Health system pharmacists do more than buy and dispense drugs to hospital patients. They save lives. Ask Heather Cusick, director of product management for clinical services at McKesson.
Before joining McKesson, Cusick was a health system pharmacist. Her experience made her believe in the power of technology to improve patient outcomes. She brings that passion to her work with other health system pharmacies across the country.
In this edition of Pharmacist to Pharmacist, we asked Cusick how health system pharmacies can improve patient outcomes and lower the cost of care at a time when patients can choose from more providers and pharmacies than ever before.
What are you responsible for in your role at McKesson?
Cusick: My team works with health system pharmacies to build out their outpatient pharmacies. We also help them adopt and use the tools they need to support their clinical programs along the continuum of care.
What are some of the operational challenges you’re hearing about from health system pharmacies?
Cusick: There’s a lot of consolidation going on right now. Different hospitals are coming together. That creates a lot of operational issues for their pharmacies. One is the interoperability between their EHRs and between their pharmacy management systems. Another issue is reconciling their drug formularies. A third is how they manage their drug inventories.
What can health system pharmacies do to overcome those challenges?
Cusick: You can manage them by coordinating your P&T (pharmacy and therapeutics) committees. The committees review drugs. They decide which ones should be in your formularies. And they set practice standards for drug use across all your sites. Now everything is consistent. Then you’ll need to centralize all your drug data in one IT system or be able to connect to a common IT system that tracks all the drugs you buy, store and dispense.
What are some of the clinical challenges you’re hearing about from health system pharmacies?
Cusick: A big focus for us and the pharmacies we work with has been medication reconciliation. When your hospital admits a patient, it’s your job to know what drugs they’re on. Are they taking everything that a doctor has prescribed to them? Are they taking the right drug for the right condition? Are they taking it in the right dose and at the right frequency? Not doing those things could be the reason that they’re here. And if you don’t have all the information, the drugs you give to them while they’re in the hospital could create a problem.
How can health system pharmacies improve their medication reconciliation processes?
Cusick: Patients aren’t always able to give you accurate information. You need a pharmacy management system (PMS) that can give you up-to-date information on a patient’s drug history and use. That means your PMS should be able to connect to any pharmacy that may have dispensed drugs to your patient. Your PMS should also be able to identify any provider that may have prescribed drugs to your patient. You need to integrate your PMS with your EHR system if you want to improve medication reconciliation.
What other clinical challenges do health system pharmacies face?
Cusick: Assuming things go well at the hospital, the next big clinical issue is medication adherence. Are your patients taking their meds the right way after they leave? That’s getting harder to do. Your patients can get their outpatient care in any number of settings. They can get their prescriptions filled at any number of sites. Prescribers don’t always talk to each other. Pharmacies don’t always talk to each other. And we know that patients who mismanage their meds often end up back in the hospital.
How can health system pharmacies improve medication adherence after patients leave the hospital?
Cusick: There are a few things you can do. The first is patient education. You need to explain to patients what drugs they’re taking, how the drugs work and why it’s important to take them the right way. You should do that before discharge. You may want to fill their prescriptions before they leave. The second is provider education. You need to tell every provider along a patient’s continuum of care which drugs the patient is taking and why. That way, everyone is up to date on a patient’s drugs and following the same drug plan. When a patient sees anyone along that continuum of care, they hear the same message. The third thing, and I’m coming back to it again, is interoperability. You need to be able to share a patient’s treatment plan electronically with all the downstream prescribers and pharmacies. That’s really important if a patient is on a specialty drug that needs prior authorization and may be available only from certain pharmacies.
What other clinical trends should health system pharmacies stay on top of?
Cusick: One is pharmacogenomics. We use evidence-based protocols to tell us when to prescribe a drug and when not to prescribe a drug. But we’re moving into the age of genetics and personalized medicine. We’ll be able to look at a patient’s genetic makeup and know if we should deviate from those standards. We’ll know what drug might work better, work better at a different dose or work better in concert with another drug. We’ll know what drug won’t work or will cause side effects. Another trend is analytics. There’s so much data out there that pharmacists need help pulling it all together to make better decisions. That also includes cost data. Analytics will help pharmacists choose between two drugs that have the same clinical results but are at different price points for the patient.
What are your thoughts on the expanding role of the health system pharmacist as provider?
Cusick: I’m 100 percent behind it. We’re experts on medications. I feel like we’ve been an underused resource in many ways, especially when you consider the push for more value. Everyone wants better patient outcomes and lower costs of care. Proper drug use can help with both, and that’s what we do. Health systems have come a long way in including pharmacists on their care teams. Now we’re seeing the reach of health system pharmacists extend into outpatient and independent pharmacies as they take more responsibility for the drug use and health outcomes of their patients.
What’s your most memorable moment as a health system pharmacist?
Cusick: My most memorable moment was when I caught a medication error that could have harmed a patient. The mistake happened when a doctor gave a verbal drug order to the nursing staff, and the staff miscommunicated it to the pharmacy because of a transcription error. The conversations I had with the doctor and nurses led them to be more open to taking the advice of the pharmacy. That also sparked my interest in using technology to improve drug safety, because it reduces the potential of human error.
Editor’s note: If you have a question for one of our pharmacists, please leave a comment and let us know. We’ll be sure to cover it in a future edition of Pharmacist to Pharmacist.
Related: Learn more about McKesson’s medication adherence solution for hospital and health system pharmacies