To better support the pharmacy department's goals of improving medication adherence and supporting population health management, CaroMont leaders considered several strategies. Dr. Chaparro said options on the table included adding full-time equivalent positions, changing the staffing workflow model, combining roles and redistributing work, and evaluating remote pharmacy models.
CaroMont ultimately decided to both change the staffing workflow and leverage a remote pharmacy model.
The first step, said Dr. Chaparro, was overhauling the pharmacy department's 20-year-old staffing model and creating three pharmacy teams: the operational team (12-hour shifts); the clinical team dedicated to medical-surgical and critical care (eight-hour shifts); and the emergency department team (24 hours-a-day).
Dr. Chaparro said the system was able to expand the pharmacy team without adding full-time equivalent positions, by outsourcing order verification tasks remotely to Cardinal Health.
Additionally, to ensure pharmacy teams were divided in a way that optimized workflow as well as employee talent, each pharmacist applied for a specific position within the department. The organization also now has four clinical pharmacy practitioners in the emergency department, which Dr. Chaparro said frees up time for providers.
As a result of this blended approach of on-site workflow re-design supported by a remote pharmacy model, pharmacists have "gotten involved in our admission teams. They've gotten involved in our trauma teams. They've gotten involved in critical care rounds. They've gotten involved in our internal medicine rounding. Our pharmacists are so much more involved because we're able to make those changes and get them in front of patients, in front of nurses," Dr. Chaparro said.
Within the last three months after the staffing changes, productivity increased from 32 medications processed per hour to 46, even with a 3 percent increase in volume. HCAHPS scores also improved: understanding the purpose of new medications improved by more than 15 points and understanding medication side effects improved by more than 14 points.
There were challenges along the way — such as pushback from staff members who were used to the old ways. Yet overall, Dr. Chaparro said the effort has been worthwhile.
"From a patient care aspect, I think our patients are getting better care. I think they're being educated a lot more than what they were in the past," he added. "The biggest thing for me now is, how do I expand that out into the community? I have two community pharmacists out there now, so we're [looking to] bridge the gap between the acute care center and the community."
He advised other systems to "think outside the box" about how to get pharmacists more involved with patient care.