schommer says.
Both community and hospital pharmacists will increasingly become involved in medication therapy management as payers and others recognize the positive clinical and financial outcomes of this model, he adds.
"There's an opportunity now that pharmacists have been recognized by Medicare, Part D, and are listed as a preferred provider for doing medication therapy management," Schommer says. "Study after study shows its value."
Also, hospital pharmacists increasingly will have a bigger role in meeting with patients face-to-face, as well as in consulting with physicians and nurses and being proactive in patient medication therapy, Tryon says.
For instance, the Oregon Health & Science University hospital will complete a decentralized pharmacy transition by the end of this year, Tryon notes.
The hospital is transitioning toward a goal of having all pharmacists provide direct patient care, serve on teams with physicians and nurses, and provide clinical services seven days a week with 24-hour coverage, she says.
"We feel like we can improve patient outcomes and optimize therapy and help with the education piece while improving patient care," Tryon says. "And doing that one shift a day isn't enough."
The goal is to have clinical services 24 hours a day, seven days a week, she adds.
"We're moving to evenings and, over time, if we can show the impact, we can continue to expand that to overnight coverage, as well," Tryon says.
Pharmacists will continue to work at the central pharmacy, but that will only be a minority of their work time.
"Everyone will be up on the unit, spending time with patients, and they'll have a rotation through the central pharmacy, but that will be a very minimal part," Tryon says.
This is no small change, and the hospital leadership has recognized that the transition will be difficult.
"Instead of having a pharmacist being somebody located at a different location in the hospital, you now are the face of the pharmacy, and you're one of the front-line providers," Tryon says. "That's a big change for a lot of our pharmacists, who have worked the majority of their careers in central pharmacy."
It's been challenging to obtain acceptance from some of the pharmacy staff, she notes.
"More of the anxiety is from pharmacists who when they went through school, clinical pharmacy wasn't something they knew about," Tryon says. "They didn't have classes in it or rotations in it."
For instance, one hospital pharmacist noted that kinetics were components of another class, whereas for younger pharmacists kinetics was an entire class by itself, she adds.
"It's a change in curriculum and in how pharmacists were changed," Tryon says. "So now that we're merging two groups, a big piece for central pharmacists is what is the role of the clinical pharmacist? What are the daily activities? What can I do to be effective?"
ASHP has created a new pharmacy practice model initiative that is intended to lead the way for hospital pharmacists.
"It's to create a vision about how to advance the pharmacy practice model, involving the role of pharmacist in direct patient care," Chen says. "This includes taking into account the information technology advances and continuing to utilize pharmacists for what their skills are best used for, such as medication management and being part of an interdisciplinary team."
Hospital pharmacy practice is changing, and ASHP and its pharmacy practice model initiative are supporting the transition, he notes.
"We envision pharmacies and pharmacy practice to meet the growing need for medication therapy," Chen explains. "Medication therapy experts will be an integral part of all decision-making in hospitals, from the bedside level in minute-by-minute caring for patients, to the administrative level in making macro decisions in how hospitals are approached for patient care."
This type of model is a cost-effective, safe, and efficient way to take care of the hospital's patient population, he adds.
[Editor's note: This is the first part of a series of articles about the major changes underway in hospital pharmacy practice in the 21st century, including a cover story in this issue about how the model of hospital pharmacists participating in patient care teams and rounds is promoted by President Barack Obama as an "island of excellence." Other stories include a look at how one hospital prepared for a transition to a decentralized pharmacy and suggestions on how to prepare staff for the change. In the September issue of Drug Formulary Review, there will be additional stories about how a hospital with long-term planning for transition to clinical pharmacy care has become a model for the industry and how pharmacists may best be part of medical management therapy.]Subscribe Now for Access
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