The Synergy of Medication Management, Patient Safety, and Financial Stewardship

Introduction

Medication use has become increasingly complex, with more medications available for the treatment of a growing array of conditions. Studies have shown increasing morbidity and mortality from adverse drug events (ADEs), and the World Health Organization (WHO) has recently declared patient safety as the 21st century's new frontier for healthcare. Medication management offers an opportunity to contribute to patient safety through the prevention of ADEs and the optimization of pharmacotherapy. Hospital pharmacists have an important role in improving medication safety, and this has been recognized by other healthcare professionals and policymakers. Various studies have shown the impact of pharmacist interventions on the detection and prevention of ADEs and the optimization of pharmacotherapy. With approximately 3.8-7.3% of hospital admissions being medication-related and 10% of patients during hospital admission having an ADE, there is a great need for pharmacist services to prevent medication-related morbidity. Furthermore, ADEs have been shown to increase the length of stay and total hospital costs, with many being preventable, creating a need for financial stewardship in dealing with ADEs.  

Patient safety and quality care are central issues in the current healthcare climate, with a developing culture of safety that has been endorsed by the Institute of Medicine. This has provided a strong platform for the contribution of hospital pharmacists to patient care through an increased focus on the safety and efficacy of medication therapy. In this climate of quality improvement, the discussion of pharmacists’ impact on patient outcomes has become increasingly common, with an emphasis on relevant clinical outcomes rather than purely economic measures.

The shifts in pharmacist practice from traditional dispensing roles to more patient-focused clinical activities can be demonstrated by various models of practice. The American Society of Health-System Pharmacists (ASHP) has published several statements on ideal pharmacy practice and the role of the pharmacist. These practice statements have been significant in shaping clinical pharmacy practice and influencing the integral role that pharmacists play on the healthcare team.

Importance of hospital pharmacist involvement

The disease burden in modern hospital pharmacy practice is shifting towards more complex, acute and chronic conditions that require pharmacotherapeutic intervention. With the growing number of medications and the increased acuity and age of hospitalized patients, medication management is a growing challenge. It has long been recognized that pharmacists have the knowledge and expertise to make an impact on improving medication use. However, it is only in the past decade that studies have increasingly demonstrated the economic and clinical benefits of the pharmacist's interventions. There is a growing body of evidence that pharmacists' involvement in patient care is associated with positive outcomes in patient safety and reduction of medication errors. There have been many reports of specific pharmacist activities resulting in the avoidance of adverse events. With the consensus that pharmacists can improve medication use and associated patient outcomes, there is a strong economic argument that supports an increased allocation of pharmacists to direct patient care. Randomized controlled trials have demonstrated the effectiveness of pharmacist interventions on patient outcomes and have shown that these outcomes are achieved in a cost-effective manner.

Cost-utility studies have demonstrated that pharmacist interventions are associated with both improved health outcomes and cost savings in a variety of inpatient and outpatient settings. Medication safety is another hot topic in healthcare and is listed as a National Patient Safety Goal by the Joint Commission. This implies that healthcare organizations are to integrate the goal of preventing medication errors into their organizations' aims and are to measure their progress toward this goal. With growing evidence that a pharmacist can play a key role in preventing medication errors, pharmacist services are becoming a vital requirement for a healthcare organization.

Synergy between medication management and patient safety

The existence of medication errors implies that there are vulnerabilities in the medication delivery system that allow for mistakes to occur. It is approximated that 1.3 million people are hurt annually in the United States from medication errors. Medication errors are costing around 3.5 billion dollars per year. Hospital pharmacists are often relied upon as a source for their medication expertise and are in an optimal position to affect a reduction in the prevalence of medication errors.

In a time of rising healthcare costs, it is important that the quality of care be maintained or enhanced while attempting to reduce the cost of care. Enhanced use of medication and an increasing population have led to amplified medication expenditures. At the same time, there is also an obvious show of harmful consequences happening from both underuse and misuse of medication, highlighting the need for optimization of medication therapy. This is where the pharmacist steps in. Pharmacists are in a unique position to optimize a patient’s medication regimen and improve therapeutic outcomes. This will lead to a decrease in overall healthcare costs due to a reduction in adverse effects, medication errors, and readmissions.

Synergy between medication management and patient safety

The close association between medication management and financial stewardship gives hospital pharmacists an opportunity to transform financial and clinical outcomes for their institutions. In an era where payment for health care services is increasingly being linked to the quality of care and the outcomes achieved, optimization of medication use makes economic sense. The synergy between medication management and financial stewardship is best illustrated by comparing the characteristics of medications that are optimally managed with those that are sub-optimally managed with respect to their clinical efficacy, safety, and cost. Close examination of a medication and its place in therapy provides an opportunity to make a significant clinical and economic impact. It is a basic principle that can be applied in all phases of medication management to improve the use of medications.

Conclusion

Hospital pharmacists serve as integral members of interdisciplinary care teams. They participate in clinical rounds, offering real-time input on medication regimens and contributing to evidence-based decision-making. Through optimization of medication utilization, mitigation of medication errors and adverse events, promotion of medication adherence, and data-driven performance improvement initiatives, pharmacists contribute to the delivery of high-quality, cost-effective care. As healthcare continues to evolve, the collaborative efforts of pharmacists and healthcare stakeholders will be instrumental in shaping a healthcare ecosystem that prioritizes patient safety, financial stewardship, and clinical excellence