One CPO explains how the pharmacy is gaining greater influence at the hospital executive table.
When Gary Johnson, chief pharmacy officer, University of Kentucky Medical Center, headed to Atlanta’s Mercer University School of Pharmacy in the mid-1990s, he planned to return to his hometown and open a small pharmacy. But interning at Emory University hospital opened his eyes to the world of hospital pharmacy management — a place he wanted to be.
After obtaining his master’s degree in business administration and completing a general practice residency and a specialty in pharmacy administration, he took a position as assistant director of pharmacy at the University of Kansas Medical Center. There, Johnson worked with an individual who had been pharmacy director for about 30 years, whom he describes as “an icon in hospital pharmacy administration.” Johnson eventually left to become corporate director of pharmacy in Fort Wayne, IN, where he oversaw pharmacy operations for Parkview Health System’s seven hospitals. But preferring the university setting, he moved on to be pharmacy director at the University of Virginia. And he took the helm as chief pharmacy officer (CPO) at the University of Kentucky in September 2011.
Over the years, the hospital pharmacy department has increasingly made its way to the executive table, Johnson says, thanks to a shift in perceptions about the pharmacy’s role in healthcare. No longer does the pharmacy just dole out drugs, it manages, at the University of Kentucky, 50 percent of the organization’s expense budget, $100 million in supplies and labor costs and some 300,000 medication drug doses a month.
It was in the mid-2000s when Johnson noticed more CPO positions emerging at institutions such as The Cleveland Clinic and UPMC. At the time, he was serving as pharmacy director at the University of Virginia, and reporting to a vice president responsible for the pharmacy, laboratory and radiology.
“The problem was Pharmacy was two levels away from the senior executive table,” Johnson says. “That VP to whom I reported then reported to the chief operating officer, who reported to the CEO. Politically, it’s difficult to secure resources, it’s difficult to move your agenda forward when you are that far removed from the CEO.” But now, at the University of Kentucky, Johnson has a direct report to the CEO: “It allows me to be part of the strategic planning of the organization.”
Technology and Safety
One way the hospital pharmacy can play a pivotal role in a healthcare organization’s operations is by saving money for the health system by working with senior leadership to craft a business model that optimizes its expenses and maximizes safety for patients, Johnson says. “Pharmacy is in the greatest position to control costs because we can affect physicians and the drugs they choose to prescribe, which is the largest expense for hospitals,” he says.
The pharmacy can streamline operations, increase safety and reduce medication errors with the help of technology. For Johnson, this is where Talyst Inc. comes in. He says the company’s hardware/software inventory management solutions, in particular bar coding, make the pharmacy safer. “We use technology to put bar codes on all of our drugs,” Johnson explains. “When we process a physician order, the electronic order creates a pending action that requires pharmacy staff to remove the drug from inventory, located on the shelves or in the carousel [automated dispensing machine], and then we use a handheld scanner. When we scan that drug, assuming it matches that pending electronic order, the drug is released and we dispense it to the floor. If it isn’t the correct drug, an error code will not allow us to proceed.
The process extends beyond the pharmacy
and to the patient bedside. An example: A patient is prescribed several medications to take at 9 a.m. The nurse comes into the patient hospital room with separately packaged medications in small containers with bar codes on them. “So not only in the pharmacy are we scanning that drug to ensure that we’re giving the right drug to the nurse, the nurse also scans that drug, and then she reaches over and scans a wristband on the patient to make sure the patient is receiving the drug that was ordered.”
Johnson believes the hospital pharmacy holds the keys to a health system’s success — from a safety and a financial perspective. Solutions such as Talyst are making this a reality. The University of Virginia has seen fewer medication errors since the system was installed, and pharmacists are rounding with physicians in specialized areas such as oncology to make recommendations as to the best drugs to use.
“The CEOs and the senior leaders are under incredible pressure to get control of costs, and the one place where they can do that is with Pharmacy,” Johnson says. “We can leverage this technology to control the inventory. We can leverage the technology to decrease medication errors, and we can use the pharmacists to help the physicians select cost-effective drugs and drugs that have the best outcomes.”