Review Article

Rethinking the hospital pharmacist service: Centralized logistics an opportunity for public and private istitutions

Author : m luisetto Hospital Pharmacist Manager , Applied Pharmacologist,European Specialist In Lab. Medicine Italy 29122E-Mail: maurolu65@gmail.com

Keywords: change management, hospital pharmacy , innovation, healthcare , pharmaceutical care

Clinical pharmacy, logistics, medical error, clinical outcomes

Introduction

In last decades the total healthcare costs are increased constantly in logarithmic way and this are involved in resource management more than past.

The pharmaceutical costs involved in drugs ,medical devices, in diagnostics or due by medical errors are a relevant voice in the hospital current budget. and are under great rationalization by institution ( pubblic or private ).

(In example U.S. national health expenditure, amounted total 3.0 -3,1 billion U.S. D . The total nominal spending on medicine in the USA was about 5 more than 400 us dollars in 2015 )

A performance HEALTHCARE organization need today : innovations ,correct management of materials ( LOGISTICS AND USE of drugs and medical devices ), new technologies knowledge, skills and other resource .

Strategic and change management approach, sharing economy philosophy ) and other new and innovative tools as velocity management (1)

Multiprofessional medical team with permanent presence of pharmacist give improving in clinical and economic outcomes (2)

Risk management activity Reduce costs due by therapy error

And hospital pharmacists complete the patient medical team

With deep pharmaceutical competencies ( To prevent therapy errors, ADR, and monitoring the therapy) .

The efficacy human resource management gives high contributed in the global results . (3) make possible rapid introduction of the different healthcare professionals in equipe.

All this instrument we have see contribute to high rationalize the healthcare systems .

But today we have a powerfull instrument to efficacy control the costs to be used : centralized logistics systems to reduce total costs of drugs and medical device logistics .

The centralized logistic and regional buying center make possible a great rationalization in costs and in hospital pharmacist working time .

Increase the number of orders (Cumulative way ) order from the many hospital linked and associated .

This systems make possible to high reduce hospital pharmacy stokes ( in example due by immobilized costs, expiration data ) but at the same time to give continuity to the drugs therapy to the hospital wards .

This imply a just in time systems and need a great support by ICT technologies .

The informatic and ICT competence of clinical pharmacist

Are instruments to manage this new systems.

The right and rapid communication with the hub and spoke make possible To have the drugs in strictly time.

The same the clinical competences of hospital pharmacist

gives the correct priority in ordering drugs and medical devices .

Is need a small stoke of drugs in the hospital pharmacy whit

50 -80 kind of molecules ( more critical ) and an emergency

Drugs Cabinets in ICU in order to cover emergencies if not present an h24 hospital pharmacist service.

This systems need a great expertize and skills by the clinical pharmacist To rationalize the systems without error in ordering time .

( right classification of critical drugs ) and a risk management system to prevent disfunctions .( root cause analisys).

The clinical pharmacist works as a liason between the ward the hospital pharmacy and the hub.

Other instrument are Dose unit drug systems , informatics prescription systems with dedicated software , oncology unit’s sterile robots, emergency drugs cabinet systems and other.

All this systems rationalize the hospital request of drugs and medical device and reduce in high way therapy error.

But what is crucial in this process is the new role of hospital pharmacist in more consultant acitivities versus the classic logistic

Functions .( cultural changes )

To do this the pharmaceutical hospital service must heavly change form the classic logistic function towards more clinical new functions.

This make possible that the pharmacist can be applied in more clinical management way to monitoring the healthcare costs ( drugs and medical devices ) containing medical and therapy error, or improving also clinical outcomes

m.luiseto et al 2015 ukjpb (2)

Informatics technologies and ICT give a great help in this works with software dedicated in example in monitoring of healthcare costs .

The same application of ward clinical pharmacist presence in stabile way in medical team gives about 30 % cost reduction ( drugs, med device, ), costs for medical errors, reducing recovery days.

The managerial comptences and skills of clinical pharmacist are often requested by general hospital manager office and by physicians director of the many discipline to monitoring and control the buying systems .(3)

Antimicrobial stewardship, medicinal gases management, high cost drugs management , specialistic medical devices competencies ,Toxicological team with clinical pharmacists presence , pharmaceutical oncologic lab , nutrition team, pain management , and other team involving clinical pharmacist create a synergy .

