Want to start moving pharmacists into clinical roles? Here's how….
Learn from this pharmacy's experiences
The Medical Center of Columbus, GA, has a decentralized pharmacy that could serve as a best practice model for other health care systems nationwide.
Here's how the hospital pharmacy moved from centralized pharmacy to a decentralized pharmacy:
• Train staff yourself as needed.
The long-term pharmacist shortage is a chief obstacle to hospitals that wish to enhance the role of pharmacists in clinical care. But it's not insurmountable, says Burnis Breland, MS, PharmD, FASHP, director of pharmacy for The Medical Center, which is part of the Columbus Regional Healthcare System.
"We trained our own practitioners when we couldn't find them in the marketplace," he adds. "We hired a few good [PharmD] pharmacists and then matched them up with existing [RPh] pharmacists so they could teach each other."
Staff pharmacists taught the new PharmD pharmacists about drug distribution and practical issues of monitoring patients' profiles and monitoring orders, and the PharmDs helped everyone move toward more clinical care, he says.
As the pharmacy became increasingly decentralized, pharmacists were given the option of staying in the central pharmacy area or moving to patient floors.
"We enabled people to do things they were excited about, which helped make them great pharmacists," Breland says.
A good strategy is to hire people who have the skills you desire, even if they lack experience and then to help experienced pharmacists on staff to upgrade their skills, he adds.
"Over time, as you improve the quality of your staff, you will wind up with staff where all of them can do many things," Breland explains. "We call all of our pharmacists clinical pharmacists now because they're all involved in patient care somehow."
Even the hospital's pharmacists in the central pharmacy are involved in medication management, adjusting doses, and doing things that in the past were considered the work of a clinical practitioner on the floors, he says.
"We've trained our folks so they're quite capable of doing antibiotic dosing and anticoagulant therapy, as well," he adds.
Some training was through staff inservices.
"Fifteen years ago we had PharmDs train RPhs, and that's how we got enough people to practice on the floor," Breland says. "If you take people out of central pharmacy and put them on a floor without additional training and monitoring, then they'll do the same thing they did in central pharmacy because they won't know how to apply drug management."
There should be a good strategic plan for directing pharmacists on the floor and showing them what clinical pharmacy practice is, he says.
On the other hand, a well-rounded hospital pharmacy program also has some pharmacists who work primarily in the central pharmacy.
"I do have a core of people who spend more time in central pharmacy than anywhere else," Breland says. "Those are people who are very effective, efficient, and proficient in drug dispensing, compounding, and making chemotherapy, and it takes some real expertise to do all that."
• Obtain physician buy-in for a new role for clinical pharmacists.
This takes patience and demonstrating the benefits of having pharmacists on the clinical care team, Breland says.
"You can't elbow your way in and say, 'I'm here to do what you've always wanted done,'" he says. "You need to work with physicians and find out what they need and in which areas they want support."
As clinical pharmacists work with physicians, providing them with information, and providing patient care services for them, they'll gain their confidence, Breland says.
"They'll start expecting pharmacists' help and actually demanding it, in fact," he adds.
"It's very beneficial to have the medical staff say they want a pharmacist in the intensive care unit or emergency room to provide care," Breland says. "Testimonials from the medical staff go a long way."
The same strategy should be employed with nurses.
"When nurses see the benefits, they'll say good things to the physicians," Breland says. "Pharmacists on the floor have skills that are needed and useful to the team, and they help support the medical staff."
This buy-in process is a gradual one, but a well-trained clinical pharmacist who is on the floor helping out consistently could be accepted very quickly in the clinical care team, he adds.
• Utilize clinical pharmacist services as efficiently as possible.
Clinical pharmacists can make automatic drug dosing conversions and order labs to ensure medication safety.
When The Medical Center's patients are prescribed one of more than a dozen different medications, there are rules in the pharmacy computer system to identify them and to automatically change an outlier dose to a recommended level, Breland says.
"This does not require a physician's signature, nor does the ordering of lab tests," Breland says.
"It's routine for physicians to ask the pharmacy to manage antibiotic or anticoagulant therapy," he adds.
Also, the pharmacy has technicians in patient care areas to help clinical pharmacists take care of problems that don't require a pharmacist-level of expertise, Breland says.
For instance, if a medication is missing, the pharmacy technician will help find it. Or if pharmacy is asked to make sure medication is directed to the right location, the technicians will assist.
"They'll help pharmacists by entering orders in the computer system and having the pharmacist verify it," Breland says. "They do a lot to help with logistics and help save the pharmacist's time."
Another strategy for ensuring efficiency is to continually revamp the hospital pharmacy program to implement different technologies that will make medication distribution more efficient. As technology improves, it helps to free staffing needs in the distribution area and enables more focus to be put on clinical pharmacy efforts.
"It's very challenging to implement new technologies," Breland notes. "But you can't lose sight of the goal to provide quality pharmacy services, providing the right drugs and having a clinical program in place so that it's functioning optimally, as well."
The Medical Center of Columbus, GA, has a decentralized pharmacy that could serve as a best practice model for other health care systems nationwide.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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