Brown: Hospital pharmacies are drastically different. The pharmacy is directly responsible for more patient deliverables than ever before. In the 1960s, hospital pharmacies only procured drugs. Today, patients can’t get their medicines until the pharmacy approves them. There’s more direct exposure to patients, too. Pharmacists dose and monitor drugs, prepare IVs, participate in patient rounds, and counsel on medication reconciliation and discharge planning.
One driver for many of these changes was the introduction of Diagnosis Related Groups (DRGs) in 1983. DRGs changed the reimbursement model for hospitals because controlling drug costs became key to a hospital’s profitability. Very quickly, pharmacies became cost centers. Then you fast forward to today and the emergence of value-based care, in which hospitals are reimbursed for quality and outcomes. This requires pharmacies to pivot again to be more involved throughout the patient’s continuum of care, including pre- and post-discharge — not just the care provided within the four walls of the hospital.
Kienle: Today, there are more specific operational requirements that pharmacists and administrators must manage that have hospital-wide impacts. In 1999, the landmark To Err is Human report first highlighted the number and sources of medical errors nationwide. This report significantly impacted the healthcare system’s focus and processes to better safeguard patient safety. Instead of being reactive to compliance directives, hospitals were expected to integrate drug compliance into protocol. Five years later, The Joint Commission revised its hospital accreditation, which changed standards and level-set regulations nationwide. At the same time, new standards for sterile compounding compliance were introduced by the United States Pharmacopeia. All of this dramatically increased awareness about the critical role the pharmacy has in promoting patient safety.
Morrison: To build on Patti’s point, the regulations and focus on compliance did more than increase awareness of the role of pharmacy and patient safety — it also paved the way for pharmacy innovation. Some of the new safety standards required the review of all “non-emergent” medication orders by a clinical pharmacist prior to being administered to a patient. This put additional demands on pharmacist availability and manpower.
Also, during the late 1990s, there was a severe pharmacist shortage. In response, a remote pharmacy model was introduced – a concept first pioneered by Cardinal Health through its pharmacy outsourcing operations business. Remote pharmacy models underscore patient safety by ensuring all non-emergent medication orders are prospectively reviewed by a pharmacist prior to administration.