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Pharmacy Practice Model Initiative

Decentralizing the Hospital Practice Model

What is the ideal pharmacy practice model? According to Fort Belvoir Community Hospital, it involves a patient-centered model in which pharmacists accept ownership and accountability for both clinical and distributive functions. Thomas Jefferson University Hospital added that the model must allow for creativity and freedom for innovation. It is because of these views that many hospitals and hospital systems are putting an emphasis on collaborative practice and moving toward a more decentralized practice model.

ASHP’s Pharmacy Practice Model Initiative has featured 20 hospitals and hospital systems on their website, spotlighting innovative practice models that have worked to improve efficiency, patient safety, and quality of care. Which practice models have been found most effective and how did they accomplish the change? Read on to find out.

What problems were found with current centralized pharmacy practice models?

As several hospitals found, the centralized practice model, in which pharmacists were divided between clinical and distributive staff, was not effectively allowing for pharmacist to have maximal benefit on patient care. Patient interaction was limited and job satisfaction was low. Because of this, many have chosen to decentralize as many pharmacists as possible. This requires the minimization of division between clinical and distributive services, thereby providing sufficient opportunity for professional growth and development of staff.

By allowing pharmacists to provide both clinical and distributive functions, they were given accountability over both types of operations. This increased pharmacist job satisfaction, evidenced by reduced pharmacist turnover rates, improved medication turn-around-time, and improved physician and nurse satisfaction. Increasing involvement of decentralized pharmacists allows for an extension in the coordination of care and improves patient safety.

How were these changes in practice models accomplished?

The various hospitals used different techniques to efficiently change models with minimal disruption of normal activities.  Florida Hospital Orlando chose to partner clinical pharmacy specialists with generalist pharmacists to aid training and provide mentors for the new decentralized roles. Greenville Hospital System altered their pharmacist work schedules with additional overlap to allow for additional training and activities. This helped increase involvement by decentralized pharmacists in several key areas, including medication histories on admission, medication reconciliation process, patient discharge counseling on medications, and expansion of patient education programs, including oral anticoagulation therapy.

What lessons were learned throughout this process?

  • Feedback at every step is important for success. Share and celebrate success with newsletters, staff meetings, etc.  –Florida Hospital Orlando
  • Pilot processes first before rolling out to larger areas, always tying programs back to quality improvement. –Greenville Hospital System
  • Add more time than originally planned; the length of time for a full practice model change will likely take longer than originally expected. Understand that not everyone will believe in the original vision. Develop a task force and train them on new responsibilities. –University of North Carolina Hospitals
  • Define specific and attainable goals in line with your strategic priorities; build and demonstrate the value for pharmacy services. –Fort Belvoir Community Hospital
  • Collaboration, engagement, and communication are the three key critical success factors for successful initiative implementation. –Bystate Health/Bystate Medical Center
  • Take risks to achieve optimal practice goals that progress to a better practice model. The opportunities are endless, and the rewards are rich. An open mind and a positive attitude will go a long way. –Thomas Jefferson University Hospital

The pharmacy profession is part of a changing healthcare environment, and the time is right for expanding our role in the provision of patient care. To read more about each hospital’s change in practice model and how they accomplished it, see the individual profiles on the PPMI website here.