Development and application of quality measures of clinical pharmacist services provided in inpatient/acute care settings

Abstract

As health care transitions to value-based care, it is more critical than ever to emphasize and quantify the impact on patient outcomes made by inpatient/acute care pharmacists and pharmacist extenders as members of the interprofessional care team.Thus, the American College of Clinical Pharmacy (ACCP) took to task the development of quality measures that were broadly applicable to the diverse inpatient/acute care landscape and important for standardizing practice, measuring impact, contextualizing benefit within the health care landscape, and allowing benchmarking within and between institutions. A framework was established by the writing committee of this paper in order to develop quality measures in a methodical manner. The resulting process led the writing committee to devise 31 foundational quality measures to be used in efforts to champion the pharmacist's role in achieving the quadruple aims in health care. Application and evaluation of quality measure performance as well as limitations and future implications of the measures are addressed to further highlight the evolving role of the inpatient/acute care pharmacist and pharmacist extender.

Positive Patient Postoperative Outcomes with Pharmacotherapy: A Narrative Review including Perioperative-Specialty Pharmacist Interviews

“…Three excellent examples of interprofessional collaboration and shared mental modeling for perioperative medication management applicable in ERPs include the online UK Handbook of Perioperative Medicines [ 149 ], a manual on decision making in perioperative care [ 150 ], and a handbook covering enhanced recovery optimization [ 151 ]. Standards of practice for pharmacy services in perioperative medicine as well as inpatient quality measures for clinical pharmacist practice have been derived recently [ 4 , 152 , 153 , 154 ].…”

Rewards, recognition, and advancement for clinical pharmacists

“…Pharmacy practice models vary greatly, and time allocation for patient care, distributive functions, research, and teaching differs significantly across institutions 49 . Additional barriers may stem from the variety of activities clinical pharmacists engage in and the difficulty with applying consistent, measurable evaluation tools across different practices 20,46 . Some tools exist to aid in measuring, evaluating, and documenting a clinical pharmacist's performance normalized across varied practice settings, such as the ACCP template developed to assess the key domains of direct patient care, pharmacotherapy knowledge, systems‐based care and population health, communication, professionalism, and continuing professional development 20 .…”

“…The following statements describe best practice recommendations for rewards, recognition, and advancement for clinical pharmacists as developed by the ACCP Clinical Practice Affairs Committee A: General recommendations to address barriers to rewards, recognition, and advancement: Overcoming barriers to rewards, recognition, and career advancement will require commitment and action from multiple stakeholders. Professional pharmacy organizations should support clinical pharmacist recognition and reimbursement at state and national levels through advocacy and legislative efforts. Professional pharmacy organizations should support global initiatives to improve clinical pharmacists' rewards, recognition, and advancement at the health system level. Health system and pharmacy administrators should make a commitment to evaluate their current reward, recognition, and advancement programs and address areas needing improvement. Professional organizations and health systems should work toward improving patient‐to‐pharmacist ratios and models with protected time for clinical activities, quality improvement, research and scholarship, and teaching and mentorship. Professional organizations should engage in initiatives to evaluate appropriate patient‐to‐pharmacist ratios and develop recommendations for best practices. Assessment of pharmacist activities to determine high versus low value add to patient outcomes should be performed. Clinical pharmacy activities not associated with an increased value or improved patient outcomes should be minimized. Collection and reporting of quality measures from high‐value clinical pharmacy services should be used to demonstrate positive impacts on patient outcomes 46 Operational services (e.g., order processing/verification) should be consolidated and optimized as able to allow for the expansion of clinical pharmacy services. Use of electronic medical record algorithms and artificial intelligence should be encouraged to streamline operational services and enhance efficiency in clinical activities. Payment models should allow reimbursement commensurate with clinical pharmacists' impact on patient outcomes, either through arrangements between private payers and pharmacists or enactment of advanced designations in more states 44 …”

“…Professional organizations and health systems should work toward improving patient‐to‐pharmacist ratios and models with protected time for clinical activities, quality improvement, research and scholarship, and teaching and mentorship. Professional organizations should engage in initiatives to evaluate appropriate patient‐to‐pharmacist ratios and develop recommendations for best practices. Assessment of pharmacist activities to determine high versus low value add to patient outcomes should be performed. Clinical pharmacy activities not associated with an increased value or improved patient outcomes should be minimized. Collection and reporting of quality measures from high‐value clinical pharmacy services should be used to demonstrate positive impacts on patient outcomes 46 Operational services (e.g., order processing/verification) should be consolidated and optimized as able to allow for the expansion of clinical pharmacy services. Use of electronic medical record algorithms and artificial intelligence should be encouraged to streamline operational services and enhance efficiency in clinical activities. …”

“…44,45 There is significant variability among clinical practice settings and lag between current roles and future opportunities for clinical pharmacists. 9,46,47 Structural barriers, such as the absence of well-defined career ladder distinctions and those with the appropriate reward for a sustained level of practice at higher rungs, may limit opportunities beyond an individual's current position or activities. Career planning and potential for career growth are important, with 84% of clinical pharmacists surveyed in 2010 expressing interest in career planning.…”