ASHP Best Practices Award Mortar and Pestle
Award Information

Maximizing the Impact of Pharmacists Across Transitions of Care: Hematopoietic Cell Transplant as a Best Practice Opportunity for Clinical Pharmacists

Kamakshi V. Rao, Pharm.D., BCOP, CPP, Tippu Khan, Pharm.D., BCOP, CPP, Lindsey B. Poppe, Pharm.D., M.S., BCPS , Scott W. Savage, Pharm.D., M.S.


University of North Carolina Hospitals and Clinics, Chapel Hill, North Carolina

Patients undergoing Hematopoietic Cell Transplant (HCT) have many factors that increase their risk of medication related complications and errors including the use of complex medication regimens, transplant related complications, and transitions between acute care and ambulatory care environments. Pharmacists play an important role in the care of these patients. At UNC Hospitals, we created a clinical pharmacy service model aimed at maximizing the impact of pharmacists on the care of patients undergoing HCT.

Creation of this model included the development of four unique processes. First, we established a new pharmacist position, in addition to our existing acute care clinical pharmacist position, to serve the HCT ambulatory care clinic. Second, we identified critical “points of transition” where pharmacist-directed medication management would be beneficial and implemented routine pharmacist touch-points at these times. Third, we developed tools to measure and describe the impact of clinical pharmacy services on providers and patients. Lastly, we undertook a unique model of pharmacy cross-coverage, pairing responsibilities between the acute care and ambulatory care pharmacists to provide consistent, specialized clinical coverage to the HCT unit and clinic.

The new model of practice has been in place for 2 years with extremely positive results. Within the first six months of data collection, pharmacists provided services for 170 HCT admissions and 290 clinic visits. Evaluation of this model was conducted through a multi-tiered process. We assessed the perception of pharmacists by patients through a survey administered to patients prior to inpatient admission and again after discharge. Average patient expectations from measured constructs of pharmacists rose between pre- and post-surveys, and experience with the pharmacists either met or exceeded patient expectations in the majority of questioned areas. Pharmacist impact on provider time was measured using a web-based tracking tool. In the initial 7 weeks of data collection, a total of 844 interventions/activities were logged, representing a time-savings of 117 hours of provider time. With implementation of the cross-coverage strategy, the amount of time patients and providers received services from a non-HCT specialist decreased from 17% to 0.8%.  In addition, we were able to implement a centralized approach to medication assistance. Using medication assistance program specialists, we were able to pre-emptively identify medication access issues and obtain appropriate authorizations, leading to improved patient satisfaction and increased utilization of our outpatient pharmacy services.

This transition of care model is an innovative program that has led to improvements in the care of patients undergoing HCT. This model is well suited to patient populations where defined groups of patients experience frequent transitions through the acute and ambulatory services. Using this model, pharmacists have dramatically expanded their scope of service to ensure that pharmacist-based services “touch” patients at every key point through their continuum of care.

View a pdf of the poster from the Midyear Meeting (200 KB)