Hospital Pharmacists Help Improve Core Measure Scores

As part of an interdisciplinary team at Pennsylvania Hospital, clinical pharmacists helped improve performance on 9 medication-related core measures.

A program featuring clinical pharmacists in a major role helped to improve a hospital’s performance on all medication-related core measures that it targeted and to reach 100% compliance on most measures. The program was implemented at Pennsylvania Hospital in Philadelphia. Three of the clinical pharmacy specialists involved in the program and the hospital’s director of pharmacy services described the program and its results in an article in the January 2013 edition of Pharmacy Practice News.

The Centers for Medicare and Medicaid Services established the core measures based on evidence-based quality indicators that have been shown to reduce the risk of complications, prevent recurrences, and promote optimal treatment of patients with particular conditions. Failure to comply with them can lead to reduced reimbursement.

Prior to the program’s start in April 2011, a plan to educate pharmacists and hospital staff was developed. Pharmacists would receive training in areas covered by the core measure initiative—acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN)—and would be familiarized with the core measures. Hospital staff received instruction on the core measures and ways in which pharmacists could help achieve compliance goals.

The core measures related to AMI were: aspirin prescribed at discharge, angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) for left ventricular systolic dysfunction (LVSD), beta-blocker prescribed at discharge, and statin prescribed at discharge. The core measure for HF was ACE inhibitor or ARB for LVSD. The core measure for PN was initial antibiotic selection. The core measures for stroke were venous thromboembolism prevention, discharged on antithrombotic therapy, and discharged on statin.

In order to address their new responsibilities, unit-based clinical pharmacists classified patients diagnosed upon admission with any of the conditions covered by the initiative and screened patients for these diagnoses while doing their daily rounds. Pharmacists also used patient-specific worksheets to keep track of medication-related core measure compliance. (After this paper process was in place for 8 months, a computerized surveillance system was implemented that produced lists of patients who were not receiving medications appropriate for their diagnosis, making the process of core measure compliance far more efficient.)

After evaluating a patient and consulting with a multidisciplinary team, clinical pharmacists would document a contraindication in the patient’s permanent medical record if the patient was noncompliant with a medication due to contraindication and consult with the provider and recommend compliance if the patient was noncompliant and no contraindication was indicated.

In the first 17 months of pharmacist involvement in the core measure initiative, pharmacists reviewed 2742 patients, made 218 documentations in patient charts, and made 224 recommendations, of which 96% were accepted. As a result, the hospital improved its compliance in 9 targeted medication-related core measures and achieved 100% compliance in most of these measures.

The authors note that the success of the program depended on the following factors: cooperation between the Pharmacy Department and the Department of Quality and Patient Safety; staff education on disease states and core measures; integration of the project into the operational structure of the department; a standardized surveillance process for identifying patients in need of attention; an interdisciplinary team including a pharmacist that met during patient care rounds; and monitoring of the program’s results at monthly meetings.