Hollywood, Fla.—Enhanced partnerships between pharmacists and hospitalists can improve patient safety and reduce costs, according to a study presented at the annual meeting of the American College of Clinical Pharmacy.
“The benefit of this type of interaction is that both groups are employees of the hospital [and are] … intensely focused on improving patient care and cost containment,” according to investigator Jonathan D. Edwards, PharmD. “I believe this process could be used in any institution that employs hospitalists.”
Dr. Edwards, a clinical pharmacy specialist at Huntsville Hospital, in Alabama, and his colleagues studied the effectiveness of such collaboration between pharmacists and hospitalists to standardize order sets, develop a patient contact program and increase appropriate interventions at the Huntsville Hospital between November 2011 and February 2012. They found that the approach improved patient care and reduced costs (abstract 247). Their real-world experience follows recommendations outlined in a joint statement from the American Society of Health-System Pharmacists and the Society of Hospital Medicine (Am J Health Syst Pharm 2008;65:260-263).
The interdisciplinary collaboration at Huntsville Hospital featured three main components. It began with development of order sets for six disease states or situations: diabetic ketoacidosis, acute alcohol withdrawal, hypoglycemia, nicotine replacement, admission orders and contrast-induced nephropathy prophylaxis. The group identified these clinical areas based on the types of hospitalized patients they most frequently manage.
“The order set development standardized the way we treat five disease states,” Dr. Edwards said in an interview. This strategy also decreased the time it takes physicians to write admission orders for these patients and helped to streamline use of formulary agents. The process also strengthened the relationship between the two disciplines, facilitating further collaboration, Dr. Edwards added.
To enhance the collaboration beyond the order sets, Dr. Edwards proposed that a clinical pharmacist review the drug regimens for hospitalists’ patients to identify potential cost savings and therapeutic adjustments. “The group agreed, and I started making recommendations via face-to-face communications with the appropriate physician.”
Dos and Don’ts When Contacting Physicians
Dr. Edwards learned a crucial strategy in the process. “The most important component of the success of this project is knowing how your physicians prefer to be contacted regarding recommendations. I did not realize that most physicians do not like notes in the medical record but prefer to have a face-to-face conversation with the pharmacist.” This more personal method of interacting with physicians has additional benefits, he said. It promotes the positive perception of pharmacists as team members and avoids any negative perception that chart notes mean pharmacy is “policing” medication use.
During the study period, the Alabama researchers identified $5,602 in cost avoidance associated with 77 patient recommendations. The recommendations included converting IV medications to oral forms, monitoring duration of therapy, adjusting medication regimens, initiating new medication therapy and discontinuing therapy.
The collaboration program had a third phase that was aimed at strengthening pharmacy’s role in patient care. “We interacted with patients on our family medicine floor on a daily basis,” Dr. Edwards said. “We asked patients about their allergies and pain control, and answered questions about their current medications and the side effects associated with these medications.” The pharmacists then shared this important information with the hospitalists.
These patient-interaction initiatives yielded an additional 79 interventions during the study period. Identification and clarification of allergies, and assessment of pain management were the primary actions taken. These actions resulted in $5,287 of cost avoidance.
“The three programs were successful in improving patient outcomes and reducing cost,” Dr. Edwards said. Added together, the pharmacist-hospitalist collaboration resulted in the development of six order sets, 165 total interventions and a total cost avoidance of $10,889 over a four-month period.
Broader Research Needed
Commenting on the study, Thomas Bookwalter, PharmD, an associate professor of health sciences at the University of California, San Francisco School of Pharmacy, called the Alabama study “a fine report.” He urged the investigators to “continue to work in this area … with a somewhat larger scope.” Dr. Bookwalter noted that several unanswered questions remain. For example, future research could determine if collaboration between pharmacists and hospitalists prevents any medical errors, lowers hospital readmission rates and/or improves patient satisfaction. He also suggested that future research should be designed to compare two groups of hospitalized patients, one treated with traditional care and another group managed through this interdisciplinary collaboration.
Drs. Edwards and Bookwalter reported no relevant financial conflicts of interest.