Hospitals tracking intervention data find huge cost avoidance, savings
Hospitals tracking intervention data find huge cost avoidance, savings
Some use information to lobby for new PharmDs
Hospital systems traditionally have been unaware of the financial benefits of having clinical pharmacists providing care interventions. Everyone has agreed there are safety and quality improvement advantages to dedicating resources to clinical pharmacy salaries, but the cost savings were overlooked.
Well now new information technology (IT) advances make it far easier for hospitals to gather information and compare costs where medication interventions are concerned.
Pharmacists can collect data about patients' prescriptions, errors, adverse events, and interventions performed to prevent problems in a database that can analyze both aggregate and individual information.
The Bon Secours Health System uses Quantifi by Pharmacy OneSource to track these data across 14 hospitals, says Carol Carson, PharmD, BCPS, clinical pharmacy specialist at Bon Secours Maryview Medical Center in Portsmouth, VA. Carson also is the system administrator for Quantifi in 14 hospitals in six Eastern states.
Quantifi is a web-based management software tool that collects medication and pharmacy data and assigns dollar value to both actual cost savings and averted expenses. It is used by more than 800 hospitals in the United States.
The IT program tracked how the hospital system saved more than $2.2 million in 2008, most of which was cost avoidance savings, Carson says.
"We did 34,066 interventions for 2008 and logged 6,634 hours of pharmacist time," she adds.
The top medication interventions by volume were vancomycin, warfarin, TPN or PPN, levofloxacin, pantoprazole, enoxaparin, piperacillin and tazobactam sodium, moxifloxacin, gentamicin, and lansoprazole. (See chart of aggregate pharmacy clinical interventions data.)
The program can track medication management and other data in a variety of ways, depending on what a hospital system wants to track.
For example, the Bon Secours Health System collects data by intervention type, showing a dollar amount that is saved per intervention and how much time the intervention takes, Carson says.
So the long list of interventions for any month might include these types of notes:
- CHEMOTHERAPY: order clarified OR dose changed;
- CHEMOTHERAPY: double check;
- CHEMOTHERAPY: drug held due to labs;
- CLARIFICATION: bad handwriting;
- CLARIFICATION: drug-dose-frequency-duration;
- DOSING/MONITORING: anticoagulants;
- DOSING/MONITORING: Aminoglycosides.
It would be impractical, maybe impossible, for pharmacists to track every intervention they do, Carson notes.
"If they were to document everything they do they'd have to keep a scribe with them all day," she says.
So pharmacists make certain they document all interventions that help improve safety or that pertain to specific hospital programs, such as antimicrobial stewardship, Carson adds.
"They know I read every single intervention relating to safety, so they're sure to get that in," she says.
Aggregate analyses can include financial data that can be used to justify clinical pharmacy resources and to market for additional resources.
Hospital pharmacy directors need hard data to show why clinical pharmacy services are financially essential, as well as important for safety and quality control purposes, experts say.
St. John Medical Center in Tulsa, OK, began using Quantifi four years ago, and within one year the pharmacy department had justified adding two more positions, says Mark Mills, PharmD, BCPS, clinical coordinator of St. John Medical Center.
"We took those numbers to our administration and said, 'If we had two, more FTEs we could produce this much more,'" Mills recalls.
One of the new positions was for a clinical pharmacist-surgery, who would help improve antibiotic prophylaxis management in surgery.
The hospital already had a clinical pharmacist who assisted with critical care patients in the intensive care unit, Mills says.
The hospital has about 100 surgeries per day, and its data suggested there were a significant number of cases in which antibiotics were continued after 72 hours, when they should have been discontinued, he explains.
So pharmacy leaders made the case that the new clinical pharmacist in surgery would prevent inappropriate use of antibiotics and have both actual cost savings and cost avoidance savings.
"We've definitely justified that position," Mills says. "What's nice about [the software program] is you can make your own interventions and label them."
New York Hospital Queens in Flushing, NY, uses Quantifi and Pharmacy OneSource's new Sentri7 systems to track and target specific medications and problem areas, says Alex Melchert, MS, RPh, director of pharmacy at New York Hospital Queens in Flushing, NY.
"We're finding that the majority of errors we're seeing include narcotics, analgesics, including morphine," Melchert says.
So the hospital has established changes that help reduce these errors, he adds.
