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How Hospital-Run Outpatient Pharmacies Improve Care

July 05, 2018

Luke Probst, PharmD, executive director of pharmacy services at Upstate University Hospital in Syracuse, NY, had long envisioned launching a hospital-run outpatient pharmacy. After years of hard work and plenty of red tape, the hospital’s pharmacy finally opened in late June to give pharmacists a platform to improve the quality of in-hospital medication management, enhance discharge transitions of care, and ensure patients take prescribed therapies as directed when they return home.

Dr. Probst spent a few minutes talking about the many benefits his pharmacy team has realized by having a say in the medications patients take after they leave the hospital.

What factors did you consider when deciding to open an outpatient pharmacy?

We've had an outpatient pharmacy presence in our medical center lobby for well over 20 years, but it was run by a local independent pharmacy chain. Our medical center’s leadership realized over the past five years that a good number of patients who are discharged from the hospital don't get their prescriptions filled as intended. In fact, data show that 30 to 40% of patients don’t get their prescriptions filled or are non-adherent to their medication regimen after acute hospitalizations.

With the development of accountable care organizations across the country, there's been a groundswell among healthcare systems to ensure continuity during post-discharge transitions of care. A hospital’s outpatient pharmacy service could be effectively integrated with inpatient and clinic services.

How does having a hospital-run pharmacy improve patient care?

We felt making it easier for patients to get needed medications before they transitioned to home would reduce hospital readmissions associated with nonadherence or lapses in important therapies. Pharmacists and their support staff are employed by the hospital. They have access to the electronic medical records of patients seen in the hospital and physicians’ clinics, and establish collaborative relationships with clinical pharmacists and the medical and the nursing teams within the hospital. That creates a tighter coordination of care in terms of identifying patient medication management needs, medication voids, or medication discrepancies associated with the discharge transition of care.

The pharmacists who work in the outpatient pharmacy have the time to evaluate the medication needs of hospitalized patients and collaborate with inpatient clinical pharmacists to identify and evaluate nuances of prescribed therapies, potentially discontinue therapies, and avoid duplications of medications. In many hospitals, because of restricted formularies, prescribers often substitute the medications patients take at home for equivalent medications. Having control of the outpatient pharmacy ensures patients don’t continue the medications they received in the hospital and resume taking similar agents that they had been taking at home. It’s a more holistic approach to care that ensures patients receive the right medications for the right duration, don’t continue taking medications that were intended for use only during their hospital stays.

How does the pharmacy enhance your hospital’s “med to beds” program?

We have the opportunity to integrate the logistical process of the meds to beds into the hospital’s electronic medical record system. When patients are admitted to the hospital, our nursing colleagues offer them the opportunity to take part in the voluntary program. Patients who express interest are highlighted in the electronic medical system, which notifies the pharmacy team to track their progress during the hospital stay. It leads to a seamless logistical process that makes the transition of care at discharge less urgent and less chaotic.

Does the pharmacy empower pharmacists to take an active role in patient care?

We’ve always had a robust patient-centered care team that involved pharmacists rounding with inpatient teams and being actively involved in medication management. One of the things that we've tried to focus on in the past few years is to optimize transitions of care. Outpatient pharmacists who work under the hospital’s umbrella speak with colleagues on the inpatient side to help establish continuity of care. The pharmacy is open 60 hours per week and staffed with two full-time pharmacists. We also have three full-time pharmacy technicians who help run the pharmacy and support the meds to bed program.

The techs are also involved in obtaining medication authorizations and identifying patients who need copay assistance or other fiscal support. We’ve added 16 full-time equivalents to staff the pharmacy because the services it provides extend well beyond counting and pouring. That investment was important because we felt strongly that the pharmacy would play an important role in the holistic approach to patient care, from supporting and facilitating medications that require prior authorization to helping patients solve financial burdens that could prevent them from receiving the medications they need.

Your hospital also implemented a drug take-back program. Why is that important, especially in the context of the opioid epidemic?

We've always faced challenges associated with patients who are prescribed medications that they no longer need or that get discontinued. Unfortunately, that can lead to unused medications remaining in households, where it can be accessed and potentially abused. There’s also sensitivity to flushing unused medications down the toilet because of concerns of contaminating the waste stream. Those issues have become more complicated because of the current opioid epidemic. Unused opioids are opportunities for intended or unintended abuse and like many healthcare organizations we were limited in our ability to take unused medications back from patients. Now, with the outpatient pharmacy, we have the mechanism in place to take back medications in an appropriate and supportive way that meets regulatory requirements. We’ve installed drug drop boxes in the hospital’s main lobby, outside the pharmacy. We encourage patients, members of our staff, and their family members to use the bins to dispose of medications—especially controlled substances—that are no longer needed. It’s a very safe and effective way to avoid problems associated with unused medications.

Dan Cook

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