Pharmacy should be part of any team evaluating an outpatient center. Effective communication between physicians, hospital administrators, pharmacists, and nursing staff is crucial to whether the infusion center will succeed.
» For specialty-drug infusion centers to be successful, pharmacists must be part of the planning.
That would seem to go without saying, but according to Fred Pane, RPh, senior director of pharmacy affairs at Premier Inc., an alliance of hospitals and health systems, it doesn't always happen.
Poor planning can result in compromised patient care, he said.
According to Pane, effective communication between physicians, hospital administrators, pharmacists and nursing staff is key.
He often sees critical construction and planning decisions made without the input of those responsible for running and managing the center, which he said often results in operational inefficiencies.
Patient flow in particular needs to be evaluated. "If patient volumes are going up, you need to look at building something out," Pane said.
It's important to think ahead, he added, and to pay close attention to how long it takes to deliver drugs to the infusion center. For example, if the pharmacy is located a significant distance from the infusion site, there will be delays. This can be crucial if a patient needs infusion at a specific time, such as with antinausea drugs that must be given at an exact time to counter the effects of chemotherapy.
Outpatients should be viewed as customers, said Teri Guidi, president and CEO of Oncology Management Consulting Group in Pipersville, Pa.
"The whole idea of turnaround time can be foreign to a pharmacist who has been primarily inpatient-focused," Guidi said. "Hospital pharmacy staff does not necessarily have experience with the fact that customer expectations are very different."
Many specialty drugs require significant lab results before the drugs can be administered. Consequently it is necessary for workers in ancillary departments such as laboratories to join pharmacy staff in changing how they provide patient care.
Hospital labs operate on a first-in, first-out philosophy, which will not work in an outpatient setting when patients have scheduled appointments and do not have the luxury of waiting.
"Make sure the systems are in place [to address this]; do not leave patients dangling," Guidi said. Also when "a lab is used to responding to inpatient demand, they run it when they run it - they can mix the drug at noon or at two, because the patient will still be there."
Physician's needs and future plans
In addition to good internal communication, dialogue with referring physicians or those who may make referrals in the future needs to be part of the planning.
"Hospital administrators and pharmacists together need to be having conversations with referring physicians - rheumatologists, oncologists, gastroenterologists, any [prescribers] who give an infusion in their office," Pane said. "Find out if they are planning on sending patients to an outpatient specialty drug-infusion center, [which provides information needed] to answer the question, 'Do we need to build an outpatient center?'"
Guidi agreed. "Remember, 60 percent or so of outpatients are being infused in doctor's offices, not in hospital infusion centers. But that is changing, making this a timely subject."
To ensure quality patient care, the pharmacy staff needs to work closely with hospital schedulers to meet patient needs. If they are not prepared for the change in patient volume, patient satisfaction may suffer.
Also, in a new center, pharmacists need to plan how they will obtain access to labs and protocols.
"Be an advocate for the patient," Pane said.
Steven Zielinski, RPh, pharmacy associate with the healthcare consulting company theFranaGroup, said that finding enough qualified pharmacists with specialty-drug expertise is a challenge. He recently set up an outpatient infusion center, but it cannot infuse specialty drugs because there is not a qualified pharmacist available to staff it.
"I have a clinic that I set up, with a room set up to do infusion, but [we] don't have a pharmacist who is eligible currently to infuse patients," he said.
The pharmacist shortage needs to be considered in the planning of a new specialty infusion center.
"If you are short on pharmacists to begin with, and now you are taking them out of the pharmacy where they are taking care of the inpatient case load, you now have a pharmacy that is understaffed and one that is barely staffed," said Zielinski.
One of the spillover benefits of an outpatient specialty pharmacy is the collaboration in patient care that will naturally develop between physicians and pharmacists, Guidi said.
"The interaction between pharmacists and physicians cannot be overvalued," she said. "The more that pharmacists and physicians or other prescribers can interact, the fewer the opportunities for errors."