Strategies for Developing Clinical Services—Advanced Practice Programs

Abstract

The Director's Forum series of articles switches its focus from the core competencies of hospital pharmacy practice to programs that enhance the ability of the pharmacy to provide patient-centered services. In the September 2006 issue, decentralized pharmacy services were reviewed and recommended as an effective patient-centered strategy for a hospital pharmacy. This issue addresses developing advanced practice programs in critical care.

Full text

Hospital
Pbarmacy
Volume 41, Number 10, pp 986-992
2006 Wolters Kluwer Health, Inc.
Director's
Forum
Strategies
for
Developing
Clinical
Services-
Advanced
Practice
Programs
Robert j. Weber, MS, FASHP *
..Associate Professor and Chair, University of Pittsburgh School of Pharmacy, Execu-
tive Director of Pharmacy, University of Pittsburgh Medical Center
The Director's Forum series of articles switches its focus from the core
competencies of hospital pharmacy practice to programs that enhance the
ability of the pharmacy to provide patient-centered
services.
In the
Sep-
tember 2006
issue,
decentralized pharmacy services were reviewed and
recommended as an effective patient-centered strategy for a hospital
pharmacy.This issueaddresses developing advanced practiceprograms in
critical care.
Decentralized pharmacy ser-
vices places pharmacists
closer to patients, enhanc-
ing their ability to be involved
directly in medication
order
review, drug dispensing, medica-
tion therapy management,
and
patient education. A recent review
of
the role of pharmacists in
patient care describes a growing
body of literature documenting
pharmacists' activities in improv-
ing the quality of care. 1The decen-
tralized services previously
described highlight order review
and processing, formulary man-
agement,
and
therapeutic drug
monitoring. In addition, the article
stressed
that
satellite pharmacy
services
are
not
necessarily a
requirement for providing decen-
tralized services. In fact, a pilot
experience at the University of
Pittsburgh Medical Center demon-
strated the success of decentraliz-
ing pharmacists and technicians
while maintaining pharmacy cen-
tralized operations and batch med-
ication fill processes.'
While basic decentralized ser-
vices positively impact patient
care, there is tremendous value in
providing advanced practice phar-
macy services.
The
American
Society of Health-System Pharma-
cists (ASHP) published adraft
report on its vision for the phar-
macy workforce in hospitals and
health systems, stating that assur-
ing the safe and effective use of
medication in health systems is
dependent on a diverse workforce
of leaders, general practitioners,
and specialized pharmacists.' The
ASHP position paper also states
that
pharmacists working in spe-
cialized areas will have completed
the
appropriate
post-graduate
training and obtained proper cer-
tification and credentials, distin-
guishing them from generalist
pharmacy practitioners.
Pharmacists engaged in
advanced practice may impact the
care of patients in a more direct
way. As an example, pharmacists
with training in critical care, or
oncology may be more effective in
preventing medication errors in
the intensive care unit (ICU) or in
an oncology clinic, compared
with pharmacists with generalist
training and education. This is
primarily because of these special-
ist pharmacists' ability to effec-
tively apply evidence-based crite-
ria for medication use to clinical
scenarios with ICU or oncology
patients.
The
previously referenced
meta-analysis by Kaboli and col-
leagues
that
describes the impact
of clinical pharmacists in hospital-
ized patients showed that services
provided by these pharmacists
resulted in improved care and
improved outcomes. Further
analysis of pharmacists' activities
in specialty areas (eg, psychiatry,
geriatrics, critical care) showed
positive clinical outcomes in
reduced medication errors,
reduced adverse drug events, and
reduced numbers of medications
prescribed for those special
patient populations.
Every hospital pharmacy
director should consider establish-
ing advanced practice pharmacy
services in order to provide for the
highest quality patient-centered
care. To accomplish this, the phar-
macy director is often faced with
the following leadership chal-
lenges: (1) How do you determine
the specialty area to establish an
advanced practice site? (2) What
steps are necessary to justify an
advanced practice pharmacy pro-
gram?
986
Volume
41, October 2006