Development, Implementation, and Impact of a Comprehensive, Medical Service Based Pharmacy Practice Model that Maximizes Pharmacist Involvement in the Patient Care Setting
Stephen F. Eckel, Pharm.D., M.H.A., BCPS, FAPhA, FASHP, Robert P. Granko, Pharm.D., M.B.A., Scott Savage, Pharm.D., M.S., Brett Crisp, Pharm.D., M.S., Edwin Smith, Pharm.D., M.B.A., and Rowell Daniels, Pharm.D., M.S.
University of North Carolina Hospitals, Chapel Hill, North Carolina
The advancement of pharmacy practice models is a continual challenge for the pharmacy profession. In November 2010, ASHP convened a Pharmacy Practice Model Initiative Summit to "significantly advance the health and well being of patients by developing and disseminating a futuristic practice model that supports the most effective use of pharmacists as direct patient care providers." While there is no individual model that works in all practice settings, there is a common goal: providing high-level clinical services in a resource-limited environment while owning the medication use process. The University of North Carolina Hospitals identified an innovative, forward-thinking model that provided guidance for its future. This model was launched in October, 2008.
UNC’s previous model was a traditional central pharmacy/clinical specialist model. All clinical specialists attended rounds daily and spent the remainder of the day following up on their patients’ needs. Many had precepting and teaching responsibilities. Centralized pharmacists were responsible for order verification, checking drug product, and answering telephone calls. They had no patient interaction.
Our new practice model included decentralizing as many pharmacists as possible in order to expand clinical coverage while at the same time increasing specialization within traditional dispensing areas. As a result, three categories of pharmacists were created: central specialists, decentral (clinical generalists), and clinical specialists. Clinical coverage was patient-centered utilizing assignment by medical service, not geographically by patient care unit.
Our model has created tangible benefits clinically, financially, and operationally over the three years since its implementation. Pharmacy took responsibility for our institution’s Surgical Care Improvement Project compliance, a Centers for Medicare and Medicaid Services Core Measure, and became responsible for anticoagulation discharge medication counseling, a National Patient Safety Goal. In each case, compliance exceeded expectations. In addition, total inpatient drug costs remained steady or decreased even as patient acuity and volume increased. Prior to the model change, pharmacist turnover rate approached 20% per year. After implementation of the new practice model, the rate decreased to approximately 5% per year and overall employee satisfaction increased. Lastly, the new model supported growth in learner capacity. Residency positions increased by 92% and the department had a 130% growth in the number of rotations precepted annually.
Our department developed a unique and innovative model organized around medical services that has successfully been used for approximately three years. Experience to date suggests that the following results have been achieved: a decrease in drug costs compared to a standard pharmacy inflation rate, a decrease in pharmacist turnover, an increase in employee satisfaction, a consistent clinical presence on patient care units, improved compliance with national quality standards, and continued support of our educational mission.
View a pdf of the poster from the Midyear Meeting (1,466 KB)