Implementation of an Advanced Pharmacy Practice Model in the Emergency Department

2019 ◽  
Vol 33 (4) ◽  
pp. 481-490
Author(s):  
Billy Sin ◽  
Christine Ciaramella ◽  
Greg Stein ◽  
Shalom Butel ◽  
Holly Thompson ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pharmacy Practice ◽  
Cost Savings ◽  
Direct Patient Care ◽  
Care Practice ◽  
Documentation System ◽  
Practice Model ◽  
Study Objective ◽  
Effective Use ◽  
The Impact

Study Objective The objective of this retrospective descriptive study was to quantify clinical activities performed by pharmacists in an advanced pharmacy practice model in the emergency department (ED). Methods Data from January 2015 to August 2017 extracted from the department of pharmacy’s electronic documentation system and the hospital’s electronic medical record were collected and reviewed. Cost savings was derived from the system with adaptation from the previous literature and had been validated by our institution’s administration as an acceptable reflection of the impact for activity. Results The ED pharmacy team participated in a total of 4106 clinical activities that resulted in a cumulative cost avoidance of $5 387 679. Overall, the most common clinical activities that the pharmacy team provided included pharmacotherapy consult (63.3%) and response to medical emergencies (20.7%). A total of 16 219 medication orders placed by ED clinicians were prospectively reviewed and 379 interventions were accepted by ED clinicians. Turnaround times for medication verification in median (interquartile range [IQR]) for 2015, 2016, and 2017 were 2 minutes (1-6 minutes), 3 minutes (1-6 minutes), and 2 minutes (1-5 minutes), respectively. A total of 14 peer-reviewed publications, primarily based on pharmacy practice or use of pharmacotherapy for acute pain, were published by a research program led by the ED pharmacotherapist. Conclusion We created and implemented an advanced practice model tailored to our institution’s needs. The model maximized opportunities for pharmacists to provide direct patient care, practice at the top of their license, and encouraged the safe and effective use of medications.

Redesigning the clinical pharmacy practice model at a psychiatric hospital

2015 ◽  
Vol 5 (1) ◽  
pp. 50-56
Author(s):  
Monica Zolezzi ◽  
Ingo Gottstein ◽  
Benjamin Nilsson
Keyword(s):  
Clinical Practice ◽  
Patient Outcomes ◽  
Clinical Pharmacy ◽  
Pharmacy Practice ◽  
Direct Patient Care ◽  
Pharmacy Services ◽  
Practice Model ◽  
Clinical Notes ◽  
Clinical Pharmacy Services ◽  
The Impact

Introduction: Integrated, patient-centered clinical pharmacy services have been shown to improve patient outcomes in a variety of settings, including mental health. In this article, we describe and report the impact of a restructured clinical practice model that incorporated direct patient care by pharmacists implemented at a psychiatric facility in Edmonton, Canada. The purpose of redesigning the clinical pharmacy program was to deliver proactive pharmacist care through integrated clinical pharmacy services and to better align pharmacists' activities with those that have been reported to have a positive impact on patient outcomes. Methods: Pharmacists' documentation notes in medical records for patients admitted and discharged from the hospital at four different time periods were reviewed. For each time period, the number, type, and documentation rate were measured and compared using a Student t test with correction for unequal variances. Significant change was defined as P < .05. Documentation rates were also compared for short-stay versus long-stay patients. Results: A consistent and statistically significant increase was found in pharmacists' clinical notes per chart from 0.15 to 1.5 (P < .001) after implementation of the redesigned clinical practice model. The proportion of clinical notes also increased from 22% in the preimplementation period to up to 68% in the current period. This indicates that pharmacists were spending proportionally more time on proactive versus reactive care. Documentation rates also increased regardless of the patients' length of stay. Discussion: The redesigned clinical practice model enabled a successful transition of the pharmacists' role, from being predominantly reactive to becoming more proactive and integrated.

scholarly journals How space design and technology can support the Pharmacy Practice Model Initiative through interprofessional collaboration

