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PGY1/PGY2 Health System Pharmacy Administration Residency
Development and Evaluation of an Outpatient Pharmacy Infusion Productivity Model
Alfred Awuah, PharmD; Adam Smith, PharmD, MS, BCPS; David Putney, PharmD, MPH, BCPS
PURPOSE
Evolving pharmacy practices have challenged historic workload efficiencies. Inadequate staffing may lead to delays in therapy and concerns for the safety of patient care. The primary objective was to identify and quantify key performance indicators (KPIs) that capture all valuable clinical and operational activities performed by staff pharmacists, pharmacy technicians, and compounding robot within outpatient pharmacy infusion areas.
METHODS
This was a retrospective review of all outpatient infusion preparations compounded at Houston Methodist Hospital between July 2020 to August 2021. Data were extracted from the electronic health record and intravenous (IV) workflow management system to examine workflows between various staff and technology implemented during the selected time frame. A relative value unit (RVU) unit of service was calculated, as a weighted value to express relative values of other activities and to conform workload into a standard unit. In this instance, 1 RVU is equivalent to 1 hour of labor. This is to incorporate cognitive clinical review and compounding activities that more accurately represent complexity-weighted verifications and complexityweighted doses dispensed.
RESULTS
A total of 12,481 hazardous preparations and 10,250 non-hazardous preparations were manually compounded during the period. The median total processing time for hazardous products was 26 minutes (0.43 RVUs) and was 15 minutes (0.25 RVUs) for non-hazardous products. For all preparations, the median time for pharmacist first verification was 9 minutes (0.2 RVUs), second verification was 4 minutes (0.07 RVUs), and sort was 13 minutes (0.22 RVUs). Additionally, the median time for technician preparation was 10 minutes (0.17 RVUs).
CONCLUSION
The number of hazardous preparations outweighed nonhazardous preparations in both quantity and complexity. This data supports a staffing model that can be predicted on median order processing times for hazardous and nonhazardous preparations, as well as ancillary functions in an outpatient pharmacy infusion satellite.
PGY1/PGY2 HEALTH-SYSTEM PHARMACY ADMINISTRATION AND LEADERSHIP PHARMACY RESIDENCY
Alfred Awuah, PharmD
Alfred earned his Bachelor of Science in biological science from Georgia State University and his Doctor of Pharmacy from the University of Georgia. Following completion of the PGY1 year, Alfred will continue his residency training in the combined program as a PGY2 Health-System Pharmacy Administration and Leadership resident. Primary project preceptor: Adam Smith, PharmD, MS, BCPS
Presented at 2021 Virtual Vizient Pharmacy Network and 2022 Midwest Pharmacy Residents Conference.
Nathan Jones, PharmD, MS; Matthew A. Wanat, PharmD, BCPS, BCCCP, FCCM; David Putney, PharmD, MPH, BCPS; Engie Attia, PharmD, BCPS; Mobolaji Adeola, PharmD, BCPS; Mabel Truong, PharmD, BCPS; Alex C. Varkey, PharmD, MS, FAPhA
PURPOSE
Utilization of traditional clinical decision support for pharmacotherapy orders at time of computerized provider order entry (CPOE) and pharmacist order verification is widely utilized in the hospital pharmacy setting. Many electronic health records (EHR) systems lack more advanced, automated clinical surveillance capabilities or alerts to assess ongoing monitoring requirements of medications. Standalone clinical surveillance software services are available that provide this more advanced monitoring assistance but come with similar challenges for pharmacist use including alert fatigue and non-integration in the EHR. This assessment will describe the changes in alert acknowledgement and intervention rate after integration of a clinical surveillance alert system with an electronic health record.
METHODS
This is a 60-day pre-post quasi-experimental study to assess an EHR integrated clinical surveillance alerting system. Eight alerts were added to an integrated alert system and included in the analysis depending on pharmacist utility, clinical value, and frequency, based on baseline alert data. The primary outcome assessed was alert acknowledgement rate by clinical pharmacists, secondary outcomes include time to alert acknowledgement and alertdriven pharmacist intervention rate.
