Pharmacy saves jobs, boosts staff image
Pharmacy saves jobs, boosts staff image
Show clinical value to peers
With bean-counters having a large say at most hospitals, pharmacy department heads increasingly must prove they use their personnel or risk losing them. Faced with such a threat, pharmacy administrators at the University of Iowa Hospitals and Health Clinics in Iowa City, undertook a plan to show the cost-cutters that the pharmacy department not only provided a needed service, but actually saved the hospital money.
Kevin Bebout, BS, assistant to the director of pharmaceutical care, says the hospital’s budget restructuring plan called for $65 million in savings by the turn of the century. "It was incumbent on us to try to beef up our cost-containment strategy and to show the value clinical pharmacy services provided to forestall potential downsizing."
With a "very strong" drug use evaluation program already in place, Bebout says it was important others knew about it. To accomplish this goal, the pharmacists document all interactions among health care staff, the patient, and the pharmacist that relate to drugs. Since 1994, the program has clocked 50,000 interactions.
An internal committee of six to eight pharmacists and departmental administrators reviews a daily report of these interactions, looking for ways to cut costs or improve patient care. For example, if a doctor prescribes one medication and a less expensive one would accomplish the same result, the pharmacist will recommend the change. If such a change was recommended, but not implemented, the pharmacist will follow up with the doctor to find out why.
Or, if a patient is receiving chemotherapy, the pharmacists will check with the clinicians to make sure he is receiving the appropriate supportive therapy, such as medication to control pain. After reviewing these interactions, the committee then sends its recommendations to the appropriate pharmacist for follow up, Bebout says.
Taking a proactive stance
"We are proactive," Bebout says. "First and foremost, it’s a review of patient care. We are making sure to close the loop on pending [issues]."
Antibiotics are a big area for savings, where his department also limits the prescription of certain drugs to keep costs low and improve patient care.
For example, pharmacists monitor certain antibiotics to prevent the development of antibiotic-resistant bacteria, a growing concern. A doctor who prescribes these restricted medications must turn in paperwork explaining why he or she chose that particular drug in lieu of another, less restricted drug. The doctor must provide in writing a clinical reason for prescribing the controlled antibiotic.
"If he says he just feels comfortable with it, we won’t approve," Bebout says. "There must be a legitimate clinical reason for prescribing it."
If the doctor doesn’t agree to prescribe an alternate drug, the pharmacist will seek permission from a higher authority to overrule the doctor. Also, if the doctor misses the 24-hour paperwork deadline, the pharmacist is authorized to discontinue therapy.
"I’m not saying we do that all the time," Bebout says. "It really hasn’t been a big problem. But we need to have these protocols to make sure therapy is used appropriately."
Substantial payoff for pharmacy involvement
Between mid-1994 and early 1996, the department made 4,648 recommendations to a prescriber. Of these, 87%, or 4,050, were accepted by the prescriber. The interventions, such as switching to a cheaper but equally effective medication, avoided $158,500 in direct costs.
Bebout adds that in some cases, pharmacists recommended a more expensive therapy, but the resulting outcome was a reduced length of stay. When calculating these related cost savings, the avoided cost grows to a total of $487,000.
Since the hospital began its restructuring plan 21¼2 years ago, the department has lost 17 full-time-equivalent employees, all through attrition. Bebout says that without the proof of the effectiveness of the DUE program, the total would be higher.
"I felt it would have been a lot worse," Bebout explains. "But we’re showing our staff are out there doing the right kind of things in the right kind of manner. We’re providing a valuable service."
To ensure the DUE program is effective, the department established a new performance assessment system. The old system assessed vague attributes such as professional demeanor and punctuality. The new system addresses the skills and behaviors needed to accomplish the goals, including the ability to identify and resolve problems, the skill to communicate and document effectively, and the desire to keep up with industry developments.
"We want to know if they’re doing the job they were hired to do," Bebout says. "If they’re not, we’ll bring in someone who will."
While it’s too early to gauge the success of the new performance evaluation system, it’s already had one positive effect on employee education: Since it went into place, more pharmacists than ever are participating in CE credit programs held in-house, Bebout says.
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