HealthDecember 20, 2021

Clinical pharmacy: Reflecting on this year and looking ahead to 2022

Pharmacy teams endured another tough year with COVID-19 and were immensely involved in protecting our communities and improving patient outcomes. We asked our clinical pharmacy team to reflect on the year and share what they are expecting in 2022. The resounding message? The future is bright, self-care is key, and we’ve come a long way. Here’s what they said:

Continued challenges, hospitals must leverage technology and artificial intelligence to improve care delivery

Helene Daskalovitz, PharmD, Applied Analytics and Health System Leadership Senior Fellow

The year 2021 began with hope of ending the COVID-19 pandemic through mass vaccination of the general public and the development of novel treatment options to protect vulnerable populations. However, the arrival of newer variants such as Delta and Omicron showed the world that COVID-19 was not going away anytime soon. The year 2022 will be met with similar challenges as 2021. We will be faced with determining the correct strategy for administering vaccine booster doses (i.e. appropriate timeline and number of boosters), tackling misinformation, and allocating resources during drug shortages. Additionally, there will be a greater need for taking care of our healthcare teams and preventing burnout as the industry faces challenges of labor shortages and high turnover rates.

Another key area hospitals must focus on this year is leveraging technology and artificial intelligence. The possibilities are endless when it comes to utilizing data to produce better outcomes in our patients and increasing transparency within our health systems, but it will take strong leadership and buy-in from those at the frontline to drive adoption. One example is developing a robust Opioid Stewardship Program (OSP) to address the national opioid crisis. With integrated technologies, hospitals are empowered to target real-time opioid use by tracking morphine milligram equivalents (MME). This provides a standard way for leadership to easily benchmark opioid prescribing and derive actionable insights.

In all, 2022 may start off very similarly to 2021 (hang in there everyone!), but I believe that it has the potential to define the role of new technologies and change the way healthcare is delivered for the better.

Beyond COVID-19, how has the pandemic affected non-COVID patients?

Richard Dion, PharmD, Pharmacy Clinical Program Manager

While not focusing heavily on COVID-19 and its ongoing impact on the world, I do think we as healthcare workers will continue to be dealing with lingering and existing issues throughout 2022. At some point, I am hoping the dust settles and we explore as individuals, and inside of our professions, regarding the way we go forward from such a difficult and intensely emotional time period. The aftermath may allow for some reorganization and reprioritization in whole swaths of healthcare systems regarding patient care, provider care and respect, and even models of work.

One area I’ve continued to be heavily interested in is the outsized impact COVID-19 has had on other care for non-COVID patients. What do those disruptions to normal patient care look like from a retrospective view? How has patient safety changed during the pandemic? Was there an increased risk of adverse events related to hospital care in this time of extreme stress? Have we learned anything about our model that could be improved drastically? What can we learn about acute changes to patient care in a pandemic environment that might better prepare us for the next one?

Opportunity for change and resilience of frontline works prove that we can tackle the work ahead, including the opioid epidemic

Meghan Ha, PharmD, Applied Analytics and Health System Leadership Fellow

If COVID-19 was a poorly executed movie series that put out an unenthusiastic sequel in 2021, one can hope that 2022 will be the once-and-for-all end to a terrible trilogy. On the bright side, we shouldn’t underestimate the invaluable lessons learned from relentlessly combating the pandemic through the years. Healthcare continues to tough out drug shortages, limited patient access, and scientific misinformation all while cultivating new technologies and collaborating across numerous service lines to ensure quality care.

If there’s one takeaway that we’ve learned in the past two-plus years, it’s that the healthcare industry must be dynamic and proactive. The compounded effect of the faults in our health system has proven to be a worthy adversary through these tough times, but the opportunity for change and the resilience of frontline workers and industry leaders in 2021 have shown that the system can and will be improved.

One area of change that I am looking forward to in 2022 is how health systems will take action in addressing the opioid epidemic. With conversations in the last half-decade significantly altering the stigma around those with opioid and substance use disorders, it is exciting to see what strides will be made in caring for this traditionally neglected patient population. The focus has shifted from “why is this important?” to “what can we do right now?” as an increasing number of individuals collaborate to align goals, define strategies, equip resources, and empower others to make a difference. This call to action could not be timelier as the COVID pandemic has severely aggravated the state of affairs for patients with opioid use disorder.

Additionally, the utilization of data will be pivotal in guiding opioid stewardship programs for every stakeholder, whether the data is integrated into clinical decision-making or analyzed for key performance metrics. The growing movement to address the opioid crisis is a small glimpse of what interprofessional collaboration can accomplish and will hopefully set a new standard for clinical and public health initiatives.

Needless to say, the healthcare industry is changing - not only in response to external crises but also because we, the system's small, yet critical constituents, are changing. I mentioned earlier that the first two releases (years 2019-2021) of COVID-19 were fairly dismal. However, I challenge you to imagine 2022 (the highly anticipated trilogy finale) as a “Choose Your Own Adventure” in which you prioritize self-care, reconnect with the value of your work, and ultimately, triumph over any challenges that arise. With that growth mindset, maybe 2022 won’t receive too many bad reviews after all!

