John Russillo, clinical pharmacy manager at John Muir Health in Walnut Creek, Calif., remembers the days, about 10 years ago now, when clinical pharmacists monitored prescription and lab information manually in hopes of identifying potential adverse drug events.
The goal of the monitoring was and is to "ensure proper dosing and safe and effective drug use," but it was a very labor-intensive and arduous process. Clinical pharmacists literally combed through reams of prescribing and lab information to try to catch potential issues.
Automating monitoring for adverse drug events
This all changed when the pharmacy department automated the process, becoming one of a small minority of hospitals in the country to do so. It was the first customer of VigiLanz, which provides technology for the real-time clinical surveillance of medication orders information, lab orders and results, and patient demographics and health information (e.g. weight, age, sex, diagnosis, etc.) and alerts clinicians to potential oversights, such as a missed lab, critical lab result or improper dosing.
In addition to freeing up significant time among the pharmacists who used to manually reconcile this information, the real-time aspect of the tool means potential oversights or errors can be remedied quickly. In the past, it may be many hours or even days until a discrepancy was identified. Real-time monitoring also helps ensure adherence to evidence-based prescribing. "Maybe a less appropriate drug to treat an infection has been prescribed," explains Mr. Russillo. With real-time monitoring, the pharmacist is alerted almost immediately and can talk to the prescribing physician about alternative medications.
How do these alerts get to the pharmacists? John Muir has developed hundreds of "rules," or algorithms to alert to potential adverse events or improper prescribing; the most serious events include alerts sent to the clinical pharmacist's cell phone or other mobile device.
As VigiLanz' first client, Mr. Russillo helped develop many of the rule sets, which are now housed within a shared rules library any user can access without additional cost. Hospitals can add their own rules and can update them regularly as new research and evidence becomes available.
Improving quality, reducing costs
The rules created by Mr. Russillo and VigiLanz have detected numerous potential events over the years they've been in place at John Muir, and Mr. Russillo says the monitoring system has been especially helpful in reducing adverse drug events around anticoagulant therapies. "Anticoagulant drugs as a class have one of the highest instances of adverse drug events," he says. "Multiple clinical data points must be taken into account to get the dose right."
A few years ago, the Joint Commission released a national safety goal related to the safe and effective use of anticoagulant therapies. For John Muir, meeting the goal was easy, as it had been real-time monitoring anticoagulant orders and patient labs for years.
Despite the benefits of real-time clinical surveillance , Mr. Russillo says only about 20 percent of hospitals have such systems in place. While they can be costly, the annual license fee is roughly equivalent to the cost of employing 0.5-1 FTE clinical pharmacist, says Mr. Russillo, which he says still allows for significant ROI because of the increased efficiency and productivity that comes from automating a manual process.
"Everything we do is related to outcomes; it's medication safety and it's patient outcomes," says Mr. Russillo.
And with the advent of value-based care, cost is also a factor. Each potential adverse drug event that is caught before it occurs means potentially thousands of dollars in savings for the hospital, says Mr. Russillo. Additionally, real-time monitoring helps improve adherence to evidence-based standards.
"We're trying to use optimal drug therapy, but the most inexpensive drug therapy based on evidence for equivalency, to achieve the best outcome" says Mr. Russillo.