Development of an operational productivity tool within a cancer treatment center pharmacy

Evaluation of oncology infusion pharmacy practices: A nationwide survey

PURPOSE

Oncology care continues to evolve at a rapid pace including provision of infusion-based care. There is currently a lack of robust metrics around oncology infusion centers and pharmacy practice. The workgroup completed a nationwide survey to learn about oncology-based infusion pharmacy services offered. The objective was to highlight consistent, measureable oncology-based infusion pharmacy metrics that will provide a foundation to describe overall productivity including emphasis on high patient-safety standards.

METHODS

A nationwide survey was developed via a workgroup within the Vizient Pharmacy Cancer Care Group beginning in April 2019 and conducted electronically via the Vizient Pharmacy Network from September to November 2020. The survey was designed to capture a number of key metrics related to oncology-based infusion pharmacy services.

RESULTS

Forty-one sites responded to the survey. Responses highlighted hours of operation (median = 11.5), number of infusion chairs (median = 45). Staffing metrics included 7.1 pharmacist full-time equivalent (FTE) and 7.6 technician FTE per week. 80.5% of sites had cleanrooms and 95.1% reported both hazardous and nonhazardous compounding hoods. 68.3% of sites reported using intravenous (IV) technology, 50.0% measured turnaround time, and 31.4% prepared treatment medications in advance.

CONCLUSION

There was variability among oncology infusion pharmacy practices in regard to survey responses among sites. The survey results highlight the need for standardization of established productivity metrics across oncology infusion pharmacies in order to improve efficiency and contain costs in the changing oncology landscape. The survey provides insight into oncology infusion pharmacy practices nationwide and provides information for pharmacy leaders to help guide their practices.

The development and evaluation of a predictive productivity model in the ambulatory oncology infusion setting

PURPOSE

Accurately describing pharmacy productivity in the ambulatory oncology infusion setting is important to ensure appropriate labor utilization. The purpose of this study was to develop a productivity model utilizing weighted medication complexity and prospective schedule data to determine if predicted productivity corresponds to actual productivity across 6 ambulatory oncology infusion sites.

METHODS

This study was a 2-part analysis. Part 1 was to modify the historic productivity model from dispense code weighting to individual medication complexity weighting. Medication-specific relative value units were determined by analyzing 12 months of historic timestamp data from the electronic health record and gravimetric technology software. The productivity model containing updated relative value units was compared to the historic model to determine if the difference in total calculated full-time equivalents (FTEs) was within 2.0 FTEs. Part 2 applied prospective infusion schedule data to the updated model to determine if predicted productivity corresponded to actual productivity (within 2.0 FTEs) for pharmacy infusion services.

RESULTS

The mean difference in total calculated FTEs for infusion during the study period was 2.46 (standard deviation = 1.87) and was within the range of 2.0 FTEs (P = 0.54), indicating that the updated model was not statistically different from the historic model. The mean difference in total calculated FTEs between the predictive and actual productivity model for infusion was 18.28 (standard deviation = 1.00) and was out of the range of 2.0 FTEs (P < 0.001), indicating that predicted productivity was statistically different from the actual productivity.

CONCLUSION

Medication complexity weighting can be used to provide a comprehensive assessment of workload and productivity across pharmacy infusion services. The methodology used to assess predictive productivity should be explored further.

Expanding oncology pharmacist teams: Justifying the return on investment

Oncology pharmacists are an integral member of the cancer care multi-disciplinary team. Despite the role being previously well defined, responsibilities continue to expand. Position justification for pharmacists is a challenge with prerequisites to optimize efficient processes, promote quality and reduce overall costs. Initiation and implementation of new oncology pharmacist services requires a clear description of value to the organization and a strong understanding of workflows. Position justifications must be data-driven and unique to the organization's need and should include physician or key stakeholder support, quality initiatives, cost-savings initiatives, and revenue-generating roles. The cases and examples described serve as a reference for individuals, teams, or organizations pursuing the value of a financial investment of an oncology pharmacist to expand or initiate new pharmacy services.

