Unitbased Pharmacy Introduction Many deaths attributed to adverse events Medication errors accounted for 7391 deaths in 1993 up from 2876 in 1983 1131 outpatient deaths 1854 inpatient deaths ID: 364886
Download Presentation The PPT/PDF document "Evaluation of" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Evaluation of Unit-based Pharmacy Slide2
Introduction
Many deaths attributed to adverse events
Medication errors accounted for 7,391 deaths in 1993, up from 2,876 in 1983
1/131 outpatient deaths1/854 inpatient deathsSlide3
Why have unit-based pharmacists?
Approximately 28% of adverse drug events (ADEs) are preventable (Bates et al.)
Institute of Medicine and Institute for Safe Medication Practices recommendations
Clinical pharmacists improve patient safety and increase cost savingsSlide4
Unit-based (UB) Pharmacists
Two pharmacists deployed to patient care areas in August 2003
Rotate biweekly between the pharmacy and critical care units (ICU, PCU, CICU)
Direct contact with patients and other healthcare professionalsSlide5
Topics of Discussion…
Patient Safety
Financial Considerations
Nursing/Pharmacy RelationsPhysician/Pharmacy RelationsPharmacist Job SatisfactionSlide6
Patient Safety: Medication Errors
Total medication errors for ICU, PCU, CICU, and pharmacy 3 months prior and 3 months following were calculated
Data normalized to med errors/1000 patient days
Substantial reduction observed in all areas examinedSlide7
ICU: Medication Errors/1000 patient days
May, June, July Total=29.3
Aug, Sept, Oct Total=6.9
76.5% Reduction!!!Slide8
PCU: Medication Errors/1000 patient days
May, June, July Total=45.5
Aug, Sept, Oct Total=33
27.5% Reduction!!!Slide9
CICU:Medication Errors/1000 patient days
May, June, July Total=40.3
Aug, Sept, Oct Total=4.4
89% Reduction!!!Slide10
Pharmacy: Med Errors/1000 patient days
May, June, July Total=5.76
Aug, Sept, Oct Total=2.49
56.8% Reduction!!!Slide11
Medication Errors Per Patient Days
ICU
PCU
CICU
Pharmacy
May
3/341
18/467
3/157
41/6127
June
23/291
4/425
11/156
33/5759
July
1/289
38/426
4/134
29/5989
TOTAL
27/921 or
29.3/1000
60/1318 or
45.5/1000
18/447 or
40.3/1000
103/17875 or
5.76/1000
August
1/315
12/429
2/155
11/6126
September
2/293
19/390
0/137
18/5472
October
3/265
10/422
0/165
15/6062
TOTAL
6/873 or
6.9/1000
41/1241 or
33/1000
2/457 or
4.4/1000
44/17660 or
2.49/1000Slide12
Medication Error Rates/1000 Patient DaysSlide13
Clinical Interventions
UB vs staff pharmacists
53.7% higher while in patient care areas
389 total CI’s made while UB180 total CI’s made while staffSlide14
MAR Discrepancies: ICU, PCU, CICU
July-52 MARs reviewed in ICU, PCU, & CICU with 60 total discrepancies
Sept-27 MARs reviewed with 21 total discrepancies
Dec-29 MARs reviewed with 12 total discrepanciesSlide15
MAR Discrepancies: 7th and 8th
Sept-37 MARs reviewed with 24 total discrepancies
Dec-46 MARs reviewed with 17 total discrepancies
Thought to decrease due to decreased workload to pharmacy.Slide16
MAR Discrepancies/MARs reviewed for ICU, PCU, and CICUSlide17
Financial Benefit: CI ADE prevention
Costs of ADEs between $2,000-$5,857 (
Leape
et al, Bates et al)ADEs associated with a mean increased length of stay of 4.6 days (Bates et al)
Value chosen for ADE costs $3,000
UB pharmacists had 10 ADE prevention CI’s
~$30,000 in savings in 3 months, and potential $120,000 over one yearSlide18
Financial Benefit:
ADEs due to Med Errors
Approximately 1% of med errors result in ADEs (Bates et al)
Roughly 0.224ADEs/1000pd prevented in ICU, 0.125 in PCU, 0.359 in CICU, and 0.0327 in pharmacy
$586 saved on ICU, $465 on PCU, $492 on CICU, and $1732 in pharmacy
Total of $3275 saved in first 3 months, ~$13,103 over an entire yearSlide19
Financial Benefit: All Cost Saving CIs
Clinical
activities tracking software
often
used to assign cost savings to specific
clinical interventions (CI)
Do not have appropriate system of documenting CIs
Used $30.35 for each CI associated with cost savings.