Hopeful for a definitive set of guidance for compounders

Annie Lambert, PharmD, BCSCP, Clinical Program Manager

In 2021, pharmacy operations continued to ebb and flow based on vaccine roll-out, surges in census, and continued drug and supply chain shortages. Technician staffing shortages only add to the challenges to maintaining compliance in such conditions. Yet, these all present an opportunity to demonstrate the agility and resiliency of the pharmacy department, highlighted in the ASHP Pharmacy Forecast for 2022.

While I hesitate to call USP, FDA, and NIOSH updates a light at the end of the tunnel, I hope in 2022 we will at least have a definitive set of guidance for compounders to follow, rather than the continuous limbo between current standards and proposed best practices we’ve experienced for the last several years. With the 2021 proposed USP compounding chapter revisions, the USP Compounding Expert Committee provided clear direction and rationale for many of their proposals. Take the time to understand the potential impact to your pharmacy, especially for resources needed to maintain staff competency every 6 months, beyond-use dates, and additional requirements if you perform Category 3 (high-risk) compounding. These requirements may help quantify the efforts required for compliance and justify additional staff. At Wolters Kluwer, we will be doing the same and preparing to implement whatever revisions become official with Simplifi 797.

Through it all - it’s easy to lose yourself while you’re doing so much to serve everyone else. Please don’t lose sight of your own self-care and mental health. The future of pharmacy is bright with new care models and valued partnerships established during the pandemic. But only if we take care of ourselves to regain a sustainable level of engagement with this meaningful work.

Tackling pharmacist burnout and prioritizing Diversity, Equity, and Inclusion

Stacey McCoy, PharmD, MS, BCPS, Pharmacy Clinical Program Manager

After another challenging year, the outlook for 2022 appears not only hopeful but welcomed by many who are ready for a new beginning. There is an increasing interest in the idea of self-care and avoiding pharmacist burnout, which will only prove to benefit both the employee and the overall situation for the pharmacy department. Examples of these include discussions during the ASHP Midyear session, along with its Well Being and Resilience campaign, which has free tools offered to members, such as a Headspace membership.

Diversity Equity and Inclusion (DEI) efforts extend beyond the walls of the pharmacy and into the most hospital initiatives for the upcoming year. It’s essential that we look for imbalances in our prior teaching regarding patient care, as well as how we relate to and communicate with colleagues. Now that we are opening the door for these discussions, the overall patient care experience will improve.

Finally, the last two years have taught us quite a bit about the importance of leveraging technology to navigate through challenging times. Pharmacists have been catapulted to the forefront of a quickly changing endemic, and our skillsets as provider (beyond that of dispensing), is being leveraged more frequently. It’s incumbent upon us to equip ourselves with technological advances that can help save time and improve our ability to serve. How can we use software applications to better manage inventory, identify potential opportunities to improve care and/or improve access to care for patients that might otherwise be overlooked?

I’m looking forward to the advances that are to come in the upcoming year as we strive to serve our patients alongside our nursing and physician colleagues with even greater recognition for our efforts as patient care providers.

Pharmacists will continue to play a leading role in the fight against COVID-19 as it evolves

Steve Mok PharmD, BCPS, BCIDP, Manager of Pharmacy Services and Fellowship Director

I was hoping not to mention COVID-19 in 2022, but unfortunately, the recent appearance of the Omicron variant will likely prolong the duration of the pandemic. Antimicrobial stewardship (AMS) pharmacists will continue to play a key role in helping their health systems and affiliated outpatient sites of care to deliver vaccines and therapeutics to patients. It’s unknown yet in mid-December whether an updated vaccine would be required, but pharmacists should be ready to stand up vaccination clinics again to deliver updated versions of vaccines if they would be required in the future. Now would be a good time to review the vaccination campaigns that were conducted in early and mid-2021 and evaluate what worked well and what could be improved. Lessons learned should be incorporated into future vaccine drives to improve operational efficiency and patient experience.

As the most accessible healthcare provider, pharmacists will likely be tasked by public health officials to coordinate the use of oral therapeutics for COVID-19. Under protocols, many localities will lean on pharmacists to provide diagnostic testing, prescribing, and dispensing of such medications to COVID-19 positive patients. Pharmacists are ideally positioned to screen for contraindications and provide education to patients on the appropriate use of these medicines to treat COVID-19. Clinical protocols should be developed in conjunction with local medical directors and public health officials to determine clinical criteria for referrals to higher levels of care for patients at higher risk of complications.

Hopefully, the new year will bring an end to the pandemic and AMS pharmacists will be able to refocus their efforts on improving antimicrobial use and mitigating the development of antimicrobial resistance. There are almost a dozen antimicrobials in phase 3 trials and it’s likely that some will be approved by the FDA in the new year. We will continue to depend on AMS pharmacists to ensure that these new antimicrobials are used in the most appropriate patients so that their longevity will be preserved.

Read all Wolters Kluwer expert predictions in healthcare technology for 2022.

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