Evaluation of Clinical Pharmacy Impact on Multiple Internal Medicine Teams Utilizing Alternative Rounding Strategies
Nguyen, Phuoc AT
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Purpose: Many studies have demonstrated the positive impact of clinical pharmacist interventions on internal medicine teams. At the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), the inpatient clinical pharmacy section has a total of five internal medicine (IM) clinical pharmacy specialists (CPSs) allotted for ten IM teams. Challenges were identified in meeting the needs of both assigned teams (e.g. rounding and medication reconciliation). Various methods were proposed including alternative rounding model. There are limited studies investigating different rounding models to accommodate multiple teams per pharmacist. Objective: To determine the effectiveness of alternative rounding strategies to maximize the impact of patient-care focused pharmacists on multiple medicine teams. The primary outcome is to compare the number of interventions and number of patients followed by the pharmacists between the two different rounding strategies. Secondary outcomes are to evaluate the change in length of stay and 30 – day readmissions and to compare the types of interventions and cost savings between the two different rounding strategies. Methods: This is a randomized retrospective cross-over study, evaluating alternative rounding strategies at a single institution from June to September 2014. This study was approved by the Michael E. DeBakey VA Medical Center, Baylor College of Medicine Investigational Review Boards, and University of Houston Investigational Review Boards. Results: Baseline characteristics were similar between the traditional (n = 20) and alternative rounding (n = 56) models with the exception of a higher rate of heart failure patients (p = 0.005) in the traditional model (50%) vs the alternative rounding (18%). Overall, alternative rounding strategies had a higher number of patients evaluated by pharmacists, increased number of interventions, and a greater cost avoidance than the traditional model. There was no statistically significant effect on length of stay or 30 – day readmissions between the two groups. Conclusion: Pharmacists who actively round with internal medicine teams are associated with increased patient evaluations, pharmacotherapy interventions, and cost savings. Implementing alternative rounding strategies may be an effective method to increase patients’ access to care and increase the number of patients being seen by pharmacists. Advocating for the presence of a pharmacist on all medicine teams provides optimal continuity of patient care.