Identifying health-system pharmacy operational process categories and corresponding tasks across a diverse health system using a modified Delphi process

DISCLAIMER

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE

The purpose of this study was to identify and build consensus on operational tasks that occur within a health-system pharmacy.

METHODS

An expert panel of 8 individuals was invited to participate in a 3-round modified Delphi process. In the first round, the expert panel independently reviewed an initial list and provided feedback. All feedback was incorporated into the second round and then reviewed and discussed as a group. The expert panel reviewed an updated list based on feedback from the second round and reached consensus on a final list of operational processes and corresponding tasks.

RESULTS

All 8 participants agreed to serve on the Delphi expert panel and reviewed an initial list of 9 process categories (hazardous intravenous [IV] medications, nonhazardous IV medications, hazardous oral medications, nonhazardous oral medications, controlled substances, total parenteral nutrition [TPN]/fluid preparations, distribution and delivery, clinical tasks, and miscellaneous operational tasks) and 44 corresponding tasks. Through the Delphi process, 72 new tasks were identified in the first round, while 34 new tasks were identified in the second round. In the third and final round, the expert panel reviewed the updated list of 9 process categories and 150 corresponding tasks, made additional edits, and reached consensus on a final list of 9 processes and 138 corresponding tasks that represented operational work within a health-system pharmacy.

CONCLUSION

The modified Delphi process effectively identified operational processes and corresponding tasks occurring within hospital pharmacies in a diverse health system. This process facilitated consensus building, and the findings may inform development of an operational workload model.

Development of a system-wide pharmacy operational weighted workload model at a large academic health system

PURPOSE

The purpose of this study is to develop a standard operational and distributional weighted workload model that is applicable across an integrated, diverse healthcare system. This model aims to not only demonstrate the operational intensity of pharmacy practice but also to inform opportunities to decrease waste, increase efficiency, facilitate growth, and demonstrate value across operational and distributional pharmacy services.

SUMMARY

Time studies were conducted at 8 hospitals within the UNC Health system to objectively measure time spent within each operational process in order to create a system-wide weighted workload model. Time study results informed the development of a system-wide weighted workload model. Data from December 29, 2019, through December 26, 2020, was then applied to this weighted workload model. With this model, acute care hospital and infusion center operational areas were compared in thousands of combinations within single operational areas and across any and all operational areas by dispense code, weighted work, and ratio of weighted work to total sum of dispenses at each site.

CONCLUSION

The model successfully achieved the objective to develop a standard operational weighted workload model that is applicable across the integrated, diverse care system. This model provides a foundation for UNC Health to further productivity measurement and fills a gap in the literature by offering a novel method of developing a system-level operational workload model that can be used to evaluate and compare operational workloads across health-system sites.

Practice-enhancing publications about the medication-use process in 2018

PURPOSE

This article identifies, prioritizes, and summarizes published literature on the medication-use process (MUP) from calendar year 2018 that can impact health-system pharmacy daily practice. The MUP is the foundational system that provides the framework for safe medication utilization within the healthcare environment. The MUP is defined in this article as having the following steps: prescribing/transcribing, dispensing, administration, and monitoring. Articles that evaluated one of the steps were gauged for their usefulness toward daily practice change.

SUMMARY

A PubMed search was conducted in February 2019 for articles published in calendar year 2018 using targeted Medical Subject Headings (MeSH) keywords, targeted non-MeSH keywords, and the table of contents of selected pharmacy journals, providing a total of 43,977 articles. A thorough review identified 62 potentially significant articles: 9 for prescribing/transcribing, 12 for dispensing, 13 for administration, and 28 for monitoring. Ranking of the articles for importance by peers led to the selection of key articles from each category. The highest-ranked articles are briefly summarized, with a mention of why they are important within health-system pharmacy. The other articles are listed for further review and evaluation.

CONCLUSION

It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article assists in identifying and summarizing recent impactful contributions to the MUP literature. Health-system pharmacists have an active role in improving the MUP in their institution, and awareness of significant published studies can assist in changing practice at the institutional level.