In example the total cost for innovative drug therapy are under high increase (in example therapy of hepatitis c ) , antimicrobials meet great resentences ,oncology therapy do not present equal efficacy towards all the neoplasia the same .

“The economic aspect are relevant on cost of drugs and payment by government and institution or insurance. (in example 30-40.000 euro/USD/ patient for some biological MABS )

Even ministry of health in some countries ( in ex. ITALY ) not pay all some new innovative anticancer drugs but use a system that verify the results obtained.( payment by results, risk sharing et other procedure ).” M luisetto 2016 editorial efficacy in oncologic drug therapy . Some to rethink ? (4)

This problems need a deep and continuous activity by clinical pharmacist .

And to do this in efficacy way the ICT instrument and centralized logistics give great help.

Material and methods

In this observational work we observed some relevant literature involved in this change and then related to the results finded we submit to healthcare institution and university a new systems to efficacy control and reduce the healthcare costs.( about 40%)

The total costs involved in this organizative change is coverd by the reduced cost in drugs and medical devices new logistic systems .

Results

From literature We have find this results :

“During the periods of 1928 to 2016 a progressive and trendy development of clinical pharmacy and pharmaceutical care was developed, as a new discipline.

This approach was observed not only in hospital settings, but also in community pharmacy in different ways, although with the same philosophy (patient-oriented pharmaceutical discipline)

It was also observed a tendency of clinical pharmacist in field of medicine laboratory and imaging for when they were related to the therapy and its monitoring.

Clinical pharmacists today are employed to reduce therapy errors and contain medication cost burdens. In addition to that what we have observed was a “general positive influence of the pharmacist’s presence as a part of the medical team, on public health as well as in various clinical outcomes”; this according to clinical studies as systematic reviews, clinical trials and meta-analysis.” • Steps and Impacts of Pharmaceutical Care and Clinical Pharmacy Development on Clinical Outcomes 2016: A Historical Analysis Compared with Results, M. Luisetto, B. Nili-Ahmadabadi, L. Cabianca, M. IbneMokbul, Clinicians Teamwork, 2016, 1:4-8 ( 5 )

“.the model of clinical pharmacy practice adopted by many pharmacy department hospitals is no longer appropriate for the demands of today's health-care services. Reviews many new models proposed for clinical pharmacy practice including an integrated model for providing a pharmaceutical care management approach in the health-care system. This model is a response to the failures of traditional drug therapy. It is primarily an idea about how health professionals and patient should integrate their work to obtain outcomes important to patients and clinicians.” 2001. al-Shaqha WM1, Zairi M. (6)

*

Hospital information system is widely used to improve work efficiency of hospitals in China. However, it is lack of the function providing pharmaceutical information service for clinical pharmacists. A novel clinical pharmacy management system developed by our hospital was introduced to improve the work efficiency of clinical pharmacists in our hospital and to carry out large sample statistical analyzes by providing pharmacy information services and promoting rational drug use. Clinical pharmacy management system was developed according to the actual situation. Taking prescription review in the department of general surgery as the example, work efficiency of clinical pharmacists, quality and qualified rates of prescriptions before and after utilizing clinical pharmacy management system were compared. Statistics of 48,562 outpatient and 5776 inpatient prescriptions of the general surgical department were analyzed. Qualified rates of both the inpatient and outpatient prescriptions of the general surgery department increased, and the use of antibiotics decreased. This system apparently improved work efficiency, standardized the level and accuracy of drug use, which will improve the rational drug use and pharmacy information service in our hospital. Meanwhile, utilization of prophylactic antibiotics for the aseptic operations also reduced.L. Bao, Y. Wang, T. Shang,1 X. Ren, and R. Ma(7)

“We submit to the scientific community “Clinical Pharmaceutical Care”as a new discipline .Discipline intended to improve clinical

andeconomic endpoint in pharmacological therapy reducing therapy errors and with a more rational application of resource in medical team (clinical pharmacist).This new approach take advantages using the Management and ICT principles. We ask also to international organization involved in hospitals accreditation and University to recognize this new health care professional activity. We think that core training must include principles of Management, ICT Professional social media, psychological behavior skills for team working added to be added to the classic clinical pharmacy programs.

