In this episode, the team from the Ohio State University Wexner Medical Center to discuss their award-winning submission to the ASHP Best Practices. They will share how their program demonstrated improvements in opioid utilization, reduction in medication errors and an increase in patient safety.
The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.
(upbeat music) - Welcome to the ASHP official podcast, your guide to issues related to