Category:

Medication errors injure thousands of patients annually, and while mistakes occur with all medication classes, those involving antiretroviral therapies are particularly troublesome...Past studies have suggested that errors are driven by prescribers’ lack of familiarity about antiretrovirals, patients’ ignorance about their complete regimens, and low patient health literacy...Antiretroviral stewardship, which involves educating prescribers and patients and reviewing orders prospectively, helps increase the use of evidence-based medication regimens...researchers addressed the impact of such stewardship on medication errors...The researchers made the following 3 key findings:

1. Medication error rates for patients admitted in the first year were high, but decreased over the 3-year period.
2. Half of the errors occurred in the first 24 hours after admission, especially during late-night and weekend hours when formal consults were unavailable.
3. Incorrect dosing was the most common error, followed by inappropriate use of proton pump inhibitors or histamine-2 receptor antagonists with atazanavir (Reyataz) or rilpivirine (Edurant).

...the study authors recommended initiating an antiretroviral stewardship team that includes infections disease-trained medical and pharmacy staff, as well as increasing staffing to review medications during late-night and weekend hours. They reported that health care systems can further minimize medication errors by triggering an automatic consult request when HIV diagnostic codes are added, or introducing a "hard stop" signaling an infectious disease or stewardship consult...

...Mercy Health has saved more than $42 million on drugs since 2010 by building a formulary within its electronic health record platform...The move...makes it easier for the system’s network of providers to order medications that are on its list and compliant with Mercy’s pharmaceutical contracts...It took Mercy Health’s pharmacy and therapeutics committee three years to create the formulary -- a comprehensive list of medicines that Mercy Health would prescribe...Mercy places drugs in one of four categories:

• on the formulary and available from order sets;
• on the formulary but not available from order sets;
• restricted to a specific disease state or provider type;
• neither on the formulary nor in order sets.

These categories correspond to Mercy’s “bullseye” -- a visual representation of each medication class that committee members use to review their decisions...We generate reports on non-formulary drugs -- how many times they were ordered, and what the cost savings would be if we were to use a formulary drug instead...Mercy Health now has an average formulary compliance of more than 98 percent...The formulary management is most effective with a single EHR across the health system because it enables the health system to make modifications as their contracts change and to monitor compliance...

...independent pharmacies have demonstrated tremendous market resiliency by offering patient-oriented amenities, niche marketing, and above all, customer service... With proper planning and direction, great staff, and tireless effort, a financially viable community pharmacy will be poised to stay put in the neighborhood for years to come...but what about the community hospital outpatient pharmacy? This pharmacy is usually located in a medical office building on the hospital campus...Our store has done well by serving the hospital employee population, the physicians from surrounding offices and their families, a local retirement facility, and many folks who drive past local big-box pharmacies just to come to our little store...no amount of service can overcome the decreasing insurance reimbursement in this competitive prescription medication marketplace. As a result, the survival of the community hospital outpatient pharmacy depends on its ability to make itself indispensable to the hospital it is associated with...Here are 6 things that an outpatient pharmacy can do to help maintain alignment with its associated hospital:

1. Make sure that the pharmacy’s hours of operation align with the peak discharge hours of the hospital and emergency room.
2. Create and maintain an open line of communication with the nursing staff, especially from the emergency room and telemetry units.
3. Make sure that the inpatient pharmacists are detailing and promoting the outpatient pharmacy services at every opportunity.
4. Ask to participate in the weekly or monthly readmission campaign meetings...How can the outpatient pharmacy participate and help meet readmission goals?
5. ...meet with the nurse case managers and social workers. We all know about the importance of medication adherence...How can the outpatient pharmacy help the discharge planning team facilitate getting the discharge prescriptions filled...
6. Begin a discussion with the hospital’s pharmacy director to create a plan that details what opportunities the outpatient pharmacy may have to help increase Hospital Consumer Assessment of Healthcare Provider and Systems...

The health system that won a 2015 Malcolm Baldrige National Quality Award for healthcare credited improvements in i.v. medication preparation as a contributing factor in earning the recognition for performance excellence...We are constantly looking at new and better processes throughout all of our departments," said Brian Sayre, director of pharmacy for Charleston Area Medical Center Health System in West Virginia... the health system had greatly reduced its drug costs by using principles of lean methodology to overhaul the batching of i.v. medications...Lean methods focus on improving services and reducing waste and have been used in many types of business operations. Six Sigma, a system that complements lean processes, is a disciplined, data-driven strategy for eliminating defects in manufacturing and other processes..."Lean principles [and] Six Sigma principles fit very nicely into pharmacy workflow processes," said Sayre...the pharmacy staff calculated that switching from one daily cart fill to five cart fills per day would reduce i.v. drug waste..."The process...saved $134,000 annually, exceeding a target of a 50% reduction," 

...the SafeMed program, which uses certified pharmacy technicians in a novel expanded role as community health workers (CPhT-CHWs) to improve transitions of care...The SafeMed experience demonstrates that...CPhT-CHWs are well suited for novel expanded roles to improve care transitions...can play a key role in care transition programs targeting superutilizing patients with complex medical and social needs. As CMS intensifies readmission penalties and providers bearing financial risk seek to reduce overall health care costs, low-cost CPhT-CHWs serving as pharmacist extenders may become an increasingly attractive component for health systems...CPhT-CHWs can assist with identification and reporting of potential DTPs identified during home visits and telephone follow-up and can coordinate with pharmacists in real time to enable patients to get targeted MTM when and where they need it. They can also assist pharmacists in scheduling outpatient CMRs and support sessions for the patients...In collaboration with state pharmacy boards, pharmacist associations, and regional community colleges, the SafeMed model can be successfully scaled to serve superutilizing patients in readmission hotspots throughout the country.

