Metamorphosis of the Pharmacy Practice Model at an Academic Medical Center: Creating Improvements in Medication Safety, Patient Outcomes, and Financial Performance via Implementation of a Comprehensive Pharmacy Practice Model
Heath R. Jennings, Pharm.D., BCPS, Dave Hicks, R.Ph., M.B.A., Katherine D. Mieure, Pharm.D., BCPS, Judith Brown-Scott, R.Ph., Sandeep Parsad, Pharm.D., BCOP, Ishaq Lat, Pharm.D., BCPS, Elisabeth Mouw, Pharm.D., BCPS, Ben Brielmaier, Pharm.D., BCPS
The University of Chicago Medical Center, Chicago, Illinois
The important role pharmacy plays in the care of patients and overall performance of a healthcare organization has been well documented. With the changing business model of healthcare and the impending impact of healthcare reform, pharmacist leaders are called upon to expand their roles within their organizations to lead improvements in medication safety, optimize patient outcomes, and reduce healthcare costs. This four-year initiative defines the development and implementation of a “Comprehensive Pharmacy Practice Model” in an academic medical center and documents the clinical impact on patient care and the economic value to the institution.
Pharmacy leadership began with a simple vision, to advance the practice of pharmacy and integrate the model by which care is delivered to all patients throughout the medical center. A portfolio of integrated and interdependent improvements were created to generate system changes in the areas of leadership, medication preparation and delivery, medication-use policy, medication safety, patient care services, human resources, education, and financial performance.
The integration of clinical and operational programs and the synergistic alignment of standardized medication processes, reliable technology, and well-trained human resources led to institution wide benefit. Reductions in medication turn-around time for routine and STAT medications (87.5% and 85.8%, respectively) and a 34-fold decrease in preventable adverse drug events were realized. Expansion of clinical pharmacy programs and experiential education translated to annual increases in patient care services of 126-352%. Twelve core patient service lines experienced deductions in complications per 100 cases (relative reduction 40.9%-82.4%) with most noting reductions in observed length of stay and length of stay index (relative reduction 1.2%-19.6% and 4.9%-18.6%, respectively) and in observed mortality and mortality index (relative reduction 16.1%-52.5% and 0.4%-53.8%, respectively). Over 40 cost reduction initiatives were implemented achieving $8.7 million in net budget savings. The average impact per pharmacist intervention remained stable at $104-$185 whereas the average return on investment for pharmacist salaries increased from 77% in 2008 to >200% in 2011. In addition, increased revenue was generated through pharmacist managed clinics ($2.3 million annually) and better identification of 340B eligible cases ($500,000 annually).
The principles and processes defined within this comprehensive program are immediately applicable to both academic medical centers and community teaching hospitals. Direct benefits include optimized patient outcomes, enhanced institutional performance, and expanded pharmacist and technician practice.
View a pdf of the poster from the Midyear Meeting (664 KB)