RESULTS
A total of 176 interventions in the pre-intervention period and 230 alerts in the post-intervention period were included. Alerts acknowledgement rate increased from 19.9% to 42.2% (95% CI 0.20 - 0.54. p<0.05), time to acknowledgement was reduced from 20.9 hours to 9.7 hours (p=0.051), and pharmacist intervention rate increased from 18.1% to 20.0% with an absolute increase of 8 interventions, (p=0.89).
CONCLUSION
The use of clinical surveillance alerting systems can identify meaningful pharmacy-led therapy interventions in a pharmacy consult service model. Integration of such systems into the EHR improved alert utilization and in our study was associated with a higher rate of pharmacist mediated therapy intervention identified by an alert.
PGY1/PGY2 HEALTH-SYSTEM PHARMACY ADMINISTRATION AND LEADERSHIP PHARMACY RESIDENCY
Nathan Jones, PharmD, MS
Nathan earned his PharmD from the University of Kansas School of Pharmacy in 2020, and MS from the University of Houston College of Pharmacy in 2022. Following completion of his residency, Nathan has accepted a manager position at Children’s Mercy in Kansas City, Missouri. Primary project preceptor: David Putney, PharmD, MPH, BCPS
Presented at 2021 Virtual Vizient Pharmacy Network and 2022 Alcalde Southwest Leadership Conference.
Impact of a Computerized Physician Order Entry Intervention on Potentially Inappropriate Medications Use and Delirium in Older Adult Patients
Alan Luu, PharmD; Kathryn Agarwal, MD; Nghi (Andy) Bui, PharmD; Mobolaji Adeola, PharmD, BCPS; Amaris Fuentes, PharmD, BCCCP; Sunny Bhakta, PharmD, MS, BCP
PURPOSE The Beers Criteria are guidelines that provide recommendations on the usage of potentially inappropriate medications (PIM) in older adults. Our institution began implementation of active clinical decision support (CDS) alerting in the computerized provider order entry (CPOE) in 2018 to six medications. After the 2019 Beers criteria revision, the initiative was expanded in 2020 to 17 medications. A passive-CDS approach to establish a geriatric ordering context within the electronic health record (EHR) and CPOE system focused on provision of appropriate dosages, frequency defaults and medication selection in older adults. This study aims to evaluate the impact of CDS geriatric context changes implemented within our health-system on medication usage patterns.
METHODS
This is a retrospective descriptive study comparing institutional EHR data between January to September 2019 (pre-implementation) and January to September 2020 (post-implementation). Data included all doses of 17 intervened medications ordered during this time in patients age 65 or older. The primary endpoint is the percentage of PIMs with an ordered dose and frequency beyond the context parameters. Secondary outcomes include total daily dose and average dose per patient, listed by each medication intervened.
RESULTS
A total of 62,738 hospital admissions were included (32,969 pre-implementation and 29,769 postimplementations). Diphenhydramine showed a change from 2.9% pre-implementation to 3.4% post-implementation (P<0.001) in doses ordered. Lorazepam showed a change from 30.8% pre-implementation to 30.9% postimplementation (P<0.018). Alprazolam, amitriptyline and chlorpromazine showed an increase in inappropriate dose. Amitriptyline, cyclobenzaprine and imipramine showed an increase in inappropriate frequency. Chlorpromazine, cyclobenzaprine, diazepam, diphenhydramine, haloperidol, hydroxyzine, lorazepam, meclizine, metoclopramide, methocarbamol and promethazine showed statistically significant reductions in AD and TDD. Chlorpromazine and diazepam showed the greatest reduction in inappropriate AD by 32% and TDD by 30% respectively.
CONCLUSION
Utilization of a passive CDS process for implementation of the geriatric context demonstrated beneficial changes to our primary and secondary endpoints. This tool has allowed our institution to align ISMP’s recommendations for designing safe and effective processes for CPOE in our geriatric cohort. Moving forward, this passive CDS model utilized in our geriatric cohort will continue to be expanded on with additional medications and other select populations.
