Unique Oncology Center Model Fully Integrates, Empowers Pharmacists

Pharmacy Times spoke with Erica Marchese, PharmD, MHA, BCPS, BCOP, BCSCP, director of pharmacy at City of Hope Chicago, about their unique model that integrates pharmacists into the oncology care teams. In addition to improving workloads for providers and improving pharmacists’ job satisfaction, Marchese said the model significantly improves patient safety and care.

Aislinn Antrim, Assistant Managing Editor: Wonderful. So, when we spoke previously, I think it was sometime last year, you mentioned that City of Hope has a really unique model for oncology pharmacists. Can you discuss how you utilize them?

Erica Marchese, PharmD, MHA, BCPS, BCOP, BCSCP: Yes, and I love speaking about this. So, here at City of Hope Chicago, we really strive for our pharmacists to practice at the top of their licensure. So, when we decentralize a pharmacist into our oncology clinics, they are really immersed into our multidisciplinary teams. And what I love most about our model, and it's the simplest thing, but it's where pharmacists are actually positioned inside of our clinics; so right when an oncologist walks out of any door within the clinic, any patient room within the clinic, they're able to start a discussion in live time with one of our pharmacists—and trust me, they do. So, they can talk about research labs, any billing needs, doses, dose adjustments, indication guidelines, the list goes on. But this sharing of patient care responsibilities saves our provider and the care team time, and this results in decreased stress and workload for our care teams. And that’s something really cool [that] was recently published in the American Journal of Health System Pharmacists. But I think overall, this model really gives our pharmacists the ability to be more proactive than reactive.

Aislinn Antrim: Absolutely, and sometimes it's those simple things that just make the hugest difference. That's wonderful. How did you come to implement this model? Has it always been this way or has it kind of taken time to reach this point?

Erica Marchese, PharmD, MHA, BCPS, BCOP, BCSCP: Yes, so it's not always been this way. It's definitely taken time. But we were really looking for ways to improve our model, and I'm sure many other health systems are doing the same. But we've always also had great relationship with our oncologists, so while we were brainstorming on ways to improve, the light bulb went on and we were like, what if we moved our pharmacists right into our oncology clinics? Right next door to our oncologists, where we could strengthen our communication even more with them. And most importantly, we could minimize delay times for patients. We recognize this change was extremely subtle, but when you're in the process of saving lives, these small changes make the biggest differences. And for us and our patients, they mean something to them, and we really recognize the importance of being more proactive than reactive. I have a feeling you're going to constantly hear me say that.

Once we really realized what the need was, we wanted to move forward but we had a couple of things that we needed to address first. So, number 1, we really needed buy-in from our leadership team, as well as our oncologists and the care team. Number 2, we needed to strengthen our communication within our pharmacy department internally, so while we've always had good communication, it needed to be better, and every staff member needed to be on board. And they needed to recognize that we were about to take individuals and move them outside of the pharmacy walls. So, communication was extremely important. And lastly, we needed to strengthen our teamwork and trust, so we put in many checks and balances to ensure that the information was safely going to stream from our oncology clinics to our central pharmacy to our clean rooms, and then out to our nurses in the infusion center.

Aislinn Antrim: Wonderful, yeah, all those logistics always blow my mind a little bit. How does this differ from other, maybe more common models?

Erica Marchese, PharmD, MHA, BCPS, BCOP, BCSCP: So yes, I think a lot of us have really seen the pharmacist’s responsibility evolve over different times throughout the history of the profession. And many times, we see a pharmacist’s role being extremely focused on distribution and minimizing medication errors. And while we still heavily focus on those tasks, pharmacists are being involved in more clinical responsibilities more than ever. We also recognize that a lot of smaller health systems, more community-based hospitals, they might not have the resources or the infrastructure to really decentralize a pharmacy. But that's okay. The profession of pharmacy is going to continue to change and evolve, and hopefully this will become a standard soon for the profession. But I do think that the pandemic really brought to light the value that a pharmacist can add to a care team, and that's in any setting, right? So, inpatient, hospital, ambulatory, retail—[COVID-19] really showed the value that we could add.

Aislinn Antrim: Absolutely. Well, that’s a wonderful transition. What value do these pharmacists bring to the care teams?

Erica Marchese, PharmD, MHA, BCPS, BCOP, BCSCP: Sure. So, great question and I probably could talk about this for hours, but I know that I'm on a time limit here. So, some of the advantages that we have seen with our pharmacists being decentralized in our inpatient floors and our oncology clinics, and I'm kind of just going to list them off, but increased patient safety, increased efficacy and patient care cost effectiveness, increased job satisfaction for our pharmacists and other members of our care team, decreased mortality and morbidity, management of adverse drug reactions, management of drug protocols, admission and discharge, medication reconciliation. A big one is improvement in nursing communication, well, communication in general with our nursing staff and our providers. And I think while all of these are very equally important, the most beneficial thing is increasing the number of pharmacists that have the ability to provide direct patient care [improves] patient outcomes, and that is the most important. That's our goal.

For me, personally, pharmacists are able to help our patients in ways that nobody else can within the walls of the hospital. We really come to the table with this different level of knowledge and these different lenses on, and I think what's really excited about this model is that it works for all different disease states, not just oncology.

Aislinn Antrim: Absolutely, that's a really good point. Why is integrating pharmacists into the care teams so crucial, both in oncology and in other areas?

Erica Marchese, PharmD, MHA, BCPS, BCOP, BCSCP: Sure, and that's an excellent question. So, one mantra that City of Hope really understands is how important speed to care is. We know cancer is not going to wait, so getting patients in within a couple of days and the importance of our speed to care model is truly at the center and the hearts of every change that we make here. So, some of the action items that we focus on that I can share are, number one, planning. I have to brag that City of Hope Chicago does a great job when it comes to planning, and the advantage of planning—and I'm going to say it again—it allows us to be more proactive instead of reactive. So, I guess, another one would be, I can't stress enough the importance of instilling in your staff members how important communication, trust, and teamwork are, and not just for the pharmacy department but for all departments that are involved with any change, especially this one. Next, I would say collaborate, collaborate, collaborate; I can't stress that enough. Get that buy-in from other health care providers, the care teams, your leadership team, really let them know and show them the value that a pharmacist can bring to their care team, and especially to their patients. I would say, lastly, look at the work that is being done by other members of the care team. Where can a pharmacist use their expertise to provide a higher quality of patient care? So, we saw that in chemotherapy counseling, this was previously done by our nursing staff, and we knew we're the experts when it comes to medication, so we could definitely help in that area.

Aislinn Antrim: Absolutely. Well, what tips do you have for other health systems or oncology centers who might be interested in emulating this model?

Erica Marchese, PharmD, MHA, BCPS, BCOP, BCSCP: Sure. So, I would say something I want to add is to remember that this is not just a change that's going to impact just your pharmacists. So, it's definitely a whole team effort and I think any pharmacist listening knows that the whole team really plays a vital part when it comes to speed to care delivery. So really focus on that, and that stems from our pharmacists verifying counseling, providing medication safety to our amazing technicians that are in the cleanroom compounding hazardous and non-hazardous medications, and then they're getting those medications out to the patient chair side and bedside. So, the importance of teamwork when it comes to speed to care, delivery, and turnaround times, keep that definitely at the center of your focus. It's going to affect your whole team. I think lastly, what I'd leave everyone with, is to have a positive attitude and that's big picture perspective. These are really exciting times for the profession of pharmacy, so I challenge everyone to really embrace that change.