Innovation in Ambulatory Care Pharmacy
Recently a post came through on ASHP Connect where a student pharmacist was asking if there is room for innovation in ambulatory care pharmacy. I responded with an astounding yes! And I though this could make a good blog post.
I think there is tons of room for innovation in all practice settings including ambulatory care. I am incredibly fortunate to work for a health-system that encourages innovation and is not afraid to try new ideas. I would like to describe two new clinical services that I was recently involved in starting hat I think might fit the label of innovative. I will close with a few clinical pearls I’ve learned along the way.
Continuous Glucose Monitoring Shared Medical Appointments
Through brainstorming with my interprofessional diabetes team, we implemented a 2- part continuous glucose monitoring (CGM) shared medical appointment program. This includes 5 patients per class along with 2 diabetes educators: pharmacist and dietitian (or nurse). Part 1 consists of CGM insertion, reviewing blood glucose goals and using a conversation map to deliver diabetes education. The second shared medical appointment is CGM interpretation, discussion of the experience of wearing the device, reviewing CGM reports, and delivering more diabetes education. Patients love it and experience peer support. We are able to get patients who really need diabetes education, but might not have otherwise signed up. And we are able to bill for it. Overall, I think CGM is a great area for pharmacists to be involved in (with reimbursement opportunities!).
Post-Transplant Insulin Adjustments
Another new service is post-kidney transplant insulin adjustments for steroid induced diabetes or pre-existing diabetes exacerbated by steroids. We were having challenges getting the patients to follow-up appointments at the diabetes center and we were finding tons of problems like patients not having the right diabetes supplies, not understanding their doses, not getting insulin intensification fast enough and having BG's in the 500's. I now come to the outpatient transplant appointments (since patients come to these twice/week anyway). I work with the transplant team and our transplant pharmacist who is super knowledgeable about the steroid doses and other transplant meds. I make insulin adjustments through a collaborative practice agreement that I have with endocrine. In a half-day, I typically see 6-8 patients. It's been a great collaboration so far that we are hopeful will reduce hospital readmissions and other complications from hyperglycemia.
Be Innovative
To be innovative, what I have found is that you need to understand the environment (do a lot of listening), and determine what could be improved. Then come up with a plan to improve it (do your research first to determine what's been tried). Then the fun part is thinking outside the box. Some people say they aren’t creative. But I think we can all be creative, the key is carving out time to do so. I find some of my best ideas come on my morning runs. You then may need to convince leadership or teammates it's a good plan to try. Then you go and do it! Don't be surprised if you have to try a few things or tweak your original idea before having success. I encourage you all to be innovative because that’s what makes our work exciting. It’s how we grow and help patients, and does anyone want to be doing the exact same thing 5 years, 10 years, or 20 years from now?
Diana Isaacs, PharmD, BCPS, BC-ADM, CDE Clinical Pharmacy Specialist
Cleveland Clinic Diabetes Center, dianamisaacs@gmail.com
Section of Ambulatory Care Pharmacists Educational Steering Committee