2014 ◽  
Vol 5 (3) ◽  
Author(s):  
Lindsay Hahn ◽  
Martha Buckner ◽  
Georgeann B. Burns ◽  
Debbie Gregory
Keyword(s):  
Patient Outcomes ◽  
Interprofessional Collaboration ◽  
Pharmacy Practice ◽  
Cost Savings ◽  
Pharmacist Intervention ◽  
Direct Patient Care ◽  
Design And Technology ◽  
Bottom Line ◽  
Practice Model ◽  
Space Design

Purpose: The Pharmacy Practice Model Initiative (PPMI) calls pharmacists to more direct patient care and increased responsibility for medication-related outcomes, as a means of achieving greater safety, improving outcomes and reducing costs. This article acknowledges the value of interprofessional collaboration to the PPMI and identifies the implications of the Initiative for space design and technology, both of which stand to help the Initiative gather additional support. Summary: The profession of pharmacy has for some time now become increasingly vocal about its desire to take on greater responsibility for patient outcomes. With drug costs representing the largest portion of a hospital's pharmacy budget and reimbursements becoming more contingent on readmission avoidance, the pharmacy's influence on a hospital's bottom line is significant. More importantly, study after study is showing that with greater pharmacist intervention, patient outcomes improve. This article addresses the ways in which developments in the fields of technology and facility design can assist in the deployment of the PPMI. Conclusion: As the PPMI achieves a critical level of support from inside and outside the pharmacy, and more empirical research emerges regarding the improved outcomes and cost savings of increasing the roles of both clinical pharmacists and pharmacy technicians, the industry sectors of healthcare technology and healthcare design stand ready to assist in the execution of this new model. By encouraging pharmacists, doctors and nurses to work together - and all caregivers to work with facility designers, biomedical engineers and IT specialists, there is the increased likelihood of these fields turning to each other to problem-solve together, all for the ultimate benefit to patients and their families.   Type: Commentary

Evaluation of Targeted Pharmacist Interventions to Reduce Length of Stay in an Acute Care Practice Model

2018 ◽  
Vol 53 (5) ◽  
pp. 471-477 ◽  
Author(s):  
Mary-Haston Leary ◽  
Kathryn Morbitzer ◽  
Bobbi Jo Walston ◽  
Stephen Clark ◽  
Jenna Kaplan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Positive Impact ◽  
Pharmacy Practice ◽  
Care Practice ◽  
Readmission Rates ◽  
A Value ◽  
Pharmacist Interventions ◽  
Semistructured Interviews ◽  
The Impact

Background: Despite widespread recognition of the need for innovative pharmacy practice approaches, the development and implementation of value-based outcomes remains difficult to achieve. Furthermore, gaps in the literature persist because the majority of available literature is retrospective in nature and describes only the clinical impact of pharmacists’ interventions. Objective: Length of stay (LOS) is a clinical outcome metric used to represent efficiency in health care. The objective of this study was to evaluate the impact of pharmacist-driven interventions on LOS in the acute care setting. Methods: A separate samples pretest-posttest design was utilized to compare the effect of pharmacist interventions across 3 practice areas (medicine, hematology/oncology, and pediatrics). Two time periods were evaluated: preimplementation (PRE) and a pilot period, postimplementation of interventions (POST). Interventions included targeted discharge services, such as discharge prescription writing (with provider cosignature). Participating pharmacists completed semistructured interviews following the pilot. Results: A total of 924 patients (466 PRE and 458 POST) were included in the analysis. The median LOS decreased from 4.95 (interquartile range = 3.24-8.5) to 4.12 (2.21-7.96) days from the PRE versus POST groups, respectively ( P < 0.011). There was no difference in readmission rates between groups (21% vs 19.1%, P = 0.7). Interviews revealed several themes, including positive impact on professional development. Conclusion and Relevance: This pilot study demonstrated the ability of pharmacist interventions to reduce LOS. Pharmacists identified time as the primary barrier and acknowledged the importance of leaders prioritizing pharmacists’ responsibilities. This study is novel in targeting LOS, providing a value-based outcome for clinical pharmacy services.

