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Jewish Healthcare Foundation

Pharmacists begin Quality Improvement Demos

November 19, 2007

Eight pharmacists from seven hospitals throughout the region will undertake demonstrations to show how expanding the role of clinical pharmacists in medication management and administration can improve safety and quality of care for patients and possibly reduce costs.

The pharmacists will perform their projects in conjunction with the Pittsburgh Regional Health Initiative (PRHI) under grants from the Jewish Healthcare Foundation's (JHF) Pharmacy Agents for Change Fellowship program. The eight participants were recently selected based on projects proposed as part of an application process that JHF concluded in August.

"We believe that getting the right medication mix may be the most critical element in overall health and recovery," said Karen Wolk Feinstein, PhD, President and Chief Executive Officer of JHF and PRHI.

Dr. Feinstein noted that healthcare reimbursements often aren't structured to support expanded roles for pharmacists. But she said the Fellowship projects, in addition to improving outcomes, may shed light on the kinds of payment changes needed to optimize pharmacists' participation in patient care.

Host institutions each will receive a $15,000 grant to support the pharmacy demonstrations and training. Fellowship participants will receive training in work redesign and process improvement through PRHI's Perfecting Patient CareSM (PPC) University and will use the Toyota-based PPC methods to implement their projects, with coaching support from PRHI and JHF staff.

The program is expected to build on findings of a 1999 study that JHF funded to see if patients with multiple medical conditions would benefit from the intervention of hospital pharmacists. Conducted by researchers at the University of Pittsburgh Center for Research on Health Care, the study concluded that patients often were able to take fewer medications when pharmacists reviewed their prescriptions and that dosing regimens often could be changed or streamlined to achieve better outcomes as well. Such changes can also result in cost reductions.

Medication-related problems result in 200,000 deaths annually in the United States and cost some $200 billion a year, according to research published in the October 20, 2006 edition of U.S. Pharmacist. The article noted that half of the illness, disability and premature death caused by medication-related problems is preventable. It also noted that an estimated 30 percent of hospital admissions in elderly patients may be related to medication-related problems and that $20 billion in healthcare costs are owing to inappropriate prescribing. Polypharmacy was cited as a key contributor to medication-related problems.

Hospitalized patients who suffer from multiple chronic diseases, such as diabetes, high blood pressure and congestive heart failure, are especially subject to complications of polypharmacy, an industry term for the use of multiple medications that may be contraindicated, redundant or, in combination, dangerous. Vulnerabilities arise when patients receive prescriptions from multiple physicians and don't realize that new prescriptions are supposed to replace ones they already are taking, or that the prescriptions conflict with or duplicate medications already in use. Many of these problems occur because there's insufficient communication among physicians, pharmacists, patients and discharge nurse—something that might be alleviated if pharmacists play a greater coordinating role. In addition, pharmacists sometimes find that patients might be better served with different drug choices, doses or dosing schedules.

Projects proposed under the Fellowship program range from a demonstration to reduce patient falls to an improved way of reviewing medications at hospital discharge. (Names of Fellowship participants and brief descriptions of their demonstrations appear below.)

The Pharmacy Agents for Change Fellowship is the latest in a series of professional development programs and demonstrations that JHF began in 2001 to bring process engineering principles, systems thinking and other quality improvement tools into the hands of the region's healthcare professionals. Those who are trained are linked in learning networks to further develop and spread understanding of these methods. In conjunction with PRHI, JHF launched quality improvement fellowships for Physician Champions and Nurse Navigators in late 2005. Late last year, JHF and its other operating affiliate, Health Careers Futures, began a fellowship program to help librarians become more acquainted with resources for researching consumer health questions. In conjunction with HCF, the Foundation also sponsors fellowships in patient safety and medical ethics for graduate students pursuing healthcare-related degrees.

Fellowship awardees, their host institutions and projects are as follows:

Rhonda Horton and Cindy Powers at Allegheny General Hospital will focus on improving communication between hospital and outpatient physicians and pharmacists.

Matthew Eberts at West Penn Hospital will develop procedures to prevent adverse events related to prescription of multiple psychotropic drugs among patients in inpatient rehabilitation.

Irina Sheyko at Jefferson Regional Medical Center will work to improve communication between hospital pharmacists, patients and their admitting physicians. The intervention will be done in collaboration with the South Hills Family Practice physician group, which admits many patients annually to Jefferson.

Karen Pater at University of Pittsburgh School of Pharmacy will attempt to prevent polypharmacy in patients at the University of Pittsburgh Medical Center's Comprehensive Lung Center by ensuring that eligible patients receive Medication and Therapy Management Services.

Julie Nowak at Magee-Womens Hospital aims to prevent polypharmacy at discharge among internal medicine patients by improving procedures enabling pharmacist medication review and by strengthening communications with medical staff and patients.

Jamie Montgomery at Western Psychiatric Institute & Clinic aims to prevent polypharmacy and increase medication compliance among patients with a serious mental illness being discharged from the Transitional Recovery Unit.

Lori Mezeivtch at the University of Pittsburgh Medical Center's HIV/AIDS Program aims to prevent polypharmacy among HIV/AIDS patients by improving the process for pre-discharge medication review in a Presbyterian Hospital unit in which many of the Program's patients are hospitalized.

Kara Lee Shirley at Western Psychiatric Institute & Clinic will improve the medication review component of a process to prevent falls among patients hospitalized in WPIC's geriatric psychiatric unit. The demonstration will draw on results of a concurrent research project designed to identify medications associated with falls among psychiatric patients.

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