Each hospital CEO must determine which departments should logically report to each senior executive. Historically, the vice president for medical affairs or chief medical officer was hired to address the medical staff and its governance, continuing medical education and quality improvement. But there is another department head that should report to the senior physician executive of a hospital: the hospital pharmacy director.
Medication administration is one of the most important functions of a hospital. Safe, effective and timely administration of medications requires coordination of multiple hospital staff departments, integration of electronic medical records, implementation of pharmacy automation, and monitoring and managing drug costs.
The triad of professionals responsible for the selection and delivery of medications consists of the physician, nurse and pharmacist. These highly educated professionals each contributes critical expertise to medication delivery. The integration of the physician/nurse/pharmacist triad is the secret to safe medication delivery.
Those three professionals each work in domains with unique challenges and cultures. Thus, when they bring to bear their particular skills and tools, they optimize the patient’s outcome.
Value of the Physician Executive
The physician is an expert in selecting the medication needed to treat a given patient. The nurse is the expert in safely administering the medication and monitoring the patient for intended benefits and adverse effects. The pharmacist is the expert at monitoring the process, delivering the medication to the bedside and providing needed support and advice, especially when polypharmacy is involved.
The Physician Executive is in the best position to understand the process and facilitate coordination of the stakeholders. Some of the critical aspects that must be led are:
- Developing guidelines and protocols that drive medication selection.
- Facilitating discussions needed to create a formulary that is appropriate, yet manageable in size, cost and complexity.
- Mediating between physicians and pharmacists when constraints are placed on the use of high cost medications.
- Advising about which functions can be delegated to technicians and which require direct doctorate-level pharmacists.
- Promoting the collaboration between the pharmacy and quality improvement departments.
- Balancing the costs and benefits of new pharmacy-led initiatives such as:
- Deployment of clinical pharmacists to the emergency department and other units such as intensive care;
- Diabetes management services to adjust insulin doses for inpatients; and
- Anticoagulation clinics to adjust warfarin dosing.
How can the VPMA or CMO best help the pharmacy to deliver on its mission? Here are a few suggestions to consider.
- Promote a culture of accountability, teamwork and safety within the department. This will require the selection and nurturing of a very skilled pharmacy director.
- Lead your physician and nursing colleagues by example. Commit time and resources to measuring outcomes, participating in teams, and presenting pharmacy concerns to medical staff and executive leadership.
- Remain current with important medication safety issues by monitoring publications from:
Finally, as with all of your direct reports, you will meet with your pharmacy director on a weekly or biweekly basis. During those meetings, the following topics should be addressed (not necessarily at every meeting):
- Review of goals for the year. Are milestones being met? How can you facilitate them?
- Review staffing. Is the pharmacy fully staffed? Are there open positions? How are those being addressed?
- Budget updates. How are expenses running compared to budget, especially staffing and drug costs?
- Medication safety reporting. What are the number and nature of medication errors for the past reporting period? Were they preventable?
- Formulary requests. Are any pending? Review the agenda for the next Pharmacy and Therapeutics meeting. Do physicians need to be contacted prior to the next meeting?
- Summary of cost reductions resulting from clinical pharmacy interventions.
- Director’s performance review (at least quarterly).
The physician executive can have a positive impact on patient care. This will be achieved by enabling the pharmacists to fully apply their expertise and by promoting the physician/nurse/pharmacist triad.
If you are a VPMA or CMO and do not currently oversee the pharmacy functions, become more involved in the department.
- Attend P and T Committee meetings.
- Support the efforts of the Pharmacy Department to engage physicians.
- Promote new clinical pharmacy initiatives that will enhance medication safety.
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