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The Expanding Role of Pharmacists: Out of the Basement and Into the Spotlight
Tina Moen, Pharm.D., Chief Clinical Officer, Truven Health Analytics
What does it mean to be a pharmacist in 2014? I recently presented at the Health Connect Partners Spring Pharmacy Conference to a room full of pharmacy leaders from across the country. We discussed the evolution of the practice of pharmacy, the things we have seen change over the years, and the opportunities and challenges we see on the horizon. Throughout the conference, many attendees shared stories of how their responsibilities as a pharmacist have evolved throughout their careers. Our conclusion is that now, more than ever, there are visible, meaningful changes to our role as it relates to patient care, collaboration with our peers, and leadership participation in the healthcare community.
Clinical pharmacy services as we know it are a result of continuous evolution of the historical pharmacy role – namely dispensing medications from behind the counter or in the basement. This evolution has taken many years. Pharmacists now deliver enhanced value to their organizations and their patients with a focus on quality, safety, and efficacy of medication therapies. Programs, such as enhanced Medication Therapy Management, continue to highlight the impact pharmacists can make on reducing adverse effects and improving efficacy of a patient’s medication regimen. Additionally, pharmacists contributing to medication reconciliation and specialty services, like anticoagulation or diabetes clinics, continue to demonstrate that rounding out the care team to include a medication specialist improves patient outcomes and enhances the practice and performance of clinical peers. And recently, I have seen emerging cross-functional leadership teams working toward goals such as the IHI “Triple AIM”, begin to include pharmacy; tying personal goals and incentives for DOPs to these efficiency and quality objectives.
Clearly, great progress has been made in the practice of pharmacy and I, for one, am proud of the role pharmacists play in enhancing the patient experience and outcomes. So, what’s next? Here are the things that come to mind when I ask myself this question:
Healthcare IT: A recent article in Healthcare IT News advocated for pharmacists playing a larger role in EHR strategy. As a pharmacist who works within the healthcare IT industry, I couldn’t agree more. What percentage of patients in a hospital have at least ONE medication order? I would venture to say most. It is an obvious conclusion that the profession charged with the safe and effective use of medications should have a significant role in the development, selection, and implementation of tools used to properly care for those patients. And then there is Meaningful Use. How many of the Meaningful Use Objectives are related to medications and the services in which pharmacists participate? Who better than to take the lead in organizational efforts for Stage II attestation and Stage III planning?
Care Collaboration: Cross-departmental coordination for initiatives that span hospital leadership continues to grow in scope and importance. Benefits of pharmacists as integral members of rounding teams within the inpatient setting are well-documented. With organizations designing and implementing Population Health and ACO strategies, pharmacy leaders can capitalize on the combination of data analytics and clinical insight that are the hallmarks of pharmacy practice. As Population Health initiatives evolve – who better than a pharmacist to guide trends in medication recommendations for treating high-risk conditions and ensuring safe, cost-conscious practice remains top of mind?
Quality Patient Care: Providing quality patient care has always been a focus of healthcare providers. Today’s environment adds a variety of incentives and penalties to drive quality. How are pharmacists contributing? In many ways! Pharmacists are well-suited to lead the charge on initiatives like Antimicrobial Stewardship, a quality and a cost management initiative. The importance of medication education and adherence in the improvement of HCAHPS scores and the reduction of readmissions are additional examples how pharmacists can and should use their skills as medication specialists to drive improved patient care. Because results summaries from nation-wide HCAHPS surveys indicate that Medication Safety and Pain Management questions are still amongst the lowest performing areas – shouldn’t pharmacists’ input at the patient care level be paramount?
As I said during my visit to Health Connect Partners, it is good to look back occasionally to see the progress that has been made and to help motivate us for the challenges and opportunities ahead of us. What is next? What have I missed? I would love to hear from my fellow pharmacists on where the practice of pharmacy will be in the next 10 years. What are you doing today to move the needle in the evolution of pharmacy?
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Introducing Micromedex Solutions Consulting Services
Hospitals are facing increasingly complex challenges to meet new and changing healthcare reform objectives and initiatives. And in many cases, hospitals have few resources available to navigate these challenges effectively.
We’re here to help. Introducing Micromedex Solutions Consulting Practice, offering professional services in key areas to help hospitals advance their organizational goals. From identifying cost efficiencies in medication management, to designing compliance and population management programs that meet clinical imperatives while driving toward financial objectives, Micromedex Solutions has proven, trusted clinicians and clinical IT healthcare specialists to help healthcare organizations better evaluate and prepare for the changes ahead.
For more information, visit micromedex.com/clinical-consulting.
