"Part I" Out-Patient Pharmacist / In-Patient Rounds

In 1990 my wife and lived in an old country home on an acre of property in a small town just south of the Oregon border.  We had a well, abundant water, flat ground and at the time it seemed like a good idea to install a sprinkler system that covered the entire property so we may develop a lush and beautiful lawn.   For four weeks, after work and on weekends, I was out in the yard shoveling a strategic campaign of trenches, all 18 inches deep.  (Being a pharmacist and not a trencher I didn't realize that I could have rented a nice machine that would have done the entire job in one day.)


One afternoon, after about 3 weeks of shoveling, my Dad stopped by to check on the trenching progress.  I will never forget his words of wisdom, "Steven, if you continue to work on a project, eventually it will come to pass".  Over 24 years have passed since he spoke those words to me; however, whenever I am in the middle of a project and feel as if it is never going to reach the next level, I remember that if I just keep shoveling, it will eventually come to pass.


Just over two years ago I read an article written by the American Society of Health System Pharmacists that described how pharmacists can be an important component of a hospitals Accountable Care Organization.  Of course, the article described all of the ways pharmacists can play a significant role as part of the patients Care Team; however, what stood out for me was something completely different. 


One paragraph of this particular article went on to explain that the hospital administrators are not going to come looking for you (the pharmacist).  It is the responsibility of the pharmacist to explain, convince and define their role to the hospital administrative team.  This is new territory.  Pharmacists have worked in an objective world of medication orders, line items, order verification and clinical interventions for years; however, it has not been common place to describe and measure the subjective value of a pharmacist. 


How does the pharmacist move to the subjective world where it is common place to offer a bedside medication education consult prior to discharge.  What factors will a pharmacist use to explain and describe to their administrator that  there is value in educating patients about Health Literacy so a patient is able to describe their diagnosis, understand what medications they are taking to treat their diagnosis and importantly, what the consequences are if they don't treat their diagnosis.  Furthermore, the pharmacist will need to convince their administrator that there is value in educating patients about Medication Adherence and helping patients understand what their specific barriers to adherence are so they may be addressed. 


I work in an out-patient pharmacy for a community hospital and the pharmacist that I work with supported us in the process of pursuing this very initiative.  Together, we formulated idea after idea and presented them to our inpatient pharmacy administrator.  It didn't take long and we were invited to sit in as regular members of the bi-weekly readmission committee.  After many months of committee meetings, multiple drafts, training, education and staffing resolutions we are ready to implement a six week trial program.


Beginning tomorrow, one of the pharmacists from our out-patient pharmacy will be available as a discharge medication education resource inside the hospital for 3.5 hours every morning. 


As stated in our policy developed for this trial program:


Pharmacist involvement in the Hospital Readmission Campaign includes:


  • Attend rounds Monday-Friday as an outpatient-discharge-pharmacy resource.  Our primary focus will be looking for patients on new medications that may be difficult to fill when discharged.  We may help coordinate authorizations and discharge insurance formulary alternatives when appropriate.
  • Accept referrals for 20 minute Bedside Medication Therapy Management Consults with patients.  These consults focus specifically on eight education points that fall under the category of Health Literacy and Adherence.
  • Offer a discharge prescription service for patients which will include a 3 and 21 day follow up phone call from the pharmacist.
  • Document all pharmacist/patient activities in the patients EHR so the information may be tracked for value.
This is a big deal for us in the out-patient pharmacy world.  After many months of discussion, the hospital is willing to let us sit in on patient rounds as a discharge medication resource and visit specific patients at their bedside to help with Health Literacy and Adherence education.  Time will tell; however, I feel that if we put as much effort in to the next six weeks as we have into the last 18 months I am sure we will see value in our efforts.


Just keep shoveling!

Thanks
Steve


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