As the Director of Pharmacy Services at SPMHC, Navy Chhay earned a Pharm.D. Degree from Howard University and a Master’s Degree in Health-system Pharmacy Administration from the University of Wisconsin-Madison. She completed a two year specialty residency in Pharmacy Administration at the University of Wisconsin Hospitals and Clinics in 1998. She has over 14 years of hospital pharmacy management experience.
Value of ASHP Membership
Navy has been a member of the Section of Inpatient Care Practitioners’ (SICP) Section Advisory Group (SAG) on Small and Rural Hospitals (SRHs) for the past three years. Currently, she serves as its vice chair for the 2012-2013 volunteer service year. In her own words, being a part of the SICP SAG on SRHs has allowed her to “give back to the pharmacy profession, as well as share and learn from colleagues working at similar institutions throughout the country.” Small and rural hospitals are often forgotten because there’s so much more focus on larger size hospitals and academic medical centers. While many of the challenges are similar, small and rural hospitals don’t necessarily have the same resources to meet these needs and address the challenges. The opportunity to network with colleagues from other small and rural hospitals has been an invaluable experience of serving on this SAG. Navy says she has been a member of the Society since the start of her career and her membership in ASHP has allowed her to continually advance the practice of pharmacy by implementing ideas learned at various ASHP sponsored meetings such as the Midyear Clinical Meetings, Summer Meetings and Leadership Conferences. Additionally, the various tool kits and articles available on the Society’s website coupled with the numerous opportunities to network with colleagues have further refined her professional development. Navy’s personal career goals align with ASHP’s mission of advancing and supporting the pharmacy practice in hospitals and health systems to ensure patients are educated about safe medication use.
Care Overview of the Health-system
Nestled in the bluffs of the Wisconsin River and surrounded by prairie grass and farmland, Sauk Prairie Memorial Hospital & Clinics is a 36-bed not-for-profit acute care hospital serving more than 40,000 people. With four satellite clinics and a service area spanning a 20-mile radius, SPMHC serves the people of the area with a mission: extraordinary healthcare from the heart — one person at a time.
This mission filters through all departments, including the pharmacy. At SPMHC, pharmacists and pharmacy technicians work together to coordinate transitions of care and provide other clinical pharmacy services for each patient.
The Success Story
A big part of SPMHC’s success in acquiring and retaining talented pharmacy staff devoted to clinical and service excellence is a result of pharmacy and hospital administration management team’s commitment to advanced practice. In 2010 SPMHC was recognized at the Commitment Level and in 2012 at the Mastery Level by the Wisconsin Forward Award program for its advanced level of performance excellence and its commitment to learning and success of continuous quality improvement. Through a multi-departmental effort, including pharmacy, SPMHC performed in the top decile for low medication error rates for Wisconsin hospitals and outperformed the national and state 80th percentile for low re-admission rates. The Wisconsin Forward Award considered these measures, and many others like them, when determining SPMHC’s award level.
Setting-Up for Success and Quality Patient Care
SPMHC recognizes that for pharmacy to successfully investigate patient clinical issues, determine good therapeutic solutions, and make clinical interventions, a fully-staffed pharmacy department is necessary. A full staff also allows adequate time to develop protocols and implement safety measures that impact our patients. Each day, two 10-hour pharmacists and three 8-hour pharmacy technicians (one each on the weekends) oversee medication distribution and clinical pharmacy services for acute, intensive, surgical, and obstetrical-care patients.
Bond and Raehl’s 2002 study highlighted the positive impact pharmacists had when functioning at high clinical levels, as opposed to mainly drug-distribution functions, on reducing medication errors and overall patient-care costs. The greatest impact in overall medication error rates was due to a lack of coordination of transitions of care.
A Commitment to Transition of Care
Our pharmacists and technicians work together to make sure accurate and timely drug histories are obtained for all newly-admitted patients. This may include interviews of the patient and/or family members, search of the pharmacy benefit manager history, and contact with the patient’s local pharmacy, nursing home or clinic for current medication lists. Doctors may then select through computerized physician order entry (CPOE) which medications they wish to continue during the patient’s hospitalization and across the continuum of care.
In addition to drug histories of newly-admitted patients, all scheduled surgical patients (orthopedic, general, and gynecologic) are contacted by pharmacists via phone. Our Joint Replacement Center (a multi-disciplinary group) has scheduled clinic appointments in which pharmacy team members talk to patients and their coaches regarding upcoming joint replacement surgery. For these patients, pharmacists perform face-to-face medication history interviews and work with nursing staff to teach patients in a classroom setting about clot prevention, wound healing, and pain management. Pharmacists also manage the inpatient post-surgical anticoagulation for joint replacement patients. When all patients are discharged, they again talk with a pharmacist about their medications and receive written information.
In addition to the more than 150 transitions of care each month and the educational emphasis of our Pharmacy department, we provide drug information to health care providers, conduct 24-hour chart review of all inpatients, review all patients’ labs and microbiology results, follow- up on pharmacokinetic and antimicrobial dosing, total parenteral nutrition and other consults, develop medication protocols that link into CPOE, and work closely with nursing and medical staff on patient care issues. We have an emergency department, one full-time hospitalist and many community physicians/surgeons. The pharmacy is not staffed overnight, but pharmacists are available via pager until the pharmacy opens the next day. We also hire pharmacy interns and teach students affiliated with the University of Wisconsin-Madison School of Pharmacy.
The CPOE and intervention programs were implemented October 2012, but more than 300 separate interventions by pharmacist and technicians are documented each month. Due to the learning curve seen with a new computer system, interventions are likely under-reported.
The Future Outlook
In the near future, SPMHC plans to open a new hospital currently under construction, increase its pharmacy-run anticoagulation services, continue and expand protocol management, and increase experiential training of pharmacy students. The future looks bright for this small rural hospital. Commitment to its patients and employees allows it to function on or above par with many larger hospitals.