Advanced clinical pharmacy services praised by hospitalist group

In a nonacademic healthcare system, an advanced clinical pharmacy services program, created and led by an internal medicine-trained clinical pharmacy specialist, made a positive impact on hospitalized patients through a number of drug intervention recommendations.

The hospitalist group accepted more than 70% of the recommendations during a 5-month evaluation period of the program in 2013, and praised the results of the clinical pharmacy services, according to a report published online for the American Journal of Health-System Pharmacy.

From January through May 2013, a faculty pharmacist from Midwestern University Chicago College of Pharmacy was contracted to develop and oversee advanced clinical pharmacy services for Edward Hospital, a 300-plus tertiary medical center in the Chicago area. With the help of pharmacy students and residents, approximately 700 interventions were documented and 75% of those were considered complex or moderately complex. The recommendations were accepted 73% of the time before an electronic medical record (EMR) was instituted and 71% of the time after the EMR was utilized, according to Laura H. Waite, PharmD, and her co-authors. The advanced clinical pharmacy services were provided four days per week.

“The most common reasons for recommendation rejection were specialist preference (e.g., a recommendation to change a cardiac medication was rejected because a cardiologist was following the patient), a patient status change, and a lack of comfort with altering a medication regimen for chronic disease management,” noted Waite and her co-authors.

“Overall, however, the program garnered very positive feedback from the hospitalist group. That feedback was communicated directly to the faculty pharmacist and also conveyed to the chief medical officer of the health system, the pharmacy administration, and other members of the health care team,” they said.

Advanced interventions were targeted mainly to issues associated with medication reconciliation at admission and discharge, acute and chronic disease state management, and pharmacokinetic dosing. Patients were prioritized based on the number of medications (10 or more) that they were prescribed prior to admission or taking during hospitalization and based on transfer status from an intensive care unit to the general medical floor. Patients were also a high priority if they were receiving antibiotics or high-alert medications such as pain killers, insulin, antithrombotic or anti-arrhythmic drugs, or chemotherapy agents.

There were a number of challenges for the advanced clinical pharmacy services program. However, the greatest challenge was the lack of face-to-face interaction with physicians because the hospitalists had no formal rounding time.

“Patients are often cared for by multiple hospitalists over the course of their admission; recommendations provided to one hospitalist might not be conveyed to the hospitalist most suited to address the intervention. Without structured interaction time, the faculty pharmacist relies on the hospitalists’ schedule to try to determine where to direct the intervention,” Waite wrote. “The faculty pharmacist attempts to triage recommendations so as to build credibility and not over load the providers.”

The authors concluded that the hospitalist group hopes to expand the advanced clinical pharmacy services program in a couple of years by adding more internal medicine pharmacist specialists to support a 5-day program. This expansion would also help support a new antimicrobial stewardship program, they said.