Pharmacy Practice Model Transformation from Medication Focus to Patient Centered Care
Gene A. Gibson, Pharm.D., Joshua R. Guinter, Pharm.D., J. Michael Vozniak, Pharm.D., BCOP, Cassandra I. Redmond, Pharm.D., M.B.A., Melissa L. Hibbs, R.Ph., Richard Demers, M.S., R.Ph., FASHP.
The Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Pharmacy practice model requirements have been described since the Pharmacy Practice Summit in November 2010, but a reproducible model has not yet been demonstrated. This report presents outcomes associated with the deployment of a patient centered pharmacy practice model of team and unit pharmacists with clinical pharmacy specialists at a university teaching hospital. Pharmacists were deployed to twenty-three nursing units along with clinical pharmacy specialists in the following six areas: Antibiotic Stewardship, Anticoagulation Management, Oncology, Critical Care, Transplant, and Emergency Medicine.
The patient centered practice model was designed to have a bed to pharmacist ratio of below 30:1. The strategic plan was to transform the current pharmacy practice model of medication order review and targeted specialized pharmaceutical care by select pharmacy specialists to the provision of comprehensive patient centered care. Pharmacist duties in the patient centered model included medication distribution, introduction to the patient within 24-hours of admission, admission medication reconciliation, daily pharmaceutical care, education for new medications, and discharge medication reconciliation with re-education of new medications and side effects to patients and families.
Baseline outcomes prior to fiscal year (FY) 2013 were compared to data from FY13. The patient centered care model demonstrated an increase in the process variables- total interventions (500/month to 10,000/month) and cost avoidance from interventions ($1.7 million/year to $12 million/year). The largest increase in interventions was demonstrated in medication reconciliation and patient education activities, 3000 and 1400 interventions/month respectively.
Improved patient outcomes were demonstrated by a decrease in 30-day unplanned readmissions from 24% to 12% and an increase in the “always” measures of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Communication Regarding Medications from 58% to 66%.
Results demonstrate that a patient centered pharmacy practice model improved pharmaceutical care and patient satisfaction (HCAHPS scores) and reduced 30-day unplanned readmissions. This patient centered pharmacy practice model is innovative and the embodiment of the optimal pharmacy practice model.
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