Pharmacists' Role Critical to Patient Safety

An Expert Interview With Brian J. Isetts, PhD, BCPS

Elizabeth McGann, DNSc, RN

January 06, 2012

January 6, 2012 — Editors note: Pharmacists play a key role in reducing adverse drug events and improving patient safety during transitions in healthcare. Pharmacists are one of the most accessible healthcare providers, and are among the best trained to help patients use their medication. Collaboration with other health professionals to implement and evaluate system-wide improvement measures is critical to promoting quality and safety and reducing healthcare costs.

"Partnership for Patients: Collaborations to Improve Safety and Care Transitions" was featured as a podium presentation at the American Society of Health System Pharmacists 46th Midyear Clinical Meeting & Exhibition, the largest international gathering of pharmacists focusing on improving patient care, held December 4 to 8, 2011, in New Orleans, Louisiana.

To find out more about improving safety and healthcare transitions, Medscape Medical News interviewed Brian J. Isetts, PhD, BCPS. Dr. Isetts is a professor at the University of Minnesota College of Pharmacy in Minneapolis. He is currently on sabbatical and is serving as a health policy fellow for the Center for Medicare & Medicaid Innovation in Baltimore, Maryland.

Dr. Isetts has been involved extensively in developing a health service in which pharmacists collaborate with physicians and other providers to help patients achieve goals of therapy by identifying and resolving drug therapy problems. It has been demonstrated that this healthcare service, known as medication therapy management, improves clinical, economic, and humanistic outcomes of care and decreases health expenditures when provided within the practice of pharmaceutical care. Dr. Isetts has worked with the Minnesota Legislature to enact the Minnesota Medicaid Medication Therapy Management Care Law, which was incorporated into the Affordable Care Act, and with the American Medical Association to recognize and report pharmacists' medication therapy management services within the official CPT health reporting and billing nomenclature.

Medscape: What are the purposes of the Center for Medicare and Medicaid Innovation's Partnership for Patients?

Dr. Isetts: The Partnership for Patients is a new public–private partnership that will help improve the quality, safety, and affordability of healthcare for all Americans. The Partnership for Patients brings together leaders of major hospitals, employers, physicians, nurses, pharmacists, and patient advocates, along with state and federal governments, in a collaborative effort between local and national groups to make hospital care safer, more reliable, and less costly.

There are 2 goals of this new partnership: First, to keep patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40%, compared with 2010. Achieving this goal would mean approximately 1.8 million fewer injuries to patients with more than 60,000 lives saved over 3 years. Second, to help patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20%, compared with 2010. Achieving this goal would mean more than 1.6 million patients would recover from illness without suffering a preventable complication requiring rehospitalization within 30 days of discharge.

Medscape: What is your role in this initiative?

Dr. Isetts: My role on the Partnership for Patients team is to work with pharmacists and pharmacy groups to decrease hospital-acquired conditions and readmissions. Aligning and measuring quality improvement related to decreasing adverse drug events and reducing drug-related readmissions is central to the aims of the partnership. Pharmacists have been working to create safer and more effective medication-use systems for many years, so it is imperative that we understand and quantify these improvements consistent with these goals.

Medscape: How does the American Society of Health System Pharmacists (ASHP) work with its membership to reduce adverse drug events and improve care transitions?

Dr. Isetts: ASHP has a significant history of working with members and institutions to build medication-use systems that improve medication effectiveness and safety. ASHP and a number of other pharmacist associations are working with the Partnership for Patients to improve medication safety. A key focus of the midyear session was the announcement by ASHP of a single email that pharmacists can use to report their quality improvement success. Pharmacists are encouraged to submit their adverse drug events and readmissions quality improvement run chart results and quality control data in an email to Quality@ASHP.org, with the subject line: Medication safety quality improvement.

Medscape: What systemic approaches are used by pharmacists to decrease adverse drug events, improve care transitions, and reduce hospital readmissions?

Dr. Isetts: Pharmacists and other healthcare providers can follow a number of best practices to prevent adverse drug events. The Partnership for Patients Web site includes links to the Agency for Healthcare Research and Quality's (AHRQ) Web site on adverse drug events, the US Food and Drug Administration's (FDA) Web sites on adverse drug event reporting and the FDA Safe Use Initiative, and related Web sites from partners like the Institute of Safe Medication Practices and the Institute for Health Care Improvement.

Medication reconciliation is the process of creating and maintaining the most accurate list possible of all medications a patient is taking, and using that list to guide the assessment of therapy. It is one such best practice that has been shown to decrease hospital utilization and prevent readmissions. Medication reconciliation begins when the patient is admitted, continues whenever the patient transitions to another level or setting of care, and occurs again when the patient is discharged. The goal is to provide correct medications to the patient at all transition points within the hospital, and is completed only when each drug the patient is taking has been actively continued, discontinued, held, or modified at each transition point.

Pharmacists have also participated in or pioneered other approaches to decrease adverse drug events. Two examples that come to mind are noted researcher Lucian Leape's work to include pharmacists on interdisciplinary rounds, and Henry Ford Health System's pharmacist-directed anticoagulation service in Detroit, Michigan.

Medscape: How do pharmacists collaborate with other health professionals in these systemic approaches?

Dr. Isetts: Team-based care is integral to improving patient safety. Nearly 900 other researchers have cited patient safety pioneer Lucian Leape's finding that pharmacy participation on interdisciplinary rounds in an intensive care unit decreases adverse drug events related to prescribing errors. More recently, the AHRQ-funded Project:RED showed that a reengineered discharge process that brings together clinical pharmacists, nurse advocates, primary care providers, and individualized instruction resulted in a 24% decrease in hospitalizations. More information about how pharmacists can collaborate with others can be found in the resources section of the Partnership for Patients Web site.

Medscape: What resources are available to healthcare providers who are interested in this topic?

Dr. Isetts: [In addition to the previously mentioned AHRQ, FDA, and related Web sites], resources available to pharmacists for understanding comprehensive medication management can be accessed through the Patient-Centered Primary Care Collaborative.

Medscape: Do patients and families have a role in improving medication safety and care transitions?

Dr. Isetts: Patient and family engagement is essential to improving patient safety in a meaningful way. The Partnership for Patients is working with a number of organizations that will engage Medicare, Medicaid, and Children's Health Insurance Program beneficiaries, their families and caregivers, and others in specific activities supporting the aims of the partnership. They will raise awareness of the problem of patient safety among patients and consumers and mobilize them to seek improvement, develop and deploy tools to help patients and families achieve smooth care transitions (e.g., discharge plans and medication cards) and good inpatient experiences (e.g., checklists to reduce the chance of infection), and convene a national council of organizations representing patients, consumers, and caregivers to test these approaches and suggest new opportunities for improvement.

Medscape: What were the most significant aspects of your presentation?

Dr. Isetts: We cannot do it alone. Every pharmacist in the country can get started by signing the pledge at the Partnership for Patients, encouraging others to do the same, and working with their pharmacy associations and others to share best practices and collect success stories.

Medscape: Is there anything else you would like to add?

Dr. Isetts: Pharmacists play a key role in the Partnership for Patients' aims to reduce adverse drug events and improve care transitions. Pharmacists are one of the most accessible healthcare providers, and are among the best trained to help patients use their medication. Whether you are a community pharmacist partnering with community organizations to offer medication therapy management services, or a clinical pharmacist partnering with physicians and others in a hospital to provide vital team-based care, there has never been a more important time for pharmacists to improve patient safety and decrease readmissions.

Dr. Isetts has disclosed no relevant financial relationships.

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