Hospital pharmacists are taking on a greater role in organizations' strategic initiatives in recent years, with pharmacists leading medication reconciliation and patient discharge programs. However, deploying pharmacists to drive these clinical initiatives creates a shortage in the workforce needed to perform more routine tasks, such as medication order entry and review.
"We see many healthcare facilities looking to try to redeploy onsite pharmacists from order entry to really focus on key strategic projects and clinical initiatives," Kelly Morrison, director of remote and retail pharmacy services at Cardinal Health, said in a Nov. 16 webinar sponsored by Cardinal Health and presented by Becker's Hospital Review. "All while personnel and project budgets continue to be flat."
During the webinar, Mark Chaparro, PharmD, director of pharmacy at Gastonia, N.C.-based CaroMont Health, and Robert Eastin, PharmD, director of pharmacy for central pharmacy and shared services at San Diego-based Scripps Health, shared how the two hospitals redistributed pharmacy services among onsite and remote staff to implement strategic efforts, such as patient discharge counseling and an EHR conversion.
Dr. Chaparro and Dr. Eastin detailed how CaroMont Health and Scripps Health successfully expanded and refocused their onsite pharmacists' work on clinical projects without forgoing timely review and verification of medication orders.
Expanding clinical services at CaroMont Health
Leadership at CaroMont Health, a 435-bed hospital serving 250,000 patients each year, wanted to grow its clinical services without expanding the number of full-time equivalent employees. "Our biggest challenge was: How do we provide more direct patient care services with the same pharmacist group?" Dr. Chaparro explained.
Hospital leaders evaluated a few options — from changing the facility's staffing models to combining select clinical pharmacist roles — before deciding to partner with a remote pharmacy service provider. With remote pharmacy services, the hospital outsources some of its order entry and verification tasks, giving onsite pharmacists time to review discharge medications with patients.
"[It's] getting those pharmacists out on the floor, working directly with the prescribers, caregivers and the patients," Ms. Morrison said. "The pharmacist, as we see, is now becoming an integral role on the care team and it is becoming critical to reallocate their time to interact with the patient."
Since implementing remote pharmacy services for medication order entry, CaroMont Health has reported a reduction in their readmission rate as well as improved operational efficiencies. For example, the hospital has experienced a two-minute reduction in medication order turnaround time per order, along with increasing its medication order productivity metric by 10 additional orders processed per hour, according to Dr. Chaparro.
"We're processing somewhere between about 5,500 to 6,000 orders a day, so that's a substantial amount of time savings," he said.
Supporting short-term project work at Scripps Health
Scripps Health, a five-hospital system with inpatient and retail pharmacy services, launched a new Epic system in April, marking the first of three waves of EHR deployment. In total, the three waves will bring the health system's hospitals, clinics, ambulatory surgery centers and infusion centers onto a single integrated EHR by the end of 2018.
Scripps Health leaders realized they would need additional pharmacist support during the EHR transition period, according to Dr. Eastin. For example, additional staff might need to fill in for existing hospital pharmacists who provided input to Scripps Health leadership during the EHR development process or who are pulled away from the pharmacy to attend training for the new EHR.
After evaluating input from Epic and other health systems, Scripps Health officials determined they would need five to seven additional pharmacists to maintain daily operations during the preparation and go-live period. The question became whether to hire additional full-time clinical pharmacists or to outsource remote entry services while existing Scripps pharmacists filled various roles needed during the transition.
"We opted with option No. 2," Dr. Eastin explained, noting Scripps Health decided to contract seven full-time equivalent remote pharmacists to provide supplemental support until the final hospital goes live on Epic. "We [have been] able to free up our clinical pharmacists to support the build, support the go-live and really help us across the implementation."
Dr. Eastin said since the go-live began in April 2016, the remote pharmacy has maintained its level of order entry support across the health system, handling 43 to 46 percent of the total order volume. "Leveraging a remote model can enable the onsite pharmacy's full commitment without distraction when they're engaging in training and implementation of a new system as well as extending pharmacy’s reach to drive clinical initiatives," Ms. Morrison added.
Listen to the webinar recording here. View the webinar slides here.