Theory and practical applications: Also the knowledge in field of medical laboratory and imaging give a great advantages in this new discipline for the hard relationship with many drug therapy .For this reason also clinical pharmacist must be involved. We strongly ask to public institution to apply this new discipline to obtain more rational drug therapies and rational method to use the clinical pharmacist resource. “ Clinical Pharmaceutical Care, Medical Laboratory Imaging, Nuclear Medicine: A Synergy to Improve Clinical Outcomes and Reducing Costs, M. Luisetto, J App Pharm 2016, 8:3 (8)

“Based on the results of this observational study, the observed achievements were due to medical laboratory and imaging knowledge and expertise of the clinical pharmacist, as part of the team in a hospital setting.

We have noticed that such imaging and medical laboratory expertise of the clinical pharmacist has resulted in a significant impact on therapy and its monitoring

For the sake of patients’ safety and health as well as cost reduction and for clinical pharmaceutical care purposes, it is incumbent upon the hospitals to engage and demand an active role from clinical pharmacists, not limited to but especially in fields such as medical laboratory and imaging.

Isn’t time for the health authorities, including hospitals, to utilize the expertise of clinical pharmacists when, especially it comes to the reduction the patients’ life threatening risks, enhancing clinical outcomes as well as cost savings, when there is such an exponential rise of the innovative treatments prices? “ M.luisetto et al 2016 (9)

“In order to obtain more efficient results in improving some clinical outcomes the clinical pharmacist (and other healthcare professionals working in medical team) must have an expert in

the field of psychological and behavior aspects to use a practical settings when member of medical equips.

This participation must be at the right level required, with professional autonomy and independence.

This can give the right response to drug related problem that a rational therapy requires.

There is a need to improve the ability of clinical ph. in providing ph care in medical team and in

particular way in the field of diagnostic for its relationship in monitoring of drugs therapy.

And even if rotation in different wards provide a good experience. We think that some cultural

instruments can be useful for this membership provided by autonomous university course.

So we ask to international organization and university to include the kind of course in university

curriculum of students that will be applied in ph. Care works.

This skill is useful in pharmacists- patients relationship in order to have high compliance level.

The same kind of conclusion can be applied to other healthcare professionals in medical team

that Collaborate with physicians.” Art. Psycological and behavior skillsfor ph. Care practice in medical team m luisetto et al ijppr 2016“ (10)

Reduction of medication therapy errors is needed and demanded by patients and health authorities, government, insurances.

“Multiprofessional healthcare EQUIPE is the right way of work in today health care systems. A WARD clinical pharmacist today contributes in many fields: haematology oncology, toxicology,

nuclear medicine, infectious diseases, emergency medicine, nephrology, nutrition service, pain management and others.” Luisetto, J App Pharm 2016, 8:3 (8)

The clinical endpoints depend on also by the medical device used and Medical devices pharmacist specialist represents a great resource in cost containment in every level (to use the right one in every different situation).

Pharmaceutical care principles can correctly be applied in the

medical devices dedicated to a single patient.

Consultant activities, property, classification, codification,

legislation, Alternative products, logistic are the working filed in which clinical pharmacist play a relevant roles in medical equipe” Luisetto, J App Pharm 2016, 8:3 The Medical Devices Pharmacists Management Role and Pharmaceutical Care (11)

“The innovation introduced with biomedical databases and searching motors has improved research works with rapid ways in all kind of scientific researches areas

Instruments as Internet, search engines and professional social media have brought a great development in rapidly connecting with other professionals.

the researchers and professionals all over the world in last 3 decades Has been great possibility to share their practical experience more than past with improving in their results.

it is very interesting to see how they are playing a crucial and relvant role today healthcare working field through this rapid development.For example, Linkedin, Slideshare, Research gate, PubMed,youtube NCBI, Facebook, Skype and other etc.

This has realy brought a revolutionary change in many working fields.The possibility to bridge researchers and professionals ; for example, with similar interests, discipline with more rapid development ,never seen in last two decades. MLUISETTO ET AL 2016 Professional Social Media: Instrument to Meet Researcher and HealthcareInstruments with a Model for a New Scientific Social Network (12)

“In ICU we can see reduction in mortality rate when pharmacist take really part of the eduip. “ B. Nili-Ahmadabadi, M. Luisetto, H. Nili-Ahmadabadi, H. Nasser, GR. Mashori, M. Nili-Ahmadabadi, Clinical Impact of Pharmacist Presence in ICU Medical Team on MortalityRate, Clinicians Teamwork, 2016, 1:15-33 (9)

