As drug costs rise, hospitals are tapping into their pharmacies to not only control spending and improve margins but to manage critical issues like drug shortages and pain management. Many hospitals are now relying on their pharmacists to oversee everything from pharmacokinetic consultations to anticoagulation management, along with the proper use of antibiotics and Antimicrobial Stewardship (AMS).
More progressive hospitals are appointing pharmacists to executive leadership positions. The goal is to embed them into hospital care teams to create partnerships between pharmacists and physicians to better manage medications so they can improve quality metrics. This balancing act requires pharmacists to keep pace with evolving guidelines and regulations as more accountability shifts to the department.
With this expanding role, pharmacists must have access to an intelligent clinical surveillance platform and analytic toolset that extends the value of the data in their electronic health record (EHR). With a comprehensive view of patient health data, medication use, and compliance with guidelines and regulations, pharmacists are in a better position to enhance medication management, patient safety, and antimicrobial and opioid stewardship.
Wolters Kluwer spoke with three hospital pharmacy leaders to better understand how they are navigating increasing clinical demands using Sentri7 clinical surveillance on the SoleSource platform integrated with their EHR.
Our expert panel includes:
- Joe DeMattei, Pharm.D, Director of Pharmacy for Crossroads Community Hospital, a 47-bed facility offering inpatient and outpatient care in Illinois.
- Ashleigh Mouser, Clinical Pharmacy Coordinator, Hardin Memorial Hospital, a 270-bed Kentucky-based general medical and surgical facility.
- Matt Baldwin, Pharm.D, Executive Director of Pharmacy for Aultman Hospital, part of a 1032-bed not-for-profit hospital system located in Ohio.
How are you extending the value of your EHR with the surveillance capabilities of Sentri7?
DeMattei: Sentri7 is really our go-to system. We currently use a very basic EHR. We just don't have the budgets to support the implementation of a state-of-the-art EHR. I suspect this is probably the case with many smaller community hospitals that have limited IT funding. Sentri7 has been very instrumental in providing safe patient care and overcoming many of our EHR's shortcomings.
Mouser: With the systems working together, we're able to identify and prioritize which patients need attention faster. In an ideal world, there would be a relatively low pharmacist-to-patient ratio. But for us, we still have a high ratio. We've utilized rules and created tiers in Sentri7 to guide our workflow so we can prioritize what we do each day. Tier 1 rules are the highest priority for safety and for the pharmacist. Lower level tiers require our attention but aren't considered a patient safety risk. We tailor the rules to our hospital workflow and help guide our priorities.
Baldwin: Simply put, the EHR is always running in the background to provide us all of the patient health data, while Sentri7 helps us manage our workflow. Sentri7 gives us information tailored to what we in pharmacy need to see and how, so we can really target certain patients. We're only limited by the granularity of the information available through our EHR and whether it's real-time. This eliminates a lot of manual paperwork and sifting through the data. We can also ramp up an initiative more quickly by tailoring the rules that are being driven by the patient data in the EHR.
Take us through some of the more innovative use cases for Sentri7 that wouldn't be possible with your EHR alone.
DeMattei: Over the last several years our usage of Sentri7 has really evolved and matured. Initially, we were using the solution exclusively for renal dosing and IV to PO, but over time we realized we could do so much more. Here's a great example. Like every hospital, we're really trying to get ahead of C. diff, but we are vulnerable overnight when we have to rely on an outside hospital pharmacy to monitor our patient population.
I set up rules in Sentri7 to alert me via text message when a patient exhibits multiple symptoms that could point to C. diff, or when culture results come back positive. Then, I can quickly alert the covering pharmacy that the patient is C. diff positive and instruct them to take action. This is something we can't do in our electronic health record (EHR), which doesn't allow us to easily pull together multiple patient health data points into a single report.
Sentri7 is really designed for the pharmacy workflow, which our EHR really isn't. I can be proactive in looking for opportunities to automate things we're doing manually. This not only helps the hospital financially but also allows us to flag patients who may have a condition that can lead to other health complications.
Mouser: We are effectively using to manage drug shortages. Every hospital is going through this right now. When there is a shortage, we have to react quickly to look for medication alternatives. We can pull the medication usage data from across our patient population through our EHR and then set up a rule in Sentri7 that allows us to see in real-time which patients in the hospital are on that particular medication. Then, our pharmacists can identify alternatives and make the switch. This saves time when we have to act fast. This also allows us to have a huge impact on patient safety. Sentri7 helps us to help our patients.
Sentri7 also helps automate our review of high-cost medications. We use Sentri7's analytic and reporting capabilities to track medication use over time and follow trends. Data and metrics are reported to the Pharmacy and Therapeutics (P&T) Committee and illustrate usage over time and how interventions are driving down use - and ultimately costs. We present data and graphs that visually show the trends and give a snapshot of medication use. It's a very powerful representation of our efforts, allowing us to synthesize and understand the data and generate actionable insights.
Question: How does Sentri7 support your priority clinical initiatives?
Baldwin: Sentri7 gives us the ability to manage our larger target clinical initiatives like anticoagulation monitoring or AMS, as well as tailor our own rules as necessary, which gives us a lot of flexibility and control. We've seen a reduction of about $1 million in AMS spend alone since the inception of the program, as well as better patient outcomes. We're looking to Sentri7 to support our future initiatives in the areas of opioid management, oncology, and diabetes. We now know what's possible in the solution and we're asking ourselves "What else can we do?"
The physicians are asking us that question too. We have decentralized pharmacy and we are embedding pharmacists in care units across the hospital. Since the pharmacists are now part of the care team, we're building an expectation with our physicians. They're asking why they have pharmacists in one care unit and not another. It's a good problem to have. Physicians are coming to us and asking for pharmacy support. We've become an integral part of the care team.