Examples: CODE response, drug allergy related, formulary switches, IV to PO switches, lab ordered, renal dosing, etc. Slide20
Financial Benefit: CI’s (cont’d.)
Cost saving CI’s while UB:
216 x $30.35=$6555.60
Cost saving CI’s while in pharmacy:136 x $30.35=$4127.60
~$2428 cost savings in first 3 months, approx. $9712 over entire yearSlide21
Financial Benefit: Cost of UB Pharmacist
Additional cost of pharmacist in pt care areas determined by productivity differences
UB pharmacist completes ~63.7% of the workload of “staff” pharmacist
Therefore, cost to re-deploy is 36.3% of pharmacist salary plus benefits
$36.30/h base pay; 36.3%=$7,716 in 3 months and ~$33,437 for an entire yearSlide22
Productivity Comparison of UB vs. Staff PharmacistSlide23
Financial Benefit: The Grand Total
1st 3 months:
($30,000+$3275+$2428)-$7716 =$27,987 in cost savings
Extrapolated to one year:
($120,000+$13,103+$9712)-$33,437 =$109,378 in cost savingsSlide24
Nursing/Pharmacy Relations
Satisfaction survey distributed to nursing staff on ICU,PCU,CICU
20 nurses completed initial survey given prior to implementation of UB pharmacist
21 nurses completed follow-up survey given after implementationSlide25
Nursing/Pharmacy Relations
Accessibility of pharmacists
# of nurses responding “very accessible”
ed by 47%Helpfulness of pharmacists
# responding “very helpful”
ed by 33%
Quality of work
# “very good” or “excellent” ed by 43%Slide26
Nursing/Pharmacy Relations
Consultation of pharmacists
# of nurses consulting pharmacists 4-6 times/day
ed by 33%
Most valuable service
# of “unit based” responses ed by 36%
Drug information, drug distribution, and appropriate drug selection remained most important duties of pharmacists according to nursing staff.Slide27
Physician/Pharmacy Relations
Small survey of physicians
Seven surveys distributed, six completed and returned
UB pharmacists very well received by responding physicians
All stated UB pharmacists improve pt care, provide useful recommendations, and would recommend continuing the program.Slide28
Job Satisfaction
Survey by
Sansgiry
et. al.Diversity, advancement opportunities, and clinical and pt focused activities key to satisfaction.
Dissatisfaction with lack of opportunity and self-actualization in areas of clinical practice. Slide29
Job Satisfaction
Dissatisfaction leads to organizational ineffectiveness.
Using pharmacists skills
satisfaction and long-term commitmentProviding clinical opportunities for pharmacists ed productivity, recruitment and retention Slide30
Why Unit-based Pharmacy Works!
Medication errors:
49% during prescribing stage
Clinical pharmacists can impact physician prescribing and provide recommendations
11% during transcription
More acutely aware of pts condition and can catch transcription errors more frequently
14% during dispensing
ed by ed distraction in the main pharmacy and ed workload in the pharmacySlide31
Why Unit-based Pharmacy Works (cont’d.)
Medication errors (cont’d.)
26% during administration
UB pharmacists readily available to answer any nursing questions re: administration
UB pharmacists also have time to monitor patients and review meds to ensure proper monitoring parameters are performed.Slide32
Literature…
Kucukarslan
et al showed 78% decline in ADE’s with UB pharmacists
McMullin et al: ~$113,000 each year saved with UB pharmacists
Projected $394,000 in savings/year if expanded throughout entire hospital
Bond et al: As staffing of clinical pharmacists
ed, drug costs ed.
…
Benefis
Healthcare’s results are reproducible and valid!!!Slide33
Improvements for future…
Clinical intervention documentation
Patient counseling and in-services to nursing staff
More involvement in protocol developmentExpansion throughout hospital!!!!!Slide34
Conclusion
Increasing costs of pharmaceuticals provide dilemma to contain costs
Deploying pharmacists to patient care areas effective and efficient in
ing costs
Patient care, interdepartmental relations, retention have all improved
Expansion throughout the hospital to provide WORLDCLASS service to patients, staff, and
administration