“Clinical

pharmaceutical care required more use also of professional social

media to meet researcher in more efficient way. And in the same time clinical pharmacist can be a scientific edge between

physicians and other professional and patient in therapy filed. PH care management can be useful instruments to have more rational therapy systems. Every drugs is registered for specifically indication, at the same time every drug to be a rational therapy need a rational decision making system that require a multidisciplinary team that can cover all aspect of

pharmaceutical molecular metabolism kinetics and

pharmacodynamics this create great possibility for clinical pharmacist but it must increase expertise in field of diagnostic (lab medicine and imaging) for the high relationship whit drug therapy. The old algorithm was “physicians - patients - classic pharmacist and drugs “today it must be “patient physicians - clinical pharmacists

(as consultant) and drug.” Luisetto M (2016) An Useful Instrument in Future Health Care Systems. J Pharma Care Health Systems (13)

“The aim of this study was to analyze the relationship between professional social media use and the healthcare

researcher. The innovation which was introduced with biomedical databases has improved research works by

making rapid steps in all kind of scientific researches. Besides, instruments such as Internet, search engines and

professional social media have brought a great development in the way of rapidly connecting with the professionals

and the researchers all over the world in last decades. So it is very interesting to see how they are playing a vital

role today in this field through this rapid development. For example, Linkedin, Slideshare, Research gate, PubMed,

NCBI, Facebook, Skype etc. has already brought a revolutionary change in the field.

The possibility to bridge researchers; for example, with similar discipline or by other different discipline using

professional social media has provided with the scientific community a rapid development which was never seen in

last decades.” Luisetto et al., Int J Econ Manag Sci 2016, 5:3 (12)

“Physicians alone cannot cover every aspect of

the pharmacological treatment, for example in the field of drug therapy monitoring, interactions,

adverse drug reaction (ADR), toxicology, novel delivery systems, immunoglobuline-based

therapeutics and other innovative drugs and medical devices systems, which have their

pharmaceutical specific worlds.

This article wants to improve the pharmaceutical care application in countries with an advanced healthcare system in order to provide more rational drug therapy to patients.

When this is not possible, it would be a good idea using pharmaceutical care, in particular populations such as: severe disease, critically ill, patients with multiple illnesses, transplants, immunosuppression, oncology or other serious conditions, at least when the treatments cost a lot.” Ukjpb 2015 luietto et al pharmacist cognitive service and pharmaceutical care today and tomorrow outlook (2)

We think that using sharing economy intruments we can reduce healthcare costs about 30-40 % and obtain this results in more rapid way vs past

The results obtained in new sharing economy time can be efficientrly applied in healthcare setting: sharing of knowledge

“ICT systems can reduce errors and waste materials, rotation drugs

and medical devices wards stokes and reducing costs: Dose unit systems

can reduce costs about 10-15% and ward clinical pharmacist presence

in stabile way in medical team can reduce cost about 30%.” Mluisetto 2016 editorial Clinical Pharmaceutical Care and New Technologies: A Synergy toHigh Reduce Healthcare Costs

Discussion

Analizyng the literature reported in this paper we can say that using drugs centralizated logistics ( hub and spoke pharmacy system) added to ICT instrument and clinical pharmaceutical care anc clinical pharmacy approach we can have reducing costs about 40%.

This result not only due by drugs and medical devices costs rationalized but also by the reducing of medical errors, days of recovery and especially by improving clinical outcomes .

( the just in time systems make possible to the hospital pharmacist can use their time in more clinical activities.)

In example the costs for an expensive transplant can be lost easy if not under efficacy pharmacological drug therapy .

The pharmacist competences and skills can improve the clinical endpoint as they are considered the drug expert for excellence .

( the same thinking about complex cardiac surgery or other critical and expensive patients situation ).

This is the real reason to shift the classic logistic competences of clinical pharmacist towards more clinical works.

Conclusion

We think that change in pharmaceutical department is needed today and the shift of pharmacist competence from the classic logistic roles towards more clinical and economic management

gives reduction about of 40% in healthcare costs

(managed by hospital pharmacy) .

The application of clinical pharmacist to strictly control the prescription of drugs ( according protocols, guidelines, central and local rules ) make possible an strictly appropriateness verify .

