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

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

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Implementation of an Advanced Pharmacy Practice Model in the Emergency Department

Journal of Pharmacy Practice ◽

10.1177/0897190018819412 ◽

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.

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Redesigning the clinical pharmacy practice model at a psychiatric hospital

Mental Health Clinician ◽

10.9740/mhc.2015.01.050 ◽

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.

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Tech-Check-Tech in Community Pharmacy Practice Settings

Journal of Pharmacy Technology ◽

10.1177/8755122516683519 ◽

2016 ◽

Vol 33 (2) ◽

pp. 47-52 ◽

Cited By ~ 11

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.

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Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: an observational study

BMJ Open ◽

10.1136/bmjopen-2021-052899 ◽

2021 ◽

Vol 11 (12) ◽

pp. e052899

Author(s):

Karen B Lasater ◽

Linda H Aiken ◽

Douglas Sloane ◽

Rachel French ◽

Brendan Martin ◽

...

Keyword(s):

Length Of Stay ◽

Patient Outcomes ◽

Nurse Staffing ◽

Cost Savings ◽

Direct Patient Care ◽

Additional Patient ◽

Staffing Ratios ◽

Lengths Of Stay ◽

Surgical Units ◽

Study Hospital

ObjectiveTo evaluate variation in Illinois hospital nurse staffing ratios and to determine whether higher nurse workloads are associated with mortality and length of stay for patients, and cost outcomes for hospitals.DesignCross-sectional analysis of multiple data sources including a 2020 survey of nurses linked to patient outcomes data.Setting: 87 acute care hospitals in Illinois.Participants210 493 Medicare patients, 65 years and older, who were hospitalised in a study hospital. 1391 registered nurses employed in direct patient care on a medical–surgical unit in a study hospital.Main outcome measuresPrimary outcomes were 30-day mortality and length of stay. Deaths avoided and cost savings to hospitals were predicted based on results from regression estimates if hospitals were to have staffed at a 4:1 ratio during the study period. Cost savings were computed from reductions in lengths of stay using cost-to-charge ratios.ResultsPatient-to-nurse staffing ratios on medical-surgical units ranged from 4.2 to 7.6 (mean=5.4; SD=0.7). After adjusting for hospital and patient characteristics, the odds of 30-day mortality for each patient increased by 16% for each additional patient in the average nurse’s workload (95% CI 1.04 to 1.28; p=0.006). The odds of staying in the hospital a day longer at all intervals increased by 5% for each additional patient in the nurse’s workload (95% CI 1.00 to 1.09, p=0.041). If study hospitals staffed at a 4:1 ratio during the 1-year study period, more than 1595 deaths would have been avoided and hospitals would have collectively saved over $117 million.ConclusionsPatient-to-nurse staffing ratios vary considerably across Illinois hospitals. If nurses in Illinois hospital medical–surgical units cared for no more than four patients each, thousands of deaths could be avoided, and patients would experience shorter lengths of stay, resulting in cost-savings for hospitals.

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Expanding the role of pharmacy technicians to facilitate a proactive pharmacist practice

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxy065 ◽

2019 ◽

Vol 76 (6) ◽

pp. 398-402 ◽

Cited By ~ 5

Author(s):

Brandi Newby

Keyword(s):

Patient Care ◽

Pharmacy Practice ◽

Medication Therapy Management ◽

Direct Patient Care ◽

Order Entry ◽

Practice Model ◽

Therapy Management ◽

Pharmacy Technician ◽

Medication Therapy ◽

Pharmacist Role

Abstract Purpose This study describes a change in pharmacy practice to expand pharmacy technician roles to allow dispensing without a pharmacist check, thereby enhancing the pharmacist role in direct patient care. Summary In an effort to optimize patient care with limited resources, we set out to change our pharmacy practice model. We transferred duties that did not require clinical judgment in the dispensary from the pharmacist to the regulated technician. The transferred roles included order entry, order entry verification, and final check of medications and preparations. The changes in roles were well received by the pharmacy staff. The pharmacist practice changed from a reactive process, where the pharmacist waited for orders to be sent to the pharmacy, to a proactive process where the pharmacist collaborated directly with patients and the health care team. The pharmacists were able to provide daily medication therapy management for every inpatient in the new practice model compared with only reactive targeted care in the former practice model. Implementation of the new practice model at our site led to a reduction in time for medications to be delivered to the patient and reduced pharmacy-related medication errors. Conclusion A new pharmacy practice model was successfully implemented whereby the pharmacy technician roles were expanded to the point where they perform all the distribution roles in the dispensary. This, in turn, allowed a change in the pharmacist role, which was focused on daily proactive direct patient care and medication therapy management.

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The consensus of the Pharmacy Practice Model Summit

American Journal of Health-System Pharmacy ◽

10.2146/ajhp110060 ◽

2011 ◽

Vol 68 (12) ◽

pp. 1148-1152 ◽

Cited By ~ 129

Keyword(s):

Pharmacy Practice ◽

Practice Model

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Proposed guidance on cost-avoidance studies in pharmacy practice

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxab211 ◽

2021 ◽

Author(s):

Asad E Patanwala ◽

Sujita W Narayan ◽

Curtis E Haas ◽

Ivo Abraham ◽

Arthur Sanders ◽

...

Keyword(s):

Clinical Pharmacy ◽

Best Practice ◽

Pharmacoeconomic Analysis ◽

Pharmacy Practice ◽

Cost Savings ◽

Sensitivity Analyses ◽

Cost Assessment ◽

Potential Consequence ◽

Cost Avoidance ◽

Pharmacist Interventions

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Cost-avoidance studies of pharmacist interventions are common and often the first type of study conducted by investigators to quantify the economic impact of clinical pharmacy services. The purpose of this primer is to provide guidance for conducting cost-avoidance studies pertaining to clinical pharmacy practice. Summary Cost-avoidance studies represent a paradigm conceptually different from traditional pharmacoeconomic analysis. A cost-avoidance study reports on cost savings from a given intervention, where the savings is estimated based on a counterfactual scenario. Investigators need to determine what specifically would have happened to the patient if the intervention did not occur. This assessment can be fundamentally flawed, depending on underlying assumptions regarding the pharmacists’ action and the patient trajectory. It requires careful identification of the potential consequence of nonaction, as well as probability and cost assessment. Given the uncertainty of assumptions, sensitivity analyses should be performed. A step-by-step methodology, formula for calculations, and best practice guidance is provided. Conclusions Cost-avoidance studies focused on pharmacist interventions should be considered low-level evidence. These studies are acceptable to provide pilot data for the planning of future clinical trials. The guidance provided in this article should be followed to improve the quality and validity of such investigations.

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