Effects of a hospitalwide pharmacy practice model change on readmission and return to emergency department rates

2014 ◽  
Vol 71 (17) ◽  
pp. 1469-1479 ◽  
Author(s):  
Sammuel V. Anderegg ◽  
Samaneh T. Wilkinson ◽  
Rick J. Couldry ◽  
Dennis W. Grauer ◽  
Eric Howser
Keyword(s):  
Emergency Department ◽  
Pharmacy Practice ◽  
Practice Model

scholarly journals LO56: Novel role of physician navigators on performance indicators in the emergency department

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S47
Author(s):  
A. Leung ◽  
G. Puri ◽  
B. Chen ◽  
Z. Gong ◽  
E. Chan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Patient Care ◽  
Mixed Linear Model ◽  
Primary Objective ◽  
Initial Assessment ◽  
Direct Patient Care ◽  
Healthcare Team ◽  
Left Without Being Seen ◽  
Before And After ◽  
The Impact

Introduction: Burnout rates for emergency physicians (EP) continue to be amongst the highest in medicine. One of the commonly cited sources of stress contributing to disillusionment is bureaucratic tasks that distract EPs from direct patient care in the emergency department (ED). The novel position of Physician Navigator was created to help EPs decrease their non-clinical workload during shifts, and improve productivity. Physician Navigators are non-licensed healthcare team members that assist in activities which are often clerical in nature, but directly impact patient care. This program was implemented at no net-cost to the hospital or healthcare system. Methods: In this retrospective study, 6845 clinical shifts worked by 20 EPs over 39 months from January 1, 2012 to March 31, 2015 were evaluated. The program was implemented on April 1, 2013. The primary objective was to quantify the effect of Physician Navigators on measures of EP productivity: patient seen per hour (Pt/hr), and turn-around-time (TAT) to discharge. Secondary objectives included examining the impact of Physician Navigators on measures of ED throughput for non-resuscitative patients: emergency department length of stay (LOS), physician-initial-assessment times (PIA), and left-without-being-seen rates (LWBS). A mixed linear model was used to evaluate changes in productivity measures between shifts with and without Physician Navigators in a clustered design, by EP. Autoregressive modelling was performed to compare ED throughput metrics before and after the implementation of Physician Navigators for non-resuscitative patients. Results: Across 20 EPs, 2469 shifts before, and 4376 shifts after April 1, 2013 were analyzed. Daily patient volumes increased 8.7% during the period with Physician Navigators. For the EPs who used Physician Navigators, Pt/hr increased by 1.07 patients per hour (0.98 to 1.16, p&lt;0.001), and TAT to discharge decreased by 10.6 minutes (-13.2 to -8.0, p&lt;0.001). After the implementation of the Physician Navigators, overall LOS for non-resuscitative patients decreased by 2.6 minutes (1.0%, p=0.007), and average PIA decreased by 7.4 minutes (12.0%, p&lt;0.001). LBWS rates decreased by 43.9% (0.50% of daily patient volume, p&lt;0.001). Conclusion: The use of a Physician Navigator was associated with increased EP productivity as measured by Pt/hr, and TAT to discharge, and reductions in ED throughput metrics for non-resuscitative patients.

scholarly journals Tech-Check-Tech in Community Pharmacy Practice Settings

2016 ◽  
Vol 33 (2) ◽  
pp. 47-52 ◽  
Author(s):  
Timothy P. Frost ◽  
Alex J. Adams
Keyword(s):  
Community Pharmacy ◽  
Patient Care ◽  
Relevant Literature ◽  
Pharmacy Practice ◽  
Direct Patient Care ◽  
Community Settings ◽  
Practice Model ◽  
Term Care ◽  
Institutional Settings ◽  
Community Pharmacy Practice