"We've looked at the information in various ways to see if we have a problem with a particular service," Melchert says. "We look at particular floors, individual drugs, and drug classes."
The electronic medication management system made it easy to comply with the Joint Commission's national patient safety goals regarding anticoagulation programs, he adds.
Electronic management and tracking systems also save time and money.
Melchert has calculated the hospital saves 80 clinical pharmacist hours per week through use of the electronic medication management system.
All of these benefits are important marketing points when pharmacy directors speak with hospital leaders about increasing or justifying clinical pharmacy resources.
"The profession of pharmacy has always given away their cognitive services for free, and they don't have methods to bill for cognitive services," says Charles Westergard, BsPharm, MBA, vice president of clinical affairs of Pharmacy OneSource Inc. of Bellevue, WA. Westergard is a co-founder of Pharmacy OneSource, which was begun in 2000 with Quantifi as its flagship product.
So in the traditional hospital, the pharmacist's cognitive services were undervalued.
Westergard recalls a moment when this reality hit home at a hospital in which he was a staff pharmacist: "We installed a Pyxis, automatic dispensing machine, and pharmacists were not involved in the process which moved distribution away from pharmacists to technicians," Westergard says.
"One day our chief operating officer came down and said, 'Hey, it's great you're getting all these drugs to the patient, and we love the machines, but what are your pharmacists doing now?'" he says. "That was a tough question to answer because all we could say was 'We're doing really great stuff,' and that wasn't good enough for him."
The chief operating officer wanted the pharmacy to justify the clinical programs that were in place, and the pharmacy couldn't do it because they weren't documenting how they made a difference in the hospital, Westergard adds.
"A lot of pharmacies face that problem around the country, and that's what led me to document what we do and assign a value to it," he says.
The Greenville Hospital System in Greenville, SC, began to use Quantifi several years ago with the main objective of capturing workload statistics and productivity of staff pharmacists, as well as the cost savings associated with pharmacists' activities, says Lynn Ethridge, PharmD, manager of pharmacy informatics at the Greenville Hospital System, which has about 1,100 beds, five campuses, and roughly 50 pharmacists.
Hospital leaders and pharmacy managers initially were surprised by the early data: "We were overwhelmed by how much our pharmacists were doing," Ethridge says.
"We didn't have any idea of how many medication errors were being prevented and how much work pharmacists were actually doing," she adds. "We were blown away with the data."
The software made it easier for the hospital to start warfarin monitoring as part of a national patient safety goal.
"We had warfarin anyway as an intervention, but when we tracked and trended what we were doing before it became mandatory in January, the numbers went through the roof," Ethridge says. "We wanted to show the administration what the staff is doing from a productivity standpoint."
And it gets administrators' attention when they're shown hard dollar savings, she adds.
"On average, we're saving the institution roughly more than $500,000 a month," Ethridge says. "So the administration likes to see that."
When pharmacists make certain patients receive the correct dose of a drug, there are potential overdoses that are avoided and there's a savings from reduced frequency of medication administration, she explains.
"We count all that as cost savings because the pharmacy tends to get [more accurate] drug levels than prescribers do, and that overall saves the institution money and improves patient outcomes, reducing length of stay," Ethridge says.
Bon Secours Maryview has an anticoagulation monitoring service in which pharmacists catch errors, such as drugs dosed incorrectly for the patient's weight, Carson says.
Much to Carson's surprise, patient weights ended up being a top intervention according to the electronic management system data.
"I was really surprised to see the top intervention we had throughout the system was the lack of proper weight evaluation on patients," Carson says.
The problem involved unit secretaries entering patient information and not always having an accurate patient weight, she explains.
If a patient were to be prescribed medication based on that incorrect weight, there could be an adverse event. The interventions occurred when pharmacists checked the orders and patients' weights and saw a problem that could be averted by having nurses weigh the patient and obtain the proper numbers, Carson says.
"We estimated we saved $250,000 just on that one intervention in cost avoidance savings," Carson says. "These included interventions in which the pharmacist clarified the weight before dosing and found it was wrong, or when the weight wasn't listed and the pharmacist obtained it."
Hospital systems traditionally have been unaware of the financial benefits of having clinical pharmacists providing care interventions. Everyone has agreed there are safety and quality improvement advantages to dedicating resources to clinical pharmacy salaries, but the cost savings were overlooked.Subscribe Now for Access
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