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St. Luke’s Outpatient Pharmacies Advance Patient Safety and Care

By Dr. David C. Pate, News and Community
March 20, 2013

While picking up a prescription recently, I had the opportunity to tour our St. Luke's Boise pharmacy and talk to staff members who, I was delighted to discover, are incorporating our vision and strategy every day in all they do.

 I visited with Pharmacy Operations Manager Mike Griffiths and was so impressed with his clarity around our mission, vision, and strategy that I asked him for a blog piece to share with our St. Luke's family that describes what he and his top-notch staff are doing.  

With the alignment we are achieving around our System through the work of folks like the pharmacy team, we can't help but be successful in achieving our Triple Aim of better health, better care, and lower costs for those we are privileged to serve. Here’s the team's first guest blog entry, written by Mike:

The health care landscape has changed dramatically since I graduated from pharmacy school in 1974. Mine was the last class to use a slide rule and the first to put the name of the drug on the prescription label. Until then, pharmacists tended to be introverts who remained behind the counter and had minimal interaction with their patients.

With the rise of the consumerism movement in the 70s, patients began to demand more information about their medical conditions and medications they were prescribed, including side effects. We were among the first pharmacists to impart our unique knowledge to our patients and share in the rewards of making a positive difference in their lives.

Forty years later, pharmacists have unlimited opportunities to team with fellow health professionals as we all adjust to the new health care landscape and the switch from paper to shared electronic health records, real-time transactions, improving outcomes, efficiency, value-driven payments based upon achieving quality measures, and constantly evolving regulations.

St. Luke’s outpatient pharmacies are continually searching for innovative ways to unlock their potential and collaborate with other health care professionals in support of the Triple Aim. We have embraced the new paradigm through an array of initiatives, some of which I would like to share with you.

MSTI Oral Chemotherapy Program

About five years ago, a few of us were discussing the manner by which MSTI patients received their oral chemo medications – picking up some of their maintenance meds at their local pharmacies and receiving chemo prescriptions by mail order. 

We realized there were opportunities to improve safety and efficiency in this process. We had the oncology specialist pharmacists right here in MSTI who were already interacting with the patients, and the outpatient pharmacy had the expertise to obtain the specialty drugs, bill insurance, and screen these meds against all the other medications and supplements the patients were taking. 

So we developed a new approach. Now, the oncology pharmacist begins by reviewing the medication with the patient in the MSTI office. The outpatient pharmacy technician processes the claim through the  insurance plan so the patient knows up front what the co-pay will be, and collaborates with the patient advocate to apply for any assistance programs to ensure all patients receive their medications. 

Next, the outpatient pharmacist fills the prescription, checking for any drug interactions. The prescription is then delivered back to the MSTI pharmacist who performs a “just in time” check with the patient’s lab results.

Everyone has benefited from this new process. It benefits the patient and reduces waste in the event a medication needs to be changed or withheld, so they are not paying for unused medication and storing the unused and often dangerous drug in their home, which can happen when patients receive prescriptions through a mail order pharmacy. Insurance companies also benefit by avoiding the dispensing of an expensive medication that would otherwise be discarded. 

 In line with the national recognition St. Luke’s has received in so many areas, our oral chemo program has won several prestigious awards, including the American Society of Healthcare Pharmacists Safety Award and the Association of Community Cancer Center’s Innovator Award, and we’ve been featured in numerous publications.

The program has grown exponentially and we anticipate it will continue to expand, since 25 percent of the new chemo drugs in the pipeline will be released as oral medications. Through the program, we have also helped secure more than $1 million in patient assistance for people in our community with no insurance or high co-pay amounts.

Electronic Prescribing Process Improvement

The transition from handwritten paper prescriptions to electronic prescribing has been anticipated to improve safety by reducing errors associated with interpreting prescribers’ handwriting and improve efficiency in the dispensing process.  

As is so often the case when adjusting to new technology and workflow, we have uncovered a new set of challenges as prescribers adjust to selecting medications, dosage forms, and instructions for use in the software systems that support e-prescribing. This has resulted in an increased number of calls between pharmacists and practitioners to clarify elements of the prescription, and occasional delays for patients waiting to pick up their prescriptions. 

With the support of a fourth-year pharmacy student, the outpatient pharmacy conducted a study classifying and documenting the issues, with the goal of sharing this information with prescribers and software manufacturers for education and programming changes. We think this is a great example of collaboration between physicians, pharmacists, and other stakeholders to improve the process.

Support for Accountable Care

St. Luke’s outpatient pharmacies are playing a crucial role in supporting the transition from a fee-for-service to a value-driven reimbursement model based upon proactive population health management and prevention of costly health care issues, such as hospital readmissions. 

As health care systems come under increasing scrutiny and are being held accountable to achieve more stringent quality measures, it is important that each member of the health care team evaluate the role he or she can play in support of this mission. Each of us has our own unique knowledge and training; by avoiding silos, making a personal commitment, and searching for innovative ways to collaborate, everyone wins – most importantly, the patient.

Studies have shown that approximately 25 percent of the prescriptions written are never filled, and up to 50 percent of patients taking medications to treat chronic diseases are not taking their medication as prescribed, due to factors such as side effects, drug interactions, cost, inconvenient dosing schedules, or not understanding the need to continue taking their medication even though they feel fine.

Through value-based services such as Medication Therapy Management, for which pharmacists are reimbursed an hourly fee, pharmacists conduct a comprehensive medication review with a patient, reviewing all their medications, including supplements and herbals. 

We make sure patients thoroughly understand how to use their medications; potential side effects and what to do if they occur; drug interactions; medication cost considerations; and self-monitoring. And we answer any questions or concerns they may have. 

We develop and prioritize action plans to resolve problems that are identified, document encounters, and communicate appropriate information to the physicians and other health care professionals, such as health coaches or dieticians.

Outpatient pharmacists also provide shingles immunizations, staff medication reconciliation and anti-coagulation clinics, and assist with formulary review. We collaborate with the hospital dieticians to serve as a bariatric and diabetic specialty pharmacy, carrying those specialty items recommended by the physicians so patients have ready access to these products and can avoid having to order them online, and we partner with the Healthy U team on projects such as Diabetes Day.

Currently we are working with the Transition of Care team to improve the process by which patients obtain their medications upon discharge. Our goal is to avoid readmissions that might otherwise result when patients leave without their medication, thereby improving patient satisfaction, and in the spirit of our lean TEAMwork principles, eliminating waste.

I would like to share with you one typical encounter I had with a patient recently. He was prescribed an oral inhaler to treat asthma. Another oral medication had been added, followed shortly thereafter by an anti-depressant. 

He had been to the emergency room twice recently with an acute asthma attack; one of those episodes resulted in a hospital admission. 

I began by asking him to demonstrate how he was using his inhaler. It turns out he was using it like a breath spray, so no medication was getting into his lungs. His prescriber had added the oral medication assuming the inhaler wasn’t working, and then the anti-depressant to counter side effects from the oral med. 

After coaching and training with the patient, we provided feedback to his prescriber, who was able to discontinue the other two medications. The patient’s asthma has remained under control.

These are exciting times to be involved in health care. Success will come to those with the vision and fortitude to seize opportunities, innovate, experiment, and share their knowledge and talents with a relentless focus on quality, safety, and ultimately, our patient’s best interests. St. Luke’s outpatient pharmacies are excited to be on this journey. 

This is fantastic work. There is so much that so many at St. Luke's are doing that many are not aware of.  The culmination of all these efforts will be better health, better, care and lower health care costs.  Congratulations, St. Luke's pharmacies!  You are helping lead our transformation!

 

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.