A fully customizable clinical-documentation and reporting tool for hospital pharmacies

THE PHARMACY DEPARTMENT AT THE VALLEY HOSPITAL, A 451-BED COMMU-
nity hospital in Ridgewood, New Jersey, had been using a database-collection system to document pharmacists’ clinical interventions. We developed this program in-house, but had never been able to completely adapt it to our needs. Because it allowed pharmacists to document the same interventions in a number of ways, the reports generated by the system were often inconsistent. Furthermore, the system was only accessible on our handheld devices, and not all of the Valley Hospital’s 25 pharmacists felt comfortable working in that platform.

The documentation of pharmacy interventions is a vital step in demonstrating to hospital administration the integral role pharmacy plays in delivering quality patient care. Recognizing that we needed an easy-to-use system for documenting clinical interventions that would inspire buy-in from all of our pharmacists, we chose Quantifi from Healthprolink.

Because Quantifi is Webbased, our pharmacists can access the program via their handhelds or their PCs, making our handheld-adverse staff members much more comfortable. Documenting an intervention takes only 15 to 20 seconds, because the website’s screens have a user-friendly design and Quantifi’s drop-down menus present a concise list of intervention categories to choose from. Compliance with Quantifi has been high, and we have seen an increase in the number of clinical interventions since implementing the program. In fact, we have documented almost 15,000 interventions over a six-month period, in comparison to only 6,000 for the same length of time while using our previous system.

Quantifi also tracks cost savings associated with pharmacist interventions, allowing us to document the effectiveness of our pharmacists. According to research published in JAMA1 and the Annals of Pharmacotherapy2 respectively, the prevalence of serious ADRs is 6.7% and the average cost to the hospital for an ADR is $5,483. We chose to use more conservative figures and estimated that 3% of our patients, or one out of every 33, would experience an ADR resulting in a cost of $2,500. Therefore, if a pharmacist can prevent an ADR through an intervention, he or she will save the institution $2,500 per 33 patients. The savings we documented with Quantifi for the last six-month evaluation period indicate that we are on pace to save about $2 million annually.

Quantifi’s intervention lists can be customized, and we have used that feature to our benefit. For example, one of our pharmacists works solely with our dialysis department, looking at hemoglobins and hematocrits, evaluating anemia management, and conducting patient interviews and counseling. Practically everything he does is worthy of documentation with Quantifi. Therefore, we added an “Anemia Management Evaluation” intervention to the program. We can now assign a clear dollar figure to his work and account for his time, which is often unsupervised. Quantifi demonstrates the work he does in avoiding adverse events and justifies his position in the hospital. In fact, Quantifi helps all of our pharmacists account for their time.

To optimize a Quantifi implementation, I suggest that the site’s Quantifi administrators determine beforehand how they want to utilize and interpret the interventions. A good first step would be to review Healthprolink’s list of standard interventions and discuss how they should be customized for your hospital. Also, determine in advance how you want pharmacists to use the program and provide specific guidelines on how activities should be documented, so that you do not waste time correcting bad habits after the implementation. If the parameters of each intervention are clearly defined at the outset, you can assure documentations are correct from the start.

By enabling proper clinical-intervention documentation, Quantifi helps justify our pharmacists’ hours, and the data provided in Quantifi’s reports allows our pharmacy director to demonstrate to hospital administrators how our energy is spent and how our efforts impact the overall facility’s performance. This gives our director ammunition to request more support for the pharmacy in the future, making documenting clinical interventions a means to an end.

The recipient of a BS in pharmacy from the University of Rhode Island, Jonathan Mintz, RPh, has served as a staff pharmacist at the Valley Hospital for over six years.
References: (1) Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reac-
tions in hospitalized patients: a meta-analysis of prospective studies.
JAMA. 1998;279:1200 – 1205. (2) Suh DC, Woodall BS, Shin SK, and Hermes-De Santis ER.
Clinical and economic impact of adverse drug reactions in hospitalized patients. Ann Pharmacother. 2000;34:1373 – 1379.