Hospitalist-pharmacist collaboration can reap benefits for organizations
ASHP and SHM promoting increased partnership
Health care organizations increasingly are realizing that pharmacists should be included in collaborative medical decisions, and one collaboration with particular potential is the one between hospitalists and pharmacists.
The American Society of Health-System Pharmacists (ASHP) and the Society for Hospital Medicine (SHM) issued a joint statement earlier this year, promoting such collaborations.1
The ASHP-SHM joint statement is intended to show how the two disciplines can optimize patient care. For instance, according to the statement, both hospitalists and pharmacists are responsible for indirect patient care and service activities, including developing institutional policies and infrastructure.1 (See key points of joint statement.)
"One of the reasons why we wrote this white paper was to increase the number of hospitalist-pharmacist collaborations," says Mark V. Williams, MD, FACP, a co-author of the joint statement. Williams also is a professor and chief of the division of hospital medicine at Northwestern University Feinberg School of Medicine in Chicago, IL.
While Williams worked at Emory University in Atlanta, he collaborated with a pharmacist on efforts to improve medication reconciliation and on a project funded by the Agency for Healthcare Research and Quality, which focused on improving the discharge process — Patient Safe-D(ischarge).
At Northwestern, there have been hospitalist-pharmacist collaborations related to medication reconciliation, as well, Williams says.
It makes particular sense for the hospitalist-pharmacist collaboration when an institution makes quality improvement a top priority.
For example, a pharmacist might be assigned a role in improving clinical quality, says Kristine Gleason, RPh, a clinical quality leader at Northwestern Memorial Hospital in Chicago.
"I'm in a unique role for a pharmacist," Gleason says.
"I participate in looking at quality practices within the organization, including publicly reported measures and national patient safety goals," Gleason adds. "We have a nice relationship with our hospitalist service, and we're interacting from a clinical quality improvement perspective."
Sometimes the collaboration is established for the purpose of improving a particular clinical practice.
"I've seen projects where pharmacists collaborated on glycemic control," Williams says.
"Ideally, I'd like to see a pharmacist interacting every day with hospitalists as they deliver care in hospitals," Williams says.
A classic example of how a collaboration could improve patient care and safety is the process of a pharmacist attending rounds with the medical team. The pharmacist might point out an instance where a medication's dosing could be dangerous for a particular patient, Williams says.
This type of situation might arise with an elderly patient who has lower renal functions, he explains.
"Using low molecular weight heparin in someone with reduced renal function can result in over-anticoagulation," Williams says. "And I've seen this happen."
Also, pharmacists who are included on rounds can point out the potential side effects that occur from mixing medications, and they're superior to physicians on collecting medication histories because of their training in doing so, he adds.
Pharmacists and hospitalists are more than willing to collaborate, but the problem is that no mechanism exists in the typical payer system to reimburse this support, Williams notes.
"Hospitals have to support it on their own, which is expensive," he says.
The places where this collaboration has worked best are those where state funding supports pharmacist support, such as in North Carolina and Wisconsin, Williams says.
One key to making a hospitalist-pharmacist collaboration work is to identify potential projects for the team.
"I've helped organize a multidisciplinary meeting led by the hospitalist to obtain input from front-line staff members regarding potential patient safety projects for the next fiscal year," Gleason says.
"Meetings like these help us identify additional opportunities from the staff's perspective beyond those required from a regulatory standpoint to enhance patient care," Gleason says. "These can be related to direct care of patients in terms of disease states like heart failure and pneumonia."
The collaborative team could work on these types of questions, Gleason suggests:
- How do we prepare a patient for discharge?
- How does technology support these efforts?
- How should we conduct medication reconciliation?
- How do we perfect pharmacy issues with technology?
Gleason's work includes supporting process improvement efforts related to medication reconciliation at patient admission and discharge.
"We have a patient safety initiative to make sure patients go home with the correct lists of drugs and that they understand their medication regimens," Gleason explains.
Health care organizations need to view the hospitalist-pharmacist collaboration as an opportunity to improve the quality of care in the hospital, Williams says.
"I think there's some evidence being published that by investing and supporting the use of pharmacists in hospital care, you can actually save money overall," Williams says. "It could provide a true return on your investment."
Other benefits would be that hospitals could identify and prevent adverse drug events, facilitate the proper use of medications in dosing, shorten the hospital length of stay, identify appropriate routes of medication administration, and give drugs orally instead of through intravenous drugs, Williams says.
The proper use of intravenous drugs could save an institution money, as well, he adds.
The key is for an institution to identify the processes and systems that need improvement and the most attention.
For example, if an institution wants to focus on improving care for heart failure patients, then a hospitalist-pharmacist collaboration might be an important strategy for ensuring that a patient's discharge instructions are followed, Gleason says.
"Hospitalists know the processes and protocols and types of patients you see in an inpatient setting — the very complex and sick patients," Gleason notes.
"It makes sense to link pharmacists who are trained in medication management with hospitalists who know the unique needs of patients in hospitals," she adds.
"When pharmacists and hospitalists collaborate, they can improve the overall care delivery and begin to develop more standardized approaches to health care," Williams says.
Reference
- Cobaugh DJ, Amin A, Bookwalter T, et al. ASHP-SHM joint statement on hospitalist-pharmacist collaboration. Am J Health-Syst Pharm 2008;65:260-263.
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