Scott J. Knoer

Effect of lean process improvement techniques on a university hospital inpatient pharmacy.

PURPOSE The effect of lean process improvement on an inpatient university hospital pharmacy was evaluated. SUMMARY The University of Minnesota Medical Center (UMMC), Fairview, implemented lean techniques in its inpatient pharmacy to improve workflow, reduce waste, and achieve substantial cost savings. The sterile products area (SPA) and the inventory area were prospectively identified as locations for improvement due to their potential to realize cost savings. Process-improvement goals for the SPA included the reduction of missing doses, errors, and patient-specific waste by 30%, 50%, and 30%, respectively, and the reallocation of two technician full-time equivalents (FTEs). Reductions in pharmaceutical inventory and returns due to outdating were also anticipated. Work-flow in the SPA was improved through the creation of accountability, standard work, and movement toward one-piece flow. Increasing the number of i.v. batches decreased pharmaceutical waste by 40%. Through SPA environment improvements and enhanced workload sharing, two FTE technicians from the SPA were redistributed within the department. SPA waste reduction yielded an annual saving of

Implementation of Clinical Pharmacogenomics within a Large Health System: From Electronic Health Record Decision Support to Consultation Services

275,500. Quality and safety were also improved, as measured by reductions in missing doses, expired products, and production errors. In the inventory area, visual control was improved through the use of a double-bin system, the number of outdated drugs decreased by 20%, and medication inventory was reduced by

Implementation of an i.v.-compounding robot in a hospital-based cancer center pharmacy.

50,000. CONCLUSION Lean methodology was successfully implemented in the SPA and inventory area at the UMMC, Fairview, inpatient pharmacy. Benefits of this process included an estimated annual cost saving of

Stewardship of the pharmacy enterprise

289,256 due to waste reduction, improvements in workflow, and decreased staffing requirements.

Pharmacy practice model for academic medical centers.

The number of clinically relevant gene‐based guidelines and recommendations pertaining to drug prescribing continues to grow. Incorporating gene–drug interaction information into the drug‐prescribing process can help optimize pharmacotherapy outcomes and improve patient safety. However, pharmacogenomic implementation barriers exist such as integration of pharmacogenomic results into electronic health records (EHRs), development and deployment of pharmacogenomic decision support tools to EHRs, and feasible models for establishing ambulatory pharmacogenomic clinics. We describe the development of pharmacist‐managed pharmacogenomic services within a large health system. The Clinical Pharmacogenetics Implementation Consortium guidelines for HLA‐B*57:01‐abacavir, HLA‐B*15:02‐carbamazepine, and TPMT‐thiopurines (i.e., azathioprine, mercaptopurine, and thioguanine) were systematically integrated into patient care. Sixty‐three custom rules and alerts (20 for TPMT‐thiopurines, 8 for HLA‐B*57:01‐abacavir, and 35 for HLA‐B*15:02‐anticonvulsants) were developed and deployed to the EHR for the purpose of providing point‐of‐care pharmacogenomic decision support. In addition, a pharmacist and physician‐geneticist collaboration established a pharmacogenomics ambulatory clinic. This clinic provides genetic testing when warranted, result interpretation along with pharmacotherapy recommendations, and patient education. Our processes for developing these pharmacogenomic services and solutions for addressing implementation barriers are presented.

A review of American pharmacy: education, training, technology, and practice

PURPOSE The implementation of a robotic device for compounding patient-specific chemotherapy doses is described, including a review of data on the robots performance over a 13-month period. SUMMARY The automated system prepares individualized i.v. chemotherapy doses in a variety of infusion bags and syringes; more than 50 drugs are validated for use in the machine. The robot is programmed to recognize the physical parameters of syringes and vials and uses photographic identification, barcode identification, and gravimetric measurements to ensure that the correct ingredients are compounded and the final dose is accurate. The implementation timeline, including site preparation, logistics planning, installation, calibration, staff training, development of a pharmacy information system (PIS) interface, and validation by the state board of pharmacy, was about 10 months. In its first 13 months of operation, the robot was used to prepare 7384 medication doses; 85 doses (1.2%) found to be outside the desired accuracy range (±4%) were manually modified by pharmacy staff. Ongoing system monitoring has identified mechanical and materials-related problems including vial-recognition failures (in many instances, these issues were resolved by the system operator and robotic compounding proceeded successfully), interface issues affecting robot-PIS communication, and human errors such as the loading of an incorrect vial or bag into the machine. Through staff training, information technology improvements, and workflow adjustments, the robots throughput has been steadily improved. CONCLUSION An i.v.-compounding robot was successfully implemented in a cancer center pharmacy. The robot performs compounding tasks safely and accurately and has been integrated into the pharmacys workflow.

Institutional Profile: Cleveland Clinic’s Center for Personalized Healthcare: setting the stage for value-based care

The implementation of health care reform has accelerated the need to achieve significant financial efficiencies within our organizations. One way to be successful in this new paradigm is to create economies of scale that minimize the infrastructure costs associated with running individual or small

Creating pharmacy staffing-to-demand models: Predictive tools used at two institutions

The pharmacist’s role in health systems continues to evolve from a product-focused to a patient-centered care model that ensures the safe and effective use of medications in all practice settings. The best way to deploy pharmacists, technicians, and technology in support of the transition has been

Strategies for success in implementing practice model change.

In the United States, pharmacists are responsible for the provision of safe, effective, efficient, and accountable medication related-care for hospital and health-system patients. Leveraging automated technologies, pharmacy technicians, and pharmacist extenders are the means through which efficient, effective, and safe medication use processes are created and maintained. These strategies limit the amount of pharmacist resources needed for nonjudgmental tasks such as medication distribution, allowing more capacity for advanced direct patient care roles.Pharmacists are directly integrated into interprofessional medical teams. Pharmacists optimize patient outcomes through a variety of channels, including: providing recommendations for evidence-based medication selection on patient care rounds; offering drug information to other health care providers and patients; monitoring therapeutic responses; and reconciling medications as patients transition across the continuum of care.Achieving the highest level of pharmacy practice necessitates that United States pharmacists are soundly educated and trained. Pharmacist education, training, and professional practice models closely mirror those of physicians. Many health-systems also pursue credentialing and privileging of pharmacists to ensure competency and facilitate growth and development. Advanced training, along with credentialing, privileging, and collaborative practice agreements have positioned pharmacists to serve as stewards of the medication use system, champions of patient safety, and essential contributors to optimal patient outcomes.

Building value: Expanding ambulatory care in the pharmacy enterprise

Cleveland Clinic (OH, USA) launched the Center for Personalized Healthcare in 2011 to establish an evidence-based system for individualizing care by incorporating unique patient characteristics, including but not limited to genetic and family health history information, into the standard medical decision-making process. Using MyFamily, a web-based tool integrated into our electronic health record, a patients family health history is used as a surrogate for genetic, environmental and behavioral risks to identify those with an elevated probability of developing disease. Complementing MyFamily, the Personalized Medication Program was created for the purpose of identifying gene-drug pairs for integration into clinical practice and developing the implementation tools needed to incorporate pharmacogenomics into the clinical workflow. We have successfully implemented the gene-drug pairs HLA-B*57:01-abacavir and TPMT-thiopurines into patient care. Our efforts to establish personalized medical care at Cleveland Clinic may serve as a model for large-scale integration of personalized healthcare.