Assessing the Value of Pharmacists' Health‐Systemwide Services: Clinical Pathways and Treatment Guidelines

Abstract

Practice guidelines and clinical pathways are increasingly being used as tools to enhance the quality of health care services and to manage costs better. This article reviews the role of guidelines and clinical pathways in health care as defined within the broader concept of practice policies. The factors that increase the effectiveness of practice policies are examined. These include the origin of development, dissemination technique, and implementation strategy. Policies that are internally developed and implemented with concurrent reminder systems are the most effective. Clinical pathways fit these criteria and are therefore highly effective policy types. The roles that pharmacists within health systems can undertake in policy development are described. These include writing the policy document, providing expert review, providing education, and most important, facilitating the desired outcomes by implementing pharmacy services that promote compliance with the guidelines. Examples of pharmacy-based guideline and pathway implementation from the Henry Ford Health System are described for inpatient anticoagulation, outpatient preferred drug formulary policy, and outpatient lipid therapy management.

A Primer on Clinical Pathways

“…These pathways required multiple documents, including order sets, educational materials, and variance reporting documents. 6 The patient chart and clinical pathway were usually located at the patient bedside, allowing limited staff to gain access to relevant documents at the same time. After integration of EMRs, all staff can access patient records and the clinical pathway for their treatment.…”

“…Clinical guidelines are based upon primary evidence, extensive analysis, and discussion amongst field experts to establish expectations for best practices. 6 Clinical pathways are operational tools for executing best practices based upon local practice and clinical guidelines that are shaped by interdisciplinary teams. These pathways create a consistent workflow for care delivery.…”

“…Prior to the development of the electronic medical record (EMR), clinical pathways were part of a paper documentation system. 5,6 Caregivers documented the completion of activities in one location within the paper chart. These pathways required multiple documents, including order sets, educational materials, and variance reporting documents.…”

Adverse Drug Reactions in the ICU

“…In the ICU, the value of the pharmacist is especially important. Pharmacists obtain medication histories; develop and manage policies and protocols for optimal patient care, drug expenditures, and cost avoidance (i.e., analgesia, anticoagulation, delirium, pharmacokinetic, sedation, and transfusion guidelines); optimize antimicrobial stewardship; respond to resuscitation events; verify accuracy of computerized order entry; educate other ICU personal; assist in discussing treatment modalities with patients and/or families; prospectively evaluate drug therapy; and monitor and identify ADRs [398][399][400][401][402][403][404][405][406][407][408][409][410]. The impact of the clinical pharmacist in the ICU has significantly decreased ADRs, antimicrobial resistance, medication costs, transfusions, hemorrhage, ventilator days, and length of stay.…”

Pharmacists as Interprofessional Collaborators and Leaders through Clinical Pathways

“…Pharmacists are pharmacotherapy experts, and possess pivotal skills which qualify them for playing active roles in the process of designing and application of clinical pathways (CPs) [ 1 , 2 ]. Literature has consistently reported that CPs can be differentiated from guidelines [ 3 , 4 ] in that CPs are time-bound patient care plans which aim to improve the quality of patient-care and optimize utilization of institutional resources [ 5 , 6 ].…”