Modern technology is now making genomic testing possible for a fraction of the time and cost..Now pharmacists and physicians can use pharmacogenomic test results to help choose safer and more effective medications for their patients...Pharmacists are undoubtedly the pharmacokinetic experts and the most educated health care providers in regard to the cytochrome P450 system. Preemptive genotyping would make a nice addition to a pharmacy’s list of service offerings and point-of-care testing panel...A clinical consultant pharmacist could use pharmacogenomic testing to guide therapy decisions and decrease drug–drug interactions. This has the potential to save countless health care dollars lost to ineffective medication use, adverse drug events, and hospital readmissions...There are also financial benefits for the testing pharmacy. Looking at pharmacogenomic testing from a medication therapy management perspective, one can imagine the usefulness of integrating genomic testing into a patient’s comprehensive medication review...to make specific evidence-based recommendations to improve patient care.

• Proven cost savings in elderly patients
• Help in predicting and preventing adverse drug reactions
• Decreased hospitalizations due to treatment failure
• Prevention of “trial-and-error” prescribing

Pharmacists are the experts on medication safety and effectiveness, and should be ready to take on the role of personalized medication consultants...Innovation is essential if pharmacy wants to act on new clinical service opportunities and earn a seat at tomorrow’s health care table. We need to be proactive in seeking out new niches...

Over the past several years, there has been a monumental push for hospitals to transition to electronic health records and computerized physician order entry, with the hope of standardizing and streamlining care, improving medication safety, and reducing errors. In fact, some studies estimate that more than 70% of prescriptions are now written electronically. Although CPOE has come a long way in a short period of time, is the technology living up to its potential?...CPOE systems are very fragmented both within hospital systems and between the hospital and the outpatient universe...CPOE in terms of safer medication prescribing is still a work in progress...We found several areas where CPOE systems fall short in terms of medication safety, and hospital pharmacists can play an important role in resolving some of these issues...

• CPOE and medication prescribing
• Interoperability
• CPOE aggravation
• The next frontier
• Room for improvement
• Hospital pharmacists’ role

When you have systems between inpatient and outpatient that don’t communicate, important information can get lost in translation…CPOE isn’t just a hospital pharmacy issue; it’s an issue for the profession at large...Pharmacy has a significant stake in the matter of CPOE, but we really are learning as we go along...that is why you see so much frustration between prescribers and the hospital systems. To solve the problem, multiple professions beyond just health care professionals, with different thought processes, will need to work together...

Congratulations to our pharmacist colleagues in Ohio! Under a new bill that was recently signed into law, Ohio pharmacists will now have more responsibility and fewer restrictions in collaborative practice...HB 188 provides new consult agreement provisions that allow Ohio pharmacists to order blood and urine tests, analyze the results of those tests, and modify a patient’s drug therapy regimen. The law also allows pharmacists to order medication refills in a small amount for patients with life-threatening illnesses when a physician can’t be reached. It will also streamline consult agreement paperwork so that multiple pharmacists can have a collaborative agreement with multiple physicians to oversee medications for multiple patients...This is a huge win for pharmacists in Ohio and is an excellent example of how collaboration among pharmacists, physicians, patients, and legislators can expand our scope of practice...

Health systems are under immense pressure to improve care quality while reducing costs under the pay-for-performance reimbursement model...The Pharmacy Forecast 2016-2020 published by the American Society of Health-System Pharmacists Foundation analyzed pharmacy trends and described strategies for health-system pharmacists to keep pace with their evolving scope of practice...Health systems and their pharmacists must plan for and react to trends in both value-based care and the pharmaceutical marketplace to ensure financial solvency and optimize patient outcomes...Here are 4 strategies for health-system pharmacists navigating new health care delivery trends:

1. Pursue prescription data-sharing partnerships
2. Ensure compliance with the 340B Drug Pricing Program
3. Expand pharmacist services in ambulatory care clinics
4. Manage the health-system’s formulary thoughtfully

Experts say that recent increases in the prices of off-patent generic drugs are closely tied to the drug shortages that have plagued hospitals for years...They have the same root cause: a lack of competition in certain parts of the generic market...The first indication we had of problems in the generic market were not prices; they were shortages. Hospitals were having serious problems filling prescriptions...The second manifestation we're getting now is the higher prices for certain generic drugs...without competition, drug companies can raise their prices several thousand percent simply overnight...arbitrary and unpredictable inflation is not sustainable for our hospitals, especially when we receive capitated payments for most of our patients...hospitals handle such high prices in the same way they do drug shortages: by rationing drugs, stocking smaller quantities, and devoting "huge hours of manpower" to managing the problem...the business strategy driving the price hikes affects a relatively small number of drugs but is destabilizing reimbursement practices surrounding those medications...compounding pharmacies could play a greater role in preventing price hikes affecting off-patent drugs...Other potential solutions...included speeding FDA's review of marketing applications for older generic drugs that have no competition in the marketplace and instituting price regulations for these drugs akin to the regulations that affect public utilities...