Objective: The benefit of a tech-check-tech (TCT) practice model in institutional settings has been well documented. To date, few studies have explored TCT beyond institutional settings. This article summarizes the existing evidence in community pharmacy–based TCT research with respect to dispensing accuracy and pharmacist time devoted to direct patient care. Data Sources: A literature review was conducted using MEDLINE (January 1990 to August 2016), Google Scholar (January 1990 to August 2016), and EMBASE (January 1990 to August 2016) using the terms “tech* and check,” “tech-check-tech,” “checking technician,” and “accuracy checking tech*”. Bibliographies were reviewed to identify additional relevant literature. Study Selection and Data Extraction: Studies were included if they analyzed TCT and were conducted in a community pharmacy practice site, inclusive of chain, independent, mass merchant, supermarket, and mail order pharmacies. Studies were excluded if the TCT practice model was conducted in an institutional or long-term care setting. Survey data on theoretical models of TCT in community pharmacy practice settings were also excluded. Data Synthesis: Over the past 14 years, 4 studies were identified indicating TCT has been performed safely and effectively in community settings. The studies demonstrate that trained community technicians perform as accurately as pharmacists and that TCT increased the amount of pharmacist time devoted to clinical activities. In the 2 studies that reported accuracy rates, pharmacy technicians performed at least as accurately as pharmacists (99.445 vs 99.73%, P = .484; 99.95 vs 99.74, P < .05). Furthermore, 3 of the studies reported gains in pharmacist time, with increases between 9.1% and 19.18% of pharmacist time for consultative services. Conclusions: The present studies demonstrate that TCT can be safe and effective in community pharmacy practice settings, with results similar to those found in institutional settings. It is anticipated more states will explore TCT in community settings in the years ahead as a strategy to improve patient care.

scholarly journals Impact of pharmacist discharge counseling on hospital readmission and emergency department visit

2017 ◽  
Vol 6 (2) ◽  
pp. 68 ◽  
Author(s):  
Tu Tran ◽  
Saijal Khattar ◽  
Tiffany T. Vu ◽  
Maggie Potter ◽  
Jane Hodding ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Readmission ◽  
Community Hospital ◽  
Descriptive Analysis ◽  
Hospital Readmissions ◽  
Outpatient Setting ◽  
Transitions Of Care ◽  
Study Objective ◽  
Entire Cohort ◽  
The Impact

Objective: The enactment of the Affordable Care Act (ACA) in 2010 imposes payment penalty on hospitals with high hospital readmission rates. In an effort to reduce readmissions, a pharmacist discharge counseling program was implemented to facilitate transition of care to the outpatient setting. Our study objective was to evaluate the impact of the program on hospital readmissions and visits to the emergency department (ED).Methods: This was a single-center, retrospective cohort study conducted at a not-for-profit, teaching community hospital with 462 total beds. Pharmacists provided counseling to patients discharged from the medicine floor between November 2013 and January 2014, and included those considered to be high-risk (e.g., taking 5 scheduled medications and had diseases such as congestive heart failure and diabetes mellitus). Descriptive analysis was performed and outcomes were compared between patients who did and did not receive pharmacist counseling.Results: Of a total of 889 discharged patients, 488 (55%) received counseling from a pharmacist. For the entire cohort, mean age was 55 ± 20 years; Charlson Comorbidity Index (CCI) score was 2.74 ± 2.95; and length of hospitalization was 4 ± 4 days. These parameters were not statistically different between the two groups. Within 30-days after hospital discharge, significantly fewer subjects who received counseling, compared with those who did not, were readmitted to the hospital (11.3% vs. 15%, p = .009) or visited the ED (10.6% vs. 15%, p = .005).Conclusions: Discharge counseling provided by pharmacists during transitions of care at a community hospital significantly reduced 30-day readmission and ED visit rates.

scholarly journals The role of patient care workers in private hospitals in the Cape Metropole, South Africa

