Dr. Angela Boord is a dedicated pharmacy team member on the Transitional Care Unit (TCU) at Iowa Lutheran Hospital. Dr. Boord has been instrumental in developing and implementing process improvements made when transferring patients from acute care to transitional care. The TCU at Iowa Lutheran provides rehabilitation services to patients requiring physical and occupational therapy before their return to their home environment after an acute stay.
Upon graduation from the University of Iowa, College of Pharmacy with a Bachelor of Science in Pharmacy, Angela Boord worked for a national retail pharmacy chain. Throughout the next few years she continued to innovate her practice. She took on new challenges as she transferred positions and continued her education, specializing in diabetes care. In January 2001 she joined the pharmacy team at Iowa Lutheran as primary diabetes educator and medication counselor. In August 2001, the DIA cited the pharmacy for incomplete reviews of patients admitted to TCU. Pharmacy services to TCU did not include dedicated staff time and a decision was made by the management team to develop a team of pharmacists to review and evaluate patients admitted to TCU. Dr. Boord joined the team and led the efforts to innovate and improve care for those patients through creativity, problem solving, and teamwork.
Over the next four years the interdisciplinary team developed new forms, consultation protocols and standard procedures to essentially eliminate medication errors at the time of transfer from acute care to the TCU when the proper procedures are followed. Through the innovation of the Iowa Lutheran staff, in 2005, a pharmacist now reconciles medications within 24 hours of admission, During this significant transition in hospital procedures, two pharmacy team members including Dr. Boord completed their doctor of pharmacy coursework. This led to another significant improvement in the care provided by this pharmacy team. Prior to doctor of pharmacy training there were 9 therapeutic interventions in 2000. With multiple pharmacy team members having now completed their doctor of pharmacy training, the number of therapeutic interventions has increased to 383 in 2004.
“We just try to provide good sound clinical patient care”, says Dr. Boord. The commitment to improving patient care has not ceased with elimination of errors in admission to the transitional care unit. The team’s latest problem-solving project involves helping diabetic patients transition to their home dietary, medication administration, and glucose monitoring routine while in the TCU. Dr. Boord stated that, “most patients don’t eat meals at home with the same regimented regularity that it is done in the hospital.” This new project is another example of entrepreneurial leadership in practice. The continued commitment to innovation and problem solving with the goal of enhancing quality patient care.
Dr. Boord is also an Adjunct Instructor of Pharmacy Practice for Drake University College of Pharmacy. She incorporates pharmacy students in every aspect of the pharmacy team. Students participate in TCU pharmacy services, medication reconciliation, and patient medication education. “It’s a huge confidence booster for them,” says Dr. Boord.
To learn more about the TCU project at Iowa Lutheran Hospital in Des Moines, Iowa read “Evaluating the Impact of a Dedicated Pharmacy Team Providing Enhanced Pharmacy Services to the Transitional Care Unit” in AJHP.
How is this profile an example of Entrepreneurial Leadership in Pharmacy?
As Dr. Boord describes, “We just try to provide good sound clinical patient care”, so how is this an example of entrepreneurial leadership? This profile may best be described as an example of Corporate Entrepreneurial Leadership. At Iowa Lutheran, an opportunity to advance patient care was identified. In this case it was identified by problem analysis resulting from the DIA review. The management team developed the concept to include a new service to be delivered by dedicated pharmacy staff. The service would include review of TCU patient medication profiles. To accomplish this, the management team had to acquire the necessary resources to develop the pharmacy team and put the pharmacy services into action. Obviously this was done. It is likely that they also had limited resources to accomplish this and had to make disciplined decisions about evaluating and moving forward in this area. From this point, the new service was implemented and managed. Over the course of the 4 years since implementation, Dr. Boord describes the increase in therapeutic interventions, the acceptance of the pharmacy team’s recommendations, and the development of new forms and protocols, all of which illustrate a perseverance to implement the change. Most likely, challenges presented themselves along the way, most notably the communication and acceptance by the physician teams that had to be overcome.
In this case, how was the venture “harvested?”
The “Harvesting of the Venture” in this case can be seen through the quality improvements in patient care. Before the new service was started only 26% of patients received a review by pharmacists, now that is 98%. The acceptance rate of the pharmacists’ recommendations has increased to 88%, and the number of interventions have increased from 9 to 383, indicating that drug therapy problems are now being identified that were previously going unnoticed. Less objectively, it is obvious that patients and the other health care providers involved see pharmacists in a much different role than before. Prior to the initiation of the service, the pharmacist was not even seen by patients and was rarely seen by the physician teams. Now, the pharmacists round with the physicians and are even at the level of being the primary healthcare provider to patients in the unit. The value provided by pharmacists and seen by patients and other healthcare providers has increased tremendously through the implementation of these services.