Using Micromedex Solutions to Boost HCAHPS Scores
A major focus for hospitals and health systems today is improving quality care and the overall patient experience. The stakes are high. How well you perform in these areas as well as how your facility scores on the HCAHPS survey can affect CMS reimbursement, with incentive payments for high scores and financial penalties for low scores.
There is a proven link between care quality, patient education, and HCAHPS scores. Medication counseling is an important aspect of patient communication in the inpatient setting. By giving patients clear, easy to understand information about their care and condition; you can improve patient outcomes, boost your medication-related HCAHPS scores, and maximize reimbursements.
Micromedex can help. View this clinical scenario and learn how you can use Micromedex Solutions to fill the gaps in patient education, improve patient satisfaction, and boost your HCAHPS scores.
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TIPS & TRICKS
Resources to Help You Manage MERS
In response to the Middle East respiratory syndrome coronavirus (MERS-CoV), the following resources are available:
Drug Consults in Micromedex Medication Management offer fully referenced, evidence-based articles that cover a wide range of topics on drug therapies and treatment guidelines. The following information, specific to MERS-CoV is now available:
- Disease etiology
- Clinical presentation
- Treatment and management
- Preventing exposure
Simply use the search term "MERS" to access the new Drug Consult.
Evidence-based Patient Education resources specific to MERS-CoV are also available:
- General information
- Inpatient care
- Discharge care
- Aftercare instructions
These resources will be available in the Micromedex CareNotes patient education solution in August.
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IN THE SPOTLIGHT
Pharmacists at Freeman Health System Improve Quality and Patient Outcomes with Real-Time Clinical Surveillance
Adult malnutrition is a common problem, affecting as many as 60 percent of hospitalized patients in the U.S., and a major contributor to poor patient outcomes, longer hospital stays, and higher healthcare costs. Malnutrition is often present on hospital admission, and if identified early, malnourished patients, or those at risk of being malnourished can be treated appropriately, leading to better outcomes.
Recognizing the prevalence of malnutrition among adult patients at their hospitals, pharmacists at Freeman Health System, a not-for-profit, three-hospital system in Southwest Missouri, implemented a process to identify patients with signs of malnutrition at admission and while in the hospital, to improve care quality and outcomes and increase revenue. Primarily, coders spent significant time each day manually reviewing patient records to identify patients with signs of malnutrition. Once identified in the hospital, a nutrition support pharmacist would ensure intervention. Charts were reviewed once more for coding accuracy to check for reimbursement. In their efforts to address malnutrition, they found it time-consuming and challenging to identify malnourished patients early enough to avoid complications and before discharge.
To improve process and manage pharmacy interventions specific to cost and care management, Freeman Health implemented Pharmacy Intervention, part of the 360 Care Insights Suite, a real-time, enterprise-wide clinical surveillance technology solution that identifies at-risk patients and informs staff when patients meet specific clinical criteria for early intervention. Specifically, pharmacists derived a profile that identifies patients who have early warning signs of malnutrition. The technology monitors patient data in real-time and from multiple sources and looks for specific criteria, including structured data, such as lab values and body mass index, and unstructured data, such as keywords in the admitting diagnosis, like weight loss and muscle wasting. When a patient is identified through surveillance, via an alert or automated list generation, staff can easily access the patient’s data and leverage built-in evidence-based guidelines to address the warning signs and avoid complications, as well as document the clinical intervention.
With real-time clinical surveillance, Freeman Health realized the following benefits:
- Improved patient outcomes. Research shows that malnutrition, when identified early and properly treated, results in shorter hospital stays and better patient outcomes. Since implementation, about 10 patients every month are identifiedas being at risk for malnourishment, or malnourished.
- Significant time-savings. Every day, a list of patients meeting specific malnutrition criteria is generated automatically, in less than three minutes. This was previously a manual process, for which it took two coders significant time toreview patient records.
- Increased revenue: Over a six-month period, the identification and diagnoses of malnourished patients resulted in 13 interventions for an estimated increase in reimbursement of over $30,000. The total estimated increase is over $115,000 this year, based on a $17,000 boost in the first two months. Additionally, timely documentation brought about additional revenue, as delayed documentation often resulted in non-payment.
As a result of these accomplishments and innovations, Freeman Health System received an 2014 Advantage Award from Truven Health Analytics for its innovative use of Micromedex 360 Care Insights in improving quality and patient outcomes.
Read the press release announcing Freeman Health System as the winner of the Advantage Award.
Learn more about Micromedex 360 Care Insights.
