Redefining a Rural Pharmacy Practice: Developing a Progressive Patient Centered Pharmacy Practice Model
John Worden, M.S., Pharm.D., BCPS, Mary Kate Blankenship, Pharm.D., Cheryl Anderson, CPhT, Jessica Hanson, CPhT, Robert Geiser, R.Ph., Terri Gehring RHIT
McPherson Hospital, McPherson, Kansas
The American Society of Health-System Pharmacists (ASHP) Pharmacy Practice Model Initiative is a broad review of the current practice of pharmacy and a description of how we want to see pharmacy practice progress in years to come. The initiative gave rise to a consensus based set of recommendations on how to leverage the talents of pharmacists to positively impact the outcomes of patients. Our program highlights how a rural facility with limited resources and staff can make a significant impact in the lives of patients.
Senior leaders at our hospital embraced the concept of a transformational expansion of pharmacy services. Starting in 2008, the pharmacy focused on three core areas. These areas were the basis for our multiyear strategic plan which included operational restructuring, personnel development and redeployment, and outcomes based services. With limited staff and monetary resources, return on investment data justified our proposed model. Through projections, we acquired funding and delivered hard dollar savings associated with our distribution model change. With increased efficiency, our focus shifted to providing medication reconciliation during transitions of care, discharge education, and enhancing core measure outcomes results.
The pharmacy obtained pre-implementation data on our traditional cart-fill distribution system regarding nursing satisfaction, staff time, and medication turnaround time. Prior to automation, 70% of medications were dispensed by a pharmacist. Post-implementation, 92% of medications were dispensed at the site of care. We identified significant savings associated with charge revenue capture and time recaptured from manual nursing and pharmacy processes. Our medication turnaround time decreased by 47% using Pyxis® profile MedStations and the order management system, Rxe-View™. This automation allowed for a 25% increase in available pharmacist hours to focus on clinical and patient focused outcomes. Prior to pharmacists’ involvement, antibiotics were appropriately administered 82% of the time. After initiation of pharmacist prospective review and intervention when necessary, our rates went to 96%. Only 72% of heart failure patients received an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker if indicated before pharmacist screening and review of all heart failure admissions. Post-implementation rates went to 96.5%. Similar rates of success were achieved with vaccinations and venous thromboembolism prophylaxis. With these significant impacts in patient outcomes, additional pharmacist resources were approved to perform medication reconciliation and discharge counseling. Without 24 hour pharmacist onsite availability, this program, with nursing assistance, achieved a reconciled medication list in 83.7% of patients served. Pharmacists were able to counsel 78% of the inpatient/observation discharges.
Our experience and data demonstrates that the Pharmacy Practice Model Initiative can be utilized in all sizes and types of facilities to achieve our professional goal of having pharmacists available as a valuable member of the health team. Practicing in a rural setting can be very rewarding, allowing us the privilege of caring for and treating our friends, family, and community with the best pharmacy services possible. Using the tools offered by ASHP and the knowledge and experience obtained in robust pharmacy practice management residencies, leaders can replicate and adapt these practice models in any setting.
View a pdf of the poster from the Midyear Meeting (194 KB)