Implementation of a standard pharmacy clinical practice model in a multihospital system

Abstract

The implementation of a standard pharmacy clinical practice model in a multihospital health system is described. An initiative to enhance the quality and scope of pharmacy clinical practices by transitioning from a pharmacy practice model focused on order entry and distributive functions to a patient-centered model focused on drug therapy management and documentation was begun within the Providence Health and Services System. After demonstrating favorable results during pilot testing in the system's largest hospital, the pharmacy practice model was implemented at two facilities, which took approximately six months. A documentation program was implemented at each hospital to provide a baseline for measuring the impact of changes in practice and to standardize clinical activity at each hospital. Changes implemented in the distribution process at the two facilities freed up as much pharmacist time as possible. These changes included the optimization of technology, automated dispensing cabinets, order-image scanner technology, and an automated telephone tree to route distribution-related calls to a technician. At both hospitals, the number of interventions documented by the pharmacists increased from 2005 (before implementation) to 2008. The associated cost avoidance also increased, and the daily supply expense per case-mix-adjusted patient day decreased during this time. Based on the positive data from these facilities, wide distribution of this clinical practice model is being adopted. The implementation in a multihospital system of a patient-centered clinical practice model was achieved through a well-coordinated effort that included gaining support of hospital administration by demonstrating the impact of clinical pharmacy services on patient care and hospital finances.