The Role of the Pharmacist
Pharmacists are critical, but underutilized personnel in health systems, which are well-positioned to improve patient outcomes while reducing costs and overuse of healthcare services. Integration of clinical pharmacy services has been shown to eliminate inappropriate and excessive care related to medications, lab tests, emergency department visits, hospital stays, and readmissions. Through management of complex drug therapies under collaborative practice agreements, participation in medical rounds to provide valuable drug information, development of order sets, and patient monitoring and counseling, pharmacists can decrease length of patient stay and hospital expenditures, while decreasing mortality and improving other patient outcomes.
Examples of Transformational Change in Pharmacy Practice
Below are highlights of the important role pharmacists play in improving overuse:
Public Awareness Campaign: A community-wide public awareness campaign at Sentara Healthcare used direct-to-consumer marketing strategies to inform the public that antibiotics are effective to treat bacterial infections, such as strep throat or pneumonia but ineffective against viral infections such as the flu or common cold. 
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In addition, the program provided targeted feedback to local prescribers about their patterns of antibiotic use. Following this intervention, based on prescription patterns of HMO members, doctors prescribed 13% fewer courses of antibiotic treatment for patients during a 5-month period compared to the same period the previous year; the second year demonstrated an additional 7% reduction in antibiotic courses.
For additional details, please contact ASHP.
Standardized Care Pathways: Pharmacist, nurse and physician project champions at Barnes-Jewish Hospital collaborated to institute standardized care pathways for severe sepsis that were supported by evidence-based treatment guidelines. Read more
Key components of the initiative included development of a severe sepsis order set focusing on early hemodynamic resuscitation and appropriate antimicrobial therapy, interdepartmental education of all patient care providers, and incorporation of the order set into the emergency department’s computerized prescriber order entry system. A comparison of before- and after-implementation data demonstrated statistically significant reductions in 28-day mortality, hospital length of stay, and hospital expenditures.
For additional details, please contact ASHP.
Drug Therapy Management: A study that evaluated drug therapy management by pharmacists in 961 U.S. hospitals demonstrated that hospitals that did not provide pharmacist-managed aminoglycoside or vancomycin therapy had 1,048 excess deaths (6.71% higher than in hospitals that had pharmacist-managed aminoglycosides or vancomycin therapy), 131,660 excess in patient days, $140,757,924 in excess total Medicare charges, $34,769,250 in excess drug charges, and $22,530,474 in excess laboratory charges. Read more
Through collaborative practice agreements, pharmacists in these facilities were able to order lab tests and initiate or adjust drug therapy to reach target drug levels. S
ee Bond CA and Raehl CL. Clinical and economic outcomes of pharmacist-managed aminoglycoside or vancomycin therapy. Am J Health-Syst Pharm. 2005;62:1596-605.
Medication Errors: Another study evaluated the roles and impact of clinical pharmacy services and pharmacy staffing on medication errors at 1,081 hospitals in the U.S. Pharmacists provided drug information services conducted drug protocol management, collected drug histories and participated in medical rounds. Read more
Medication Reviews: A review of 17 studies in which pharmacists conducted medication reviews to identify drug-related problems in primary care, nursing home, hospital, and community settings found that pharmacists decreased the number of medications or doses, increased adherence, decreased adverse drug reactions, and improved quality of life while demonstrating facility and drug cost savings. See Chumney EC, Robinson LC. The effects of pharmacist interventions on patients with polypharmacy. Pharmacy Practice. 2006; 4(3): 103-9.
Patient-Discharge Plan: An AHRQ-funded study showed that a comprehensive patient-discharge plan that included follow-up from a pharmacist decreased subsequent hospital visits by approximately 30%. Two to four days after discharge, a clinical pharmacist contacted patients in the intervention group to review and reinforce the discharge plan. Read more
The intervention group demonstrated an estimated $150,000 in savings in emergency department, hospital, and primary care visits, or approximately $412 per patient.
See Jack B, Chetty V, Anthony D, et al. A reengineered hospital discharge program to decrease rehospitalization: A randomized trial. Ann Intern Med 2009; 178-87.
Relevant ASHP Best Practices
Other ASHP Resources