• How Expanding Pharmacy Technician Roles Contributes to Quality Improvement

    Angela N. Powell Nov 05, 2015

    Baxter Regional Medical Center has shifted many functions previously covered by pharmacists and nursing to pharmacy technicians.

    Angela N. Powell, Baxter Regional Medical CenterWhat process or outcome is your organization trying to improve?

    For more than a decade, Arkansas-based Baxter Regional Medical Center (BRMC) has been on a strategic journey to fully leverage pharmacy and nursing staff by using a top-of-license approach that allows staff to practice at the full extent of their education and training, instead of spending time doing something that could be effectively done by someone else. Central to this value-added strategy is the expanded use of pharmacy technicians within medication distribution processes at the 268-bed community hospital.

    Through an ongoing and comprehensive training effort, BRMC has been able to shift many functions previously covered by pharmacists and nursing over to pharmacy technicians, expanding the role and responsibilities of these professionals. Today, 85 percent of the pharmacy technician staff is nationally certified as a certified pharmacy technician (CPhT) and have expanded their skill sets to cover such functions as preparing sterile products, distributing controlled substances, and interviewing patients about their medication histories.

    What was the impetus for this project?

    The link between increasing clinical resources and increasing patient satisfaction is strongly causal—as evidenced by a recent Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) study that indicates a 30 percent increase in patient satisfaction scores after introduction of more patient-facing pharmacy roles.

    To accommodate for this shift in today’s lean, quality-driven healthcare climate, value and resourcefulness must become key drivers of workflow design and process improvement. Systems and people must operate at maximum capability and work together synergistically to ensure optimal care delivery and outcomes.

    What results have you achieved to date?

    With the increased responsibilities of pharmacy technicians, pharmacists, and nurses at BRMC can now focus more on patient care and safety, and the return on investment has been substantial. For example, in 2005, BRMC pharmacists documented more than 16,000 clinical interventions, with an estimated cost savings of $1.3 million. In 2014, those numbers grew to more than 71,000 interventions, with an estimated cost savings/avoidance of $8.3 million—a conservative estimate based on available literature.

    From an employee engagement and retention standpoint, these expanded roles also have significantly increased workplace engagement metrics, with BRMC pharmacy technicians reporting engagement levels that exceeded the National Research Council’s average in a recent survey. The organization also has realized overall positive improvements in their HCHAPS scores, with more top-of-license pharmacy work as a contributing factor.

    What improvements or innovations have been implemented?

    Pharmacists are now able to spend four to five hours on the patient floor during a typical 10-hour shift. A clinical pharmacist has also been assigned to the intensive care unit full time, and BRMC is working to deploy pharmacy resources to hospital-owned clinics to assist with medication therapy management. Pharmacist workstations are available on the floors to allow ongoing management of pharmacy operations, while at the same time providing nurses and physicians with direct access to pharmacists for “real-time” consultation, ensuring a cohesive, team-based approach to care.

    Pharmacy intervention efforts are delivering substantial improvements to care delivery and cost savings at BRMC through this heightened clinical practice. Top patient interventions impacted by pharmacy technicians and clinical pharmacists include medication history interviews, issues dealing with medication reconciliation upon admission and discharge, antimicrobial stewardship, and renal dosing. An effort is also underway to expand pharmacy involvement in patient education and post-discharge follow-up, which will improve care transitions for patients at high risk for readmission.

    By elevating the role of technicians and leveraging pharmacy resources, BRMC is also enhancing its nurses’ engagement and allowing these professionals to spend more time at the patient bedside. With this model in place, nursing and pharmacy essentially become part of a care team—a marriage all hospitals are striving to achieve to impact patient satisfaction and outcomes.

    Finally, from a quality and safety perspective, leveraging staff with a top-of-license approach is critical to moving high-level initiatives forward to elevate and optimize care processes. For example, BRMC is advancing antimicrobial stewardship efforts and piloting a transition of care effort—two national priorities that would be cost prohibitive without heightened use of pharmacy technicians.

    What other programs or resources were important to this initiative?

    This type of shift does not happen successfully without proper training and investment. For this reason, BRMC has created a culture that encourages the advancement of competencies by financing pharmacy technician certifications. While Arkansas does not require the pharmacist certification, BRMC values the added competencies because they represent a high standard of practice.

    Applicants for certification take an exam that assesses their knowledge on various subjects, including pharmacology, pharmacy law and regulations, sterile and non-sterile compounding, medication safety, quality assurance, medication order entry and dispensing, inventory management, billing and reimbursement, and pharmacy information systems. These competencies create greater value for BRMC by allowing pharmacy technicians to take on more responsibility and enabling pharmacists to spend more time on the units engaged in clinical interventions and relationship-building with nurses, physicians, and patients.

    While comprehensive training and certification strategies are critical to expanding roles, having the right technological infrastructure in place is equally important. Pharmacists must have confidence in the process and trust that patient safety will not be compromised by shifting their focus out of the central pharmacy.

    Facilitated by a long history of strong collaboration between pharmacy and nursing, BRMC employs use of a centralized medication distribution strategy, leveraging robotics and carousel technology within central pharmacy operations and dispensing cabinets on the units. With this system in place, there are safeguards built into every step of the dispensing and distribution process through bar-code scanning and medication tracking systems.

    Simply put, patient safety must be held paramount when designing better processes, and use of bar code technology remains a focal point of industry best practices for medication management.

    Ultimately, BRMC’s decision to invest in its pharmacy technicians has yielded benefits on a number of fronts. By leveraging a top-of-license approach to pharmacy resources, the self-worth and engagement of technicians is enhanced, giving them confidence in their ability to positively impact care delivery. The role of pharmacists and nurses is further elevated, enabling increasingly comprehensive and personalized care that increases satisfaction and optimizes overall outcomes.

    Angela N. Powell, PharmD, is director of pharmacy, Baxter Regional Medical Center, Mountain Home, Ark.

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