By Lindsey Clark, Pharm.D., MBA, pharmacy manager, Transitions of Care and Emergency Services, Michigan Medicine, Ann Arbor
The American Society of Health-System Pharmacists (ASHP) Practice Advancement Initiative (PAI) empowers the pharmacy profession to leverage pharmacy technicians to improve patient care across acute and ambulatory care settings.1 At the intersection of the acute and ambulatory care settings, patients experience transitions of care (TOC), which is defined as the movement of patients between healthcare practitioners, settings, and home as their health condition and care needs change.2 At each TOC, patients are at greater risk of experiencing an adverse drug event, which may lead to costly readmissions and emergency department visits.3 With their knowledge and expertise on the medication use process, pharmacy technicians are well-positioned to help facilitate a safe TOC for our patients. There is also tremendous opportunity to implement advanced and innovative roles for pharmacy technicians in TOC. At Michigan Medicine, advanced pharmacy technician roles have been implemented to improve patient care across the continuum. In doing so, the team strives to advance both patient care and the profession, in alignment with the recommendations established by the ASHP PAI.
The TOC pharmacy discharge team consists of six pharmacy technicians and one student pharmacist who provide medication access, discharge medication planning and bedside delivery services to inpatients being discharged home, through a program called MiRxExpress. These services are provided in collaboration with both inpatient and outpatient pharmacists, as well as providers, nurses, social workers and case managers. The team also participates in hospitalist patient care rounds, serves on hospital committees related to the discharge process and helps to ensure that discharge prescriptions for patients identified for an early discharge are filled in a safe and timely manner. The team also focuses on using Lean process improvement methodology to improve workflow efficiencies. Over the past year, the team has helped more than 6,000 patients gain access to their discharge medications. The service has proven to be a significant patient satisfier, with over 95 percent of patients indicating that they were very satisfied with the convenience, timeliness and quality of the service provided. Additionally, over 97 percent of patients served indicated they would very likely recommend the service to others.
The TOC pharmacy clinic team consists of nine pharmacy technicians who offer medication access assistance to patients receiving care in the dermatology, gastroenterology/infectious disease, hepatology, pulmonary/nephrology, post-kidney transplant and rheumatology Taubman Outpatient Clinics and the metabolism, endocrinology and diabetes clinic at Domino’s Farms. At these locations, TOC pharmacy technicians are integrated into the interdisciplinary healthcare team and are highly relied upon for their expertise and services. The pharmacy technician services have significantly improved the timeliness with which patients gain access to their medications. They have also eased provider, nurse and medical assistant workload within the clinics, allowing these professionals to focus more time on other important patient care functions. Nearly 100 percent of respondents to a clinic staff satisfaction survey indicated they were very satisfied with the services provided. Due to the team’s positive impact on patient care and clinic workflow, expansion to additional clinics within the health system is ongoing.
1. American Society of Health-System Pharmacists, ASHP practice advancement initiative overview, education and tools and resources. American Society of Health System Pharmacists. Available at: http://www.ashpmedia.org/pai/.
2. Clark, K, Doyle, J, Duco, S, et. Al. Hot topics in health care: Transitions of care. The Joint Commission. Available at: https://www.jointcommission.org/assets/1/18/Hot_Topics_Transitions_of_Care.pdf.
3. Hume, AL, Kirwin J, Bieber HL, et. Al. Improving care transitions: Current practice and future opportunities for pharmacists. ACCP White Papers. Pharmacotherapy 2012; 32 (11): e326-e337.