Methods
Setting
The University Medical Center of Princeton at Plainsboro (UMCPP), part of the Princeton HealthCare System, is a 230-bed community acute care hospital located in central New Jersey. The hospital facility relocated in May 2012 from its previous location in Princeton to a new state-of-the-art facility in Plainsboro. As an affiliate of the Robert Wood Johnson Medical School and the Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey (ie, Rutgers), it is an academic teaching hospital with a mixed model for providing patient care. UMCPP employs both faculty physicians leading academic teams alongside hospitalists and private attendings.
Pharmacy services are provided on facility 24 hours a day, 365 days a year. The department of pharmacy services provides a full scope medication services from a centralized location with 3 full-time day pharmacists and 1 oncology satellite pharmacist. During weekdays, decentralized pharmacists provide medication review, patient education, and medication reconciliation on 2 to 3 inpatient care units. Centralized support decreases to 2 pharmacists in the evening and 1 overnight. Clinical pharmacists, both hospital-based and Rutgers faculty, work in conjunction with the staff pharmacists to ensure appropriate management of patients throughout different levels of care.
Program Overview and Implementation
To enhance protocols allowing pharmacists to more holistically and robustly optimize pharmacotherapy, UMCPP implemented the Clinical Pharmacy Services policy in February 2012. The policy outlined 8 protocols through which registered pharmacists within the acute care hospital could implement outlined medication order adjustments for adults of inpatient status. Pediatric patients or those treated outside of the acute care hospital (eg, in the psychiatric hospital, surgical center or outpatient facilities) were excluded. While the hospital had existing traditional programs such as IV-to-PO conversions, the programs were restricted to specific agents or conditions. As such, pharmacists were assigned to review queues in the clinical computer system to which orders for the agents outlined by the specific program would flow. Review would occur at set intervals and focus on that detail of the patient’s care as opposed to broadly encompassing an evaluation of the patient’s comprehensive pharmacotherapy. The goal of the new policy was to better utilize the pharmacists’ expertise by broadening these assessments to all applicable agents, refine workflow (by allowing protocol management instead of requiring individual prescriber calls for each issue) and integrate holistic refinement of pharmacotherapy regimens during the usual course of the pharmacist’s clinical care.
In the state of New Jersey, the Pharmacy Practice Act (updated on 14 January 2004) formally recognizes pharmacists as health care professionals and permits for collaborative practice in the community setting [34]. However, pharmacist management by protocol in the acute care hospital setting is defined separately, requiring only medical approvals within the system [35]. In accordance, the policy and associated protocols were approved by the institution’s multidisciplinary pharmacy and therapeutics (P&T) and medical executive committee processes.