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Micromedex Drug Information App for Android and Windows 8 Devices
The current version of the Micromedex Drug Information mobile app is retired from the Google Play® and Windows® Stores. In its place, there are two apps to choose from, each providing the same functionality and evidence-based clinical decision support content you’ve come to rely on from Micromedex: Free Micromedex Drug Reference is available free of charge, exclusively to those with an online subscription to Micromedex. For those who don't have access to an Internet subscription to Micromedex, Micromedex Drug Essentials will be available for just $2.99 per year. For more information about these upcoming changes, visit micromedex.com/mobile.
NHSN Reporting Made Easier With Micromedex 360 Care Insights Release
NHSN reporting is now even easier with Infection Prevention, part of the Micromedex 360 Care Insights Suite. The latest 360 Care Insights release includes the auto-population of patient-specific microbiology results into NHSN reporting forms — saving valuable time, streamlining documentation, and reducing reporting errors.
Learn more about 360 Care Insights.
Free Trial: Award-Winning Health Education to Engage Patients of All Ages
Educate and engage patients of all ages to get well and stay well with award-winning health education videos from Health Nuts Media, an excellent complement to Micromedex CareNotes.
Register for a free trial.
With Micromedex Pediatric Video Education:
- Explain difficult concepts using terms, graphics, and characters understood by children
- Foster health literacy
- Ease a child's concerns about specific healthcare conditions
- Provide an enhanced, interactive, and effective patient education experience for the entire family
- Educate families together, particularly those for whom English is not a first language
Learn more at micromedex.com/pediatric-video-education.
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New CareNotes Titles Planned for Q4 Release
For a list of titles we are working on for our next release, visit micromedex.com/carenotes/updates. While the exact list may change, this will gives an idea of what’s coming soon.
CLINICAL CONTENT UPDATES
Selected New Drug Approvals
U.S. Food and Drug Administration (FDA)
: A glucagon-like peptide-1 receptor agonist (GLP-1) approved for once-weekly subcutaneous administration as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes. It is not intended as first-line therapy. It is approved with a REMS strategy.
Antihemophilic factor (recombinant) Fc protein fusion injection (Eloctate)
: Approved for the prevention, control, and perioperative management of hemophilia A in adults and children. It contains a protein fragment, Fc, which allows for a longer duration in the blood. More frequent dosing may be needed for children younger than 6 years.
: Approved for the treatment of patients with anaplastic lymphoma kinase (ALK)-positive metastatic non-small cell lung cancer who have progressed on or are intolerant to crizotinib. This indication is approved under accelerated approval based on tumor response rate and duration of response. An improvement in survival or disease-related symptoms has not been established. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials.
: Approved for acute skin and skin structure infections caused by susceptible strains of Gram-positive microorganisms. The pharmacokinetic profile allows for once-weekly dosing. It has excellent activity against gram-positive bacteria with potent inhibition of Staphylococcus aureus, including methicillin-resistant S. aureus.
: New oral suspension dose form, approved for the treatment of patients with acute lymphoblastic leukemia as part of a combination regimen.
: New hand-held autoinjector dose form for the emergency treatment of known or suspected opioid overdose; intended to be used by family members or caregivers for suspected opioid overdose.
: Approved for the treatment of advanced stomach cancer or gastroesophageal junction adenocarcinoma. This is the first monoclonal antibody approved to treat gastric cancer.
: Approved for the treatment of patients with multicentric Castleman’s disease who are human immunodeficiency virus (HIV) and human herpesvirus-8 (HHV-8) negative. This is the first treatment approved for this condition.
Umeclidinium inhalation powder (Incruse Ellipta)
: Approved for the treatment of COPD.
: Approved to treat adults with moderate to severe ulcerative colitis or moderate to severe Crohn‘s disease. Studies have shown good results in ulcerative colitis and mixed results in patients with Crohn’s disease.
Vorapaxar (Zontivity) A new class of antiplatelet, indicated to reduce thrombotic events in patient with a history of myocardial infarction or peripheral arterial disease.
European Medicines Agency Approvals
: Approved for the treatment of pulmonary multidrug-resistant TB in adults when other regimens are no longer effective or tolerable. Delamanid must be administered in combination with a WHO guideline recommended optimized background regimen.
: Approved for the treatment of type 2 diabetes. Individual agents are FDA-approved.
New FDA-Approved Indications
Dabigatran etexilate mesylate: Now approved for the treatment of deep venous thrombosis and pulmonary embolism in patients who have been treated with a parenteral anticoagulant for 5-10 days and to reduce the risk of recurrence of DVT and PE in patients who have been previously treated.
Mesalamine oral delayed-release capsules (Delizicol): Now approved for mild-to-moderate active ulcerative colitis in children 12 years or older.
Ofatumumab: Now approved in combination with chlorambucil for the treatment of previously untreated patients with chronic lymphocytic leukemia (CLL) for whom fludarabine-based therapy is considered inappropriate.
