Return on investment: a practical calculation tool to convince your institution

Financial impact of medication reviews by clinical pharmacists to reduce in-hospital adverse drug events: a return-on-investment analysis

BACKGROUND

Adverse drug events contribute to rising health care costs. Clinical pharmacists can reduce their risks by identifying and solving drug-related problems (DRPs) through medication review.

AIM

To develop an economic model to determine whether medication reviews performed by clinical pharmacists could lead to a reduction in health care costs associated with the prevention of potential adverse drug events.

METHOD

Two pharmacists performed medication reviews during ward rounds in an internal medicine setting over one year. Avoided costs were estimated by monetizing five categories of DRPs (improper drug selection, drug interactions, untreated indications, inadequate dosages, and drug use without an indication). An expert panel assessed potential adverse drug events and their probabilities of occurrence for 20 randomly selected DRPs in each category. The costs of adverse drug events were extracted from internal hospital financial data. A partial economic study from a hospital perspective then estimated the annual costs avoided by resolving DRPs identified by 3 part-time clinical pharmacists (0.9 full-time equivalent) from 2019 to 2020. The return on investment (ROI) of medication review was calculated.

RESULTS

The estimated annual avoided costs associated with the potential adverse drug events induced by 676 DRPs detected was € 304,170. The cost of a 0.9 full-time equivalent clinical pharmacist was € 112,408. Extrapolated to 1 full-time equivalent, the annual net savings was € 213,069 or an ROI of 1-1.71. Sensitivity analyses showed that the economic model was robust.

CONCLUSION

This economic model revealed the positive financial impact and favorable return on investment of a medication review intervention performed by clinical pharmacists. These findings should encourage the future deployment of a pharmacist-led adverse drug events prevention program.

Improving Inpatient Medication Dispensing with an Automated System

Introduction

Medication inventory management and error prevention are complex issues. Single interventions are insufficient to make improvement across the spectrum. A uniform system for dispensing and distributing medications can help reduce the risk of medication errors, improve efficiency, and minimize waste. This quality improvement project aims to: 1) decrease - the time from ordering medication to administration, including delay incidents, by > 70%; and 2) decrease the inpatient monthly total medication consumption by > 20% and ward medication stock items by > 70%, including decreasing returned items and loss from in-house expired medications by > 70%.

Methods

A Six-Sigma approach was applied to eliminate deficiencies throughout the medication management process. Failure mode effect analysis and staff surveys were used to evaluate implementation of automated dispensing cabinet (ADCs) and reengineered workflows for expensive, misused, and restricted medications.

Results

After the new processes were implemented, the turnaround time from ordering medication to administration was reduced by 83%, with zero delay incidents reported. Most nurses (64%) and pharmacists (67%) stated that implementation of ADCs increased their productivity by more than 40%. Monthly medication consumption was reduced by 24%, with an estimated annual saving of $4,100,000 USD. The number of returned items per month was reduced by 72%, and the estimated annual savings from loss of in-house expired medications was $750,000 USD.

Conclusions

This quality improvement project positively impacted stock control while reducing costs and turnaround time for inpatient medication dispensing. Medication delay incidents were reduced, and staff satisfaction levels were positive. Next steps are to reengineer narcotic, anesthesia, and refrigerated products' management.

Engaging Frontline Physicians in Value Improvement: A Qualitative Evaluation of Physician-Directed Reinvestment

Purpose

Methods

Results

Conclusion

Robotic Pharmacy Implementation and Outcomes in Saudi Arabia: A 21-Month Usability Study

Background

We describe the introduction, use, and evaluation of an automation and integration pharmacy development program in a private facility in Saudi Arabia. The project was specifically undertaken to increase throughput, reduce medication dispensing error rates, improve patient satisfaction, and free up pharmacists’ time to allow for increased face-to-face consultations with patients.

Objective

We forecasted growth of our outpatient service at 25% per annum over 5- and 10-year horizons and set out to prepare our outpatient pharmacy service to meet this demand. Initial project goals were set as a 50% reduction in the average patient wait time, a 15% increase in patient satisfaction regarding pharmacy wait time and pharmacy services, a 25% increase in pharmacist productivity, and zero dispensing errors. This was expected to be achieved within 10 months of go-live. Realignment of pharmacist activity toward counseling and medication review with patients was a secondary goal, along with the rapid development of a reputation in the served community for patient-centered care.

Methods

Preimplementation data for patient wait time for dispensing of prescribed medications as a specific measure of patient satisfaction was gathered as part of wider ongoing data collection in this field. Pharmacist activity and productivity in terms of patient interaction time were gathered. Reported and discovered dispensing errors per 1000 prescriptions were also aggregated. All preimplementation data was gathered over an 11-month period.

Results

From go-live, data were gathered on the above metrics in 1-month increments. At the 10-month point, there had been a 53% reduction in the average wait time, a 20% increase in patient satisfaction regarding pharmacy wait time, with a 22% increase in overall patient satisfaction regarding pharmacy services, and a 33% increase in pharmacist productivity. A zero dispensing error rate was reported.

Conclusions

The robotic pharmacy solution studied was highly effective, but a robust upstream supply chain is vital to ensure stock levels, particularly when automated filling is planned. The automation solution must also be seamlessly and completely integrated into the facility’s software systems for appointments, medication records, and prescription generation in order to garner its full benefits. Overall patient satisfaction with pharmacy services is strongly influenced by wait time and follow-up studies are required to identify how to use this positive effect and make optimal use of freed-up pharmacist time. The extra time spent by pharmacists with patients and the opportunity for complete overview of the patient’s medication history, which full integration provides, may allow us to address challenging issues such as medication nonadherence. Reduced wait times may also allow for smaller prescription fill volumes, and more frequent outpatient department visits, allowing patients to have increased contact time with pharmacists.

Procurement 4.0 to the rescue: catalysing its adoption by modelling the challenges

Purpose

The pandemic crisis has resulted in global chaos that had caused massive disruption to the supply chain. The pharmaceutical industry, in particular, has been working tirelessly to ensure that they can cater to the people who need them. With restrictions being imposed to prevent the spread of the COVID-19 virus, the movement of raw materials required has been affected, thus creating the need for the procurement function to be innovative. This study proposes the application of Industry 4.0 concepts into the procurement activities of an organization to make it more resilient and efficient.

Design/methodology/approach

To study the intensity of the challenges, Total Interpretive Structural Modelling is used alongside the “Matrice des Impacts Croises Multiplication Appliquee a un Classement” (MICMAC) technique.

Findings

Resilience can be achieved through the collaboration between the organization and its network of suppliers. This is however easier said than done. High and unclear investments have been identified as the challenge that is taking a toll on all technological investments in the pandemic era. The study also shows that organizational inertia which is present in established and structured firms are a deterrent as well.

Originality/value

This study is based on the application of procurement 4.0 to ensure that pharmaceutical supply chains stay least affected since they are essentials. This study using a multi-criteria decision-making approach to prioritize the challenges. This will help practitioners make decisions faster.