(Management Case Study) Pharmacists Lead Improvement in a Clinical Pharmacy Program at a Rural Medical Center

Purpose: This case describes the methods in which the negative findings of a medication use evaluation of doxycycline were used to initiate changes with education and follow-up in clinical pharmacy practices at a rural medical center during the COVID-19 pandemic.

Methods: A medication use evaluation of doxycycline was conducted that revealed duplications in antibiotic therapy and lack of intravenous (IV) to oral (PO) conversions in patients that would have qualified for oral therapy. The medication use evaluation was presented at the hospital’s Pharmacy and Therapeutics committee, as well as reviewed with each pharmacist. Pharmacists were retrained on each of the clinical reports and why they are done. Completed clinical reports were also periodically reviewed to identify areas for improvement. Results were communicated to the hospital’s Pharmacy and Therapeutics committee.

Results: When comparing the 6 months prior to the education and clinical report follow-up with the 6 months after the education and clinical report follow-up, the average number of pharmacist interventions per month increased by 113% (294 to 625 interventions). The antibiotic intervention monthly average increased by 317% (18 to 75 interventions), and the intravenous to oral conversion intervention monthly average increased by 200% (50 to 150 interventions). For doxycycline, average monthly cost per acute patient day decreased by 31% ($1.18 to $0.81), average monthly days of therapy (DOT) per 1000 patient days decreased by 10% (62.1 to 56), and average monthly defined daily dose decreased (DDD) by 13% (104.44 to 91.25).

Conclusion: Medication use evaluations and education with periodic monitoring can result in improvements in clinical pharmacy services.