New Off-Label Indications
Axitinib for the first-line treatment of renal cell carcinoma (Favors Efficacy; Class IIb, Recommended in Some): Compared with sorafenib, axitinib significantly improved overall response rate and improved, but not significantly, progression-free survival in a randomized trial of patients with treatment-naïve metastatic renal cell carcinoma. Adverse events that occurred more frequently with axitinib included hypertension, diarrhea, weight loss, and asthenia; palmar-plantar erythrodysesthesia was more common with sorafenib.
Hydroxyurea for the treatment of recurrent intracranial meningioma after surgery and radiotherapy (Ineffective; Class III, Not Recommended): Hydroxyurea produced no objective responses in two small retrospective studies of patients with meningioma recurrent after surgery and radiation therapy. Treatment was well tolerated, but less than half of patients achieved stable disease, which was of short duration.
Drug Safety Updates
Combination acetaminophen products: The US Food and Drug Administration recommends discontinuation of prescribing and dispensing of prescription products that contain more than 325 mg of acetaminophen per dosage unit due to the risk of severe liver damage; marketing of these products has been discontinued.
Epidural corticosteroids: betamethasone, dexamethasone sodium phosphate, hydrocortisone sodium succinate, methylprednisolone acetate, methylprednisolone sodium succinate, triamcinolone acetonide New warnings issued surrounding rare but serious adverse events, including loss of vision, stroke, paralysis, and death, with the injection of corticosteroids into the epidural space.
Eszopiclone (Lunesta): New warning alerts clinicians that eszopiclone can cause next-day impairment of driving and other activities that require alertness. The recommended starting dose of eszopiclone has been reduced to 1 mg at bedtime.
Opioid analgesic warnings: Warnings for long acting analgesics now include more specific language on use in patients at risk for addiction, misuse, and abuse. The indication has also been revised limiting to use in patients with “severe” pain. Additional warnings around the risk of neonatal withdrawal syndrome have also been added.
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Find updated information regarding the management of atrial fibrillation throughout drug monographs, the Atrial Fibrillation Emergency Medicine Review, and the Atrial Fibrillation – Drug Treatment Guidelines Drug Consult.
In Micromedex: Search Atrial Fibrillation in the search box to access the atrial fibrillation dashboard and related drug content.
Other Significant Updates
Atrial Fibrillation: Updated with guidelines from the American Heart Assoc, the American College of Cardiology and the Heart Rhythm Society, providing the most recent recommendations for pharmacologic and nonpharmacologic treatments and updated information on antithrombotic therapy.
In Micromedex, enter atrial fibrillation in the search box to access the atrial fibrillation Dashboard and monographs.
HIV/AIDS: Updated with recommendations from: 1) 2014 Panel on Antiretroviral Guidelines for Adults and Adolescents updated treatment information including specific drug regimens and dosing. 2) The US Public Health Service Guidelines on Preexposure Prophylaxis for men who have sex with men at risk, heterosexual men and women at risk, and IV drug users at risk, 3) American College of Obstetricians and Gynecologists update on routine testing for women aged 13 to 64 years, and 4) the HHS Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the US, including recent recommendations for perinatal management.
In Micromedex, enter HIV or AIDS in the search box to access the disease monographs.
Ischemic Stroke and Transient Ischemic Attack: Updated to include guidelines from the American Heart Association and the American Stroke Association on the (secondary) prevention of stroke in patients with an ischemic stroke or a patient with TIAs.
In Micromedex, enter ischemic stroke or TIA in the search box to access the disease monographs and Clinical Checklists.
Middle East Respiratory Syndrome: New topic to address the emergence of MERS, which has now spread beyond the Arabian Peninsula, and has been identified in the US.
In Micromedex, enter MERS in the search box to access the disease monographs.
Otitis Externa: Updated with guidelines from the American Academy of Otolaryngology, emphasizing medical therapy including acute pain management.
In Micromedex, enter otitis externa in the search box to access the otitis externa dashboard and monographs.
Valvular heart disease reviews:
• Aortic Stenosis
• Aortic Regurgitation
• Mitral Stenosis
• Mitral Regurgitation
Updated with guidelines from the American Heart Association and the American College of Cardiology, emphasizing appropriate therapy to prevent thromboembolism and appropriate use of valve replacement.
In Micromedex, enter one of the valvular heart disease names in the search box to access the detailed monograph.
96 new Staples brand products added to Commercial Products Database: Staples branded products, which include commercial cleaning supplies commonly found in offices, may now be searched in the Micromedex Tox & Drug Product Lookup to support quick identification of ingredients in an exposure situation.
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