Meet Michigan Medicine: Department of Pharmacy

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“Almost every patient we see receives a medication in some way, shape or form,” said Stan Kent, chief pharmacy officer for Michigan Medicine, when asked how the Department of Pharmacy fits into the overall picture of patient care within the organization.

That’s huge when you stop and think about it. Pharmacy spans all of Michigan Medicine, with 500 employees working throughout locations that serve both the inpatient population at the hospitals and the outpatient population. Teams provide care in clinics at five ambulatory care community pharmacies, ship specialty medications and support seven infusion pharmacies.

Each year, Pharmacy processes roughly 4.4 million medication orders, provides about 6.9 million inpatient doses, and dispenses approximately 264,000 specialty and outpatient prescriptions.

Kent, who also serves as associate dean for clinical affairs at the U-M College of Pharmacy, recalled the emergence of pharmacy and advancement in services over the last 40 years.

“Historically, we were a behind-the-scenes department,” he said. “Our job was to distribute medication. Today, we are much more involved in treatment decisions directly affecting patient care.”

Evolution of services

As health care has evolved and medications have become more complex and expensive, a greater need has developed for specialization and management within pharmacy.

Today, clinical pharmacists are integrated into service teams across all areas of Michigan Medicine, helping providers make decisions about the best medications for individual patients.

“More than half of our pharmacists consult with providers around medication decisions and help monitor patients to determine whether or not a drug is achieving effectiveness in the timeframe we want it to,” said Kent.

“Being a pharmacist used to require a bachelor’s degree,” he said. “Now, 80 percent of pharmacists have an undergraduate degree in biochemistry, chemistry or another related field, plus four more years of pharmacy school, followed by residency for one to two years.”

Many clinical pharmacists are highly trained in specialized areas. For example, all of the clinical pharmacists providing direct patient care on the cardiovascular and surgery teams within the hospitals are Board of Pharmacy Specialties Certified in an area of focus related to their practice.

Much of the work done by pharmacists in years past — such as purchasing, preparing, packaging and distributing medications — is now done by certified pharmacy technicians.

Pharmacy teams

In addition to clinical pharmacists and pharmacy technicians, the department is made up of a handful of teams that oversee compliance, finance, quality and safety, training and research.

The finance team is critical. In fiscal year 2019, the Michigan Medicine Department of Pharmacy spent approximately $555 million on drugs. Roughly $450 million was for outpatient prescriptions and infusions, including chemotherapy. The remainder was for medications used for the inpatient population.

The finance team works carefully to oversee and manage costs, and works with insurance companies on medication reimbursements.

Quality and safety is always at the forefront of pharmacy’s work. The industry is highly-regulated and the team must meet stringent, ever-changing guidelines set by the government to ensure the safety of patients and staff.

Changing FDA regulations often mean expensive updates, like the recent consolidation of satellite pharmacies in University Hospital into one central pharmacy location in order to meet new compounding guidelines.

The pharmacy training team, meanwhile, makes sure all employees are up-to-speed on mandatory continuing education, medication use, compounding and other important advancements in medication management.

The research team is responsible for clinical trials. They coordinate setup, handle logistics and prepare drugs for as many as 600 clinical trials going on at any given time.

Technological advancements

Technology has changed many aspects of pharmacy in recent years, from expediting order placement and delivery to reducing the potential for error and patient harm.

“Electronic order entry today means that pharmacists receive orders from doctors within a matter of seconds,” said Kent, “and are able to quickly verify information and make drugs available to nurses from Pyxis machines on inpatient units within minutes.”

Pyxis machines are described by Kent as “ATMs for medication” and are positioned on all inpatient units. Approximately 80 percent of medications in patient care areas come out of these machines.

A new system called Dispense Prep allows for bar code scanning to be sure medications dispensed from the pharmacies match the medication, dose and prescribing information ordered for each patient. Bar codes are also used on patient wrist bands, and are scanned against the medication bar codes to ensure the patient is receiving the right medication.

Additionally, the infusion pumps used today are smart pumps that sound alerts if a nurse accidentally puts in the wrong rate for a medication being given.

Access to patient Electronic Health Records has helped to reduce medication errors by limiting available dose ranges and building in alerts, based on a patient’s history, medication list and current medical condition. Pharmacists are able to review orders for appropriateness for the patient, which adds an important layer of protection.

“There is potential for error during every part of the medication use cycle,” said Kent. “Technology allows us to mitigate risks during each step of the process to ensure safe and effective treatment for patients.” 

Looking ahead

In the months and years ahead, the Department of Pharmacy will continue to evolve to meet the needs of patients.

In keeping with Michigan Medicine’s journey toward high reliability, Kent envisions a future with even more safety measures in place, like pharmacists and nurses in patient care areas dedicated specifically to medication safety.

“Pharmacy plays a critical role in our care for patients,” said Kent. “We are always looking for ways to improve the services we provide and the way we provide them. I’m excited to see where we go from here.”

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