Pharmacists provide clinical training and operational skillsets.
A pharmacist-led, hospital-based infusion center based in Teaneck, NJ has been successful in both controlling costs and implementing a comprehensive, integrated care team, according to a presentation at the annual American Society of Health-System Pharmacists Midyear Clinical Meeting & Exposition being held in Las Vegas this week.
To begin her presentation, Nancy Palamara, PharmD, the Director of Pharmacy Services at the Infusion Therapy and MS Center at Holy Name Medical Center in Teaneck, NJ opened her presentation with what she dubbed “mysterious case of the ‘high cost pharmacy.’” She noted that the hospital where she worked had the lowest cost in every area except drug spending when compared to all hospitals in the state. In fact, she explained, their hospital had the highest drug spending.
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Palamara attributed this to the hospital “doing such a good job of controlling inpatient costs” that it skewed the results. She attributed the highest spend to having a lack of control in outpatient spending, where there was “far less control and no contract negotiating.” As a solution, a team was created to help manage costs that could be controlled outside, such as maximizing reimbursement. The team also reached out to hospital management and implemented a program where the infusion team reported into a few pharmacy managers, rather than falling into the model that had been in place, which was the oncology department.
Palamara explained that pharmacy managers can play a strategic role in hospital settings because they can provide two essential skill sets in their role. The first skill set centers on clinical training, where pharmacists offer skills such as direct patient care and help with continuity of care and medication assistance. Secondly, pharmacists have operations skills such as an understanding of supply chain, improving processes, and streamlining workflow. This knowledge ensures the best patient care and best practices for cost saving and smooth operation.
Despite these skills sets, Palamara noted that those involved in the infusion department were initially skeptical. She acknowledged that some of the nurses in the center were resistant to be managed by non-nurse staff, which she attributed to a misconception that pharmacists are largely science and operations oriented rather than staying centered on compassionate patient care. In addition, pharmacy managers do not have the same level of support staff as nurses. This means they need to be sure they spend enough time with pharmacy staff and finding time to make the rounds, Palamara noted in her presentation.
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After two years of implementing the pharmacy manager model in the infusion unit, however, Palamara said the outcomes have been a patter on better communication with fully engaged nurses who now embrace the model and are now working as a “truly interdisciplinary care team.” The culture of the clinical setting had also greatly improved, she said.
She attributed the success to the open-mindedness of her C-suite staff, who embraced the concept the pharmacy staff support, the work of the director/manager, the clinical pharmacy specialists, the nurses. and the administrative assistants working as a collaborative care team.
Palamara N, Schiller D, Tichy EM. Advancing pharmacy practice with strategic clinical leadership [208-L04]. Presented at ASHP Midyear Clinical Meeting & Exposition. December 8, 2019. Las Vegas, Nevada.