Curationis ◽  
2017 ◽  
Vol 40 (1) ◽  
Author(s):  
Louise A. Aylward ◽  
Talitha Crowley ◽  
Ethelwynn L. Stellenberg
Keyword(s):  
Patient Care ◽  
Support Staff ◽  
Direct Patient Care ◽  
Private Hospitals ◽  
Direct Supervision ◽  
Nursing Support ◽  
Study Objective ◽  
Care Workers ◽  
The Impact

Background: Nursing managers have to meet expectations of patients despite economic pressures, an increasing burden of disease and nursing shortages. Shifting health care-related tasks to lower categories of staff, including non-nursing support staff, has become one solution to address this dilemma. Patient care workers are a specific group of non-nursing support staff working in South African hospitals. Although patient care workers have been used for several years and their numbers are increasing, there are controversial opinions about the role of patient care workers, ranging from praise for their contribution towards patient care to serious concerns about the impact of their role on patient safety.Objective: The study objective was to explore and describe the role of patient care workers in private hospitals.Methods: A qualitative, descriptive design was applied to explore the role of patient care workers. Purposive sampling was used to select unit managers, nurses and patient care workers from medical and surgical wards of three private hospitals. Fifteen semi-structured interviews were conducted and transcribed verbatim. The researcher applied interpretative data analysis to move from the participants’ descriptions of their experiences to a synthesis of all participants’ descriptions.Results: Patient care workers are involved in direct patient care and spend much time with patients, often not working under direct supervision of registered nurses despite limited training and lack of regulation. Their contribution, however, is valued by nurses.Conclusion: Patient care workers are well-integrated into the patient care team and are mostly seen as nurses. Yet, there are concerns about their evolving role despite their limited training and the lack of direct supervision. Regulating the work of patient care workers is recommended.

Exploring practice site contributions and professionalization impact of engaging student pharmacists on hematology-oncology advanced pharmacy practice experience rotations

2021 ◽  
pp. 107815522098557
Author(s):  
Matthew J Yacobucci ◽  
Christina L Lombardi ◽  
Laurie L Briceland
Keyword(s):  
Patient Care ◽  
Pharmacy Practice ◽  
Healthcare Personnel ◽  
Direct Patient Care ◽  
Self Awareness ◽  
Patient Counseling ◽  
Student Activities ◽  
Self Reflection ◽  
Oncology Practice ◽  
The Impact

Introduction Student pharmacists contribute meaningfully to patient care during Advanced Practice Pharmacy Experiences (APPEs) in varied settings. We aimed to characterize and evaluate the impact of student participation in hematology-oncology (hem-onc) APPEs on the practice site, and on student professionalization. Methods For students completing hem-onc APPEs during 2016–2019, rotation activities and post-APPE self-reflections describing meaningful impact were reviewed; activities were categorized into direct and indirect patient care, and up to three reflection themes of professionalization impact were extracted from each self-reflection. Hem-onc preceptor cohort was surveyed to assess impact of student contributions on the practice site. Results 171 students completed hem-onc APPEs in ambulatory care (133) and/or inpatient (38) settings. Of 932 student-reported activities, the most common were: evaluating patient pharmacotherapy (209), providing education to medical staff (132), patient counseling [non-chemotherapy (99); chemotherapy (82)], and providing drug information (96); 89% involved direct patient care/education. Survey results from 16 of 33 preceptors identified the most impactful student activities as evaluating pharmacotherapy, medication education/adherence resources, and in-service presentations. Of 392 student self-reflections, themes of impact focused on professionalization/self-awareness (39.3%), counseling/communication skills (27.8%), practice skills development (20.4%) and collaborative teamwork (12.5%). Conclusion Pharmacy students make significant direct patient care contributions to hem-onc practice settings by evaluating pharmacotherapy and providing education to patients and healthcare personnel. Participation in hem-onc APPEs is highly influential to the professionalization of students, particularly in developing skills in oncology practice, patient interactions/communications, and developing self-awareness.

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