We think that the efficacy instruments avaiable to the clinical pharmacist and healthcare institution to manage healthcare costs are:

• Management principles

• clinical Pharmaceutical care criteria ( a new discipline ) (19)

• ICT and technologies

• Sharing economy principles

The costs involved in this change in working activities of hospital pharmacist are included in the total costs rationalized by this new management system.

So we can say that is not a cost but a resource.

References

1) Luisetto, J Bus Fin Aff 2016, 5:4 Velocity Management Strategy in Healthcare DOI: 10.4172/2167-0234.1000e148

2)2015 Pharmacist Cognitive Service and Pharmaceutical Care: Today and Tomorrow Outlook, M. Luisetto, F. Carini, G. Bologna, B. Nili-Ahmadabadi, UKJPB UK Journal of Pharmaceutical and Biosciences Vol. 3(6), 67-72, 2015 [Source]

3) Mauro luisetto , Bus Eco J 2017, 8:1 Attitudes and Skills in Business Working Settings: A HR Management Tool

4)Editorial Efficacy of Oncologic Drug Therapy: Some to Rethink in the Management of the System? M luisetto 2016 JOURNAL OF BUSINESS MANAGEMENT AND ECONOMICS

5)Steps and Impacts of Pharmaceutical Care and Clinical Pharmacy Development on Clinical Outcomes 2016: A Historical Analysis Compared with Results, M. Luisetto, B. Nili-Ahmadabadi, L. Cabianca, M. IbneMokbul, Clinicians Teamwork, 2016, 1:4-8

6)al-Shaqha WM1, Zairi M. Int J Health Care Qual Assur Inc Leadersh Health Serv. 2001;14(6-7):282-301. Pharmaceutical care management: a modern approach to providing seamless and integrated health care

7)Bao L1, Wang Y, Shang T, Ren X, Ma R. Indian J Pharm Sci. 2013 Jan;75(1):11-5. doi: 10.4103/0250-474X.113531.A novel clinical pharmacy management system in improving the rational drug use in department of general surgery.Bao L1, Wang Y, Shang T, Ren X, Ma R.

8)Clinical Pharmaceutical Care, Medical Laboratory Imaging, Nuclear Medicine: A Synergy to Improve Clinical Outcomes and Reducing Costs Luisetto, J App Pharm 2016, 8:3

9) Nili-Ahmadabadi, M. Luisetto, H. Nili-Ahmadabadi, H. Nasser, GR. Mashori, M. Nili-Ahmadabadi, Clinical Impact of Pharmacist Presence in ICU Medical Team on MortalityRate, Clinicians Teamwork, 2016, 1:15-33

10) Luisetto M (2016) Psychological and Behavior skills for Ph. care practicein medical team, IJPPR 5.

11) The Medical Devices Pharmacists Management Role and Pharmaceutical Care Luisetto, J App Pharm 2016, 8:3

12) Professional Social Media: Instrument to Meet Researcher and Healthcare Instruments with a Model for a New Scientific Social Network ,Luisetto et al., Int J Econ Manag Sci 2016, 5:3

13) Luisetto M (2016) An Useful Instrument in Future Health Care Systems. J Pharma Care Health System

14) M. Luisetto, B. Nili-Ahmadabadi, An Open Letter to all Pharmacists, 2016: Pharmaceutical Care,Medical Laboratory and Imaging, Clinicians Teamwork, 2016, 1:1-4

15) Editorial Clinical Pharmaceutical Care and New Technologies: A Synergy to High Reduce Healthcare Costs m.luisetto Luisetto, J Bus Fin Aff 2016, 5:3

16) Pharmaceutical Care in Surgery Field editorial m luisetto journal of ph. Care and health systems 2016 Luisetto, J Pharma Care Health Sys 2016, 3:3 DOI: 10.4172/2376-0419.1000e142

17) Review article Emergency Hospital Drug Cabinet Systems Managed by Hospital. journal of applied pharmacy 2016 Luisetto and Nili-Ahmadabad, J App Pharm 2016, 8:4

18) Management Instrument in Pharmaceutical Care and Clinical Pharmacy m.luisetto et al 2016 int. jour. economics and management sciencesLuisetto et al., Int J Econ Manag Sci 2016, 5:5DOI: 10.4172/2162-6359.1000369

19) Clinical Pharmaceutical Care A New Management Health Care Discipline in 2016UK Journal of Pharmaceutical and Biosciences Vol. 4(1), 63-64, 2016 m.luisetto R. Sahu