“Doing more with less” has become the new standard practice for hospitals and health systems. At the same time, clinical teams and staff are held increasingly responsible for improving the quality of care, outcomes and the patient experience.
The hospital pharmacy in particular has adopted a wider range of responsibilities since the advent of the Affordable Care Act, according to Kelly Morrison, Director Remote Pharmacy Services, at Dublin, Ohio-based Cardinal Health.
“There’s an increased need for pharmacy-led clinical programs to drive cost-saving initiatives, reduce readmission rates and increase patient satisfaction,” Ms. Morrison said during a July 20 webinar sponsored by Cardinal Health. “And we also know that pharmacy personnel and project budgets are flat, despite hospital administration expectations.”
Pharmacists are playing increasingly important roles in various system wide initiatives, including the implementation of meaningful use technologies such as computerized physician order entry and medication reconciliation programs. They are also becoming highly involved in carrying out transitions of care programs to help reduce readmissions, among other strategic objectives.
However, as pharmacists emerge as critical players in several new areas, it’s critical to ensure their participation in these initiatives doesn’t compromise their core responsibility: effective medication order review. Under guidelines from CMS, state boards and accreditation organizations, hospital pharmacists must clinically review all non-emergent medication orders prospectively before they are administered to patients to maximize patient safety and reduce adverse drug events.
Previously, small hospitals or those that lacked pharmacy staff during the night shift most commonly turned to RPS for support. Large hospitals and health systems, which until recently maintained highly efficient pharmacies on their own, generally did not need to supplement pharmacy staff. However, now hospitals of all types — large and small, urban and rural — are finding RPS to be an invaluable asset.
RPS: A short- or long-term solution
When onsite pharmacists are redeployed from order entry to assist with strategic projects and clinical initiatives, remote pharmacists can fill the gaps, ensuring medication orders are reviewed thoroughly and in a timely manner.
With supplemental help from RPS, hospital pharmacists can more effectively manage their workload, reduce order review entry times — especially during peak hours — and provide nursing and technician supervision.
A case study
Two leading hospitals in Boston — Brigham and Women’s Hospital and Massachusetts General Hospital — sought a partner to provide supplemental support during their conversion to the EPIC CPOE system. While both hospitals have 24/7 pharmacies, they realized they would need help managing the increased workload during the technology cutover as well as post-conversion, according to Ms. Morrison.
Brigham and Women’s, Massachusetts General and their selected partner, Cardinal Health, developed a multi-phase solution to prepare and manage the transition to EPIC..
While many hospitals enlist RPS support prior to CPOE cutover to cover pharmacist shortages during system training — which can result in shortages of 30 percent, on average — Brigham and Women’s and Massachusetts General decided to deploy RPS to help with the cutover and the transition period after CPOE implementation. This is because the hospitals had been using a proprietary pharmacy system, and therefore decided they would benefit most from the support of RPS after the conversion to the EPIC system.
In the first phase of the CPOE implementation, 10 Cardinal Health pharmacists actually went onsite for 24 hours to assist in the transfer of existing medication orders.
“These two hospitals found this very helpful because during the cutover, the volume of orders that needed to be processed was so significant,” said Ms. Morrison. “The onsite team was supplemented by remote teams so as questions arose or clinical interventions came up, they could be handled efficiently.”
“During that cutover period, about 40 percent of the hospital’s pharmacy workforce came from the remote supplemental team,” Ms. Morrison added.
Brigham & Women’s Hospital initially planned to retain partnership with Cardinal Health RPS for four months post-CPOE in the second phase of the implementation, during which time the remote team would process approximately 30,000-plus line orders per month. They extended RPS because there is a learning curve for onsite pharmacy staff as they become acclimated to the new system while continuing to play a larger role in various system wide clinical initiatives. Ultimately, Brigham & Women’s retained the Cardinal Health RPS for a total of 11 months post-CPOE to provide supplemental help. Massachusetts General Hospital retained RPS for four months post conversion with the RPS team processing 70,000+ line orders per month.
“If you’re approaching a CPOE conversion or implementing medical reconciliation technology, it is always good to know upfront that once you get to the cutover, you may continue to need supplemental help,” said Ms. Morrison. “It’s important to continuously evaluate the length of time you will need supplemental support. You may make an initial assumption, but be open to the possibility that these plans could change.”
The more responsibilities pharmacists obtain — be it assisting with the implementation of new technology systems or guiding strategic clinical initiatives — the greater the need for additional support. Strategic partners like Cardinal Health enable hospitals to enlist as many or as few pharmacists as needed, with room to scale up or down to meet the demands of various initiatives.