PGY1/PGY2 HEALTH-SYSTEM PHARMACY ADMINISTRATION AND LEADERSHIP PHARMACY RESIDENCY
Alan Luu, PharmD
Alan earned his PharmD from the University of Houston College of Pharmacy in 2021. Following completion of his PGY1, Alan will continue postgraduate training as a PGY2 pharmacy resident in the health-system pharmacy administration and leadership program at Houston Methodist Hospital. Primary project preceptor: Nghi (Andy) Bui, PharmD
Presented at 2021 Virtual Vizient Pharmacy Network and 2022 Midwest Pharmacy Residents Conference.
Impact of Unit-Based Pharmacy Technicians at a Tertiary Academic Medical Center
Niha Zafar, PharmD, MS; Engie Attia, PharmD, BCPS; David Putney, PharmD, MPH; Amanda Beck, PharmD, MS; Alex Varkey, PharmD, MS; Kevin Garey, PharmD, MS
PURPOSE
This study aimed to evaluate the impact of a unit-based pharmacy technician service on the quality of patient care provided within a tertiary academic medical center, defined by its effect on clinical pharmacist efficacy, the discharge process, and operational efficiency.
METHODS
A quasi-experimental, single-center pilot study was conducted to evaluate the integration of two unit-based pharmacy technicians on four acute care cardiology and neurology floors. Their specific primary functions included completing medication histories, performing insurance coverage verification, screening for high-cost medications and prior authorizations, and facilitating utilization of the bedside medication delivery program. The primary endpoint was a composite of clinical pharmacist efficacy, defined as the documented number of advanced clinical interventions (aside from pharmacy consult-related interventions), prior authorizations, discharge counseling, and discharge process support. Secondary endpoints included various operational and outcomes metrics, such as medication re-dispense rates, medication message rates, length of stay, length of stay index, 30-day readmission rates, and patient satisfaction scores. Patients were included only with a discharge disposition to home in the pre-intervention period from October 2020 to January 2021 and the post-intervention period from October 2021 to January 2022.
RESULTS
of the 2076 patients who met inclusion criteria in the postintervention period, approximately 35.5% had an intervention performed by a unit-based pharmacy technician during hospitalization. The composite rate of clinical pharmacist interventions per number of patients discharged significantly increased from 31% in the pre-intervention period to 38% in the post-intervention period (95% CI, -12.86 to -2.03, p<0.01). There was also a significant increase in the rate of prior authorizations completed from 2% to 7% (95% CI, -6.65 to -2.98, p<0.01). A nonsignificant increase was noted in the number of discharge counseling from 9% to 10% (95% CI, -5.06 to 2.38, p=0.47), other discharge support interventions from 3% to 4% (95% CI, -1.77 to 0.37), and non-consult interventions from 17% to 18% (95% CI, -3.91 to 2.83) performed between the pre- and post-intervention periods. A statistically significant reduction in the 30-day readmission rate from 9.7% to 7.3% was observed (95% CI, 0.43 to 4.29, p=0.02). There was no significant difference in length of stay, length of stay index, or satisfaction scores for patients who were seen by unit-based pharmacy technicians.
CONCLUSION
Unit-based pharmacy technicians contributed to improving clinical pharmacist efficacy, decreasing 30-day readmission rates, and decreasing the rate of missing doses through various patient care support and operational tasks in this study. Additional studies are needed to identify the most optimal workflow and productivity metrics for unit-based pharmacy technicians to achieve desired goals in a targeted area of focus.
PGY1/PGY2 HEALTH-SYSTEM PHARMACY ADMINISTRATION AND LEADERSHIP RESIDENCY
Niha Zafar, PharmD, MS
Niha completed her undergraduate coursework and earned her PharmD from the University of Houston College of Pharmacy in 2020. She also concurrently completed her MS in Pharmacy Leadership and Administration from the University of Houston over the course of the residency program. Following completion of her PGY2 residency, Niha will assume the role of Pharmacy Administrative Specialist at Houston Methodist Hospital. Primary project preceptor: Engie Attia, PharmD, BCPS
Presented at 2021 Virtual Vizient Pharmacy Network and 2022 Alcalde Southwest Leadership Conference.
