In 2021, the American Society of Health-System Pharmacists in their Pharmacy Forecast recommended that to achieve optimal results for patients with chronic and life-threatening diseases, pharmacist leaders should develop comprehensive medication management services. To that end, L. Hayley Burgess, PharmD, BCPP, and colleagues implemented a clinical surveillance technology program and observed the results of this initiative on practice management.
From 2015 to 2021, the program grew to 177 hospitals and was monitored with data points gathered on the frequency of drug therapy modifications, pharmacist response times, clinical pharmacy metrics results, and return on investment. The results of this observational study were published in HCA Healthcare Journal of Medicine. Dr. Burgess shared the findings of this work with Physician’s Weekly.
PW: Why did pharmacy practice models in hospitals need to be re-examined?
Dr. Burgess: Pharmacists are uniquely positioned to provide medication management services, and studies have shown that pharmacist-delivered patient care services can improve patient outcomes, increase cost efficiency, and reduce demands affecting the healthcare system. However, hospital pharmacy departments often must balance operational and clinical activities, which may dramatically reduce the amount of time pharmacists are able to dedicate to the patient care process. We successfully redesigned pharmacy services by integrating clinical pharmacy surveillance technology to focus on improving patient outcomes and optimizing processes to enhance patient-centered care with a more efficient workflow.
What are the most important findings from your study?
After implementing the redesigned pharmacy services model, pharmacists were more efficient and patient outcomes improved. Comparing 2015 to 2021, the number of frontline clinical pharmacist drug therapy modifications more than doubled, resulting in annual savings. The time for pharmacists to respond to alerts during this same time period decreased from 13.9 to 2.6 hours. Efficiencies gained from alerting pharmacists to potential interventions instead of pharmacists searching manually for intervention opportunities supported clinical patient-centered care activities, such as interdisciplinary rounds, formulary management, committee presence, and medication reconciliation.
Many measures positively impacted appropriate antibiotic utilization. For example, the percentage of patients on vancomycin de-escalated by 3 days of therapy increased by 12% since 2015, and the percentage of patients with a UTI [urinary tract infection] treated with a fluoroquinolone decreased by 25% over the same period. Clinical pharmacy surveillance technology gave us the ability to trend measures and determine strategic initiatives to judiciously use antimicrobial agents. Outcomes also resulted in hard and soft dollar cost savings.
How can these findings be incorporated into practice?
Pharmacists are essential healthcare professionals with expertise in medication therapy management, yet budget cuts often affect the clinical services they can provide. Implementing clinical surveillance technology can expand the reach of the clinical pharmacist to benefit both patients and the healthcare system while saving healthcare dollars. Utilizing the highly curated data and clinical outcomes measures from surveillance technology scorecards allows visibility into the care provided by the interdisciplinary team and opportunities for performance improvement. Additionally, advocating for a clinical pharmacist presence with “C-suite” leadership is an important role physicians are able to play to translate findings into practice.
What would you like future research to be focused on?
While pharmacy surveillance technology became an integrated tool in the clinical pharmacist workflow for us, opportunities remain to study how these tools further support the identification of medical errors that can result in the prevention of harm due to early interventions. Utilizing the technology to deliver the right data to the right person at the right time for physicians, nurses, dieticians, and others are future areas of study that still need to be explored for inpatient and ambulatory settings.
Is there anything else that you feel Physician’s Weekly readers would benefit from knowing about your research?
This research is important for physician leaders to consider how the staffing of clinical pharmacists can enhance patient outcomes and the physician support model. Anecdotally, we engaged in discussions with many physician leaders who greatly appreciated the surveillance technology model and would inquire during patient rounds to understand which alerts were triggered for patients, as well as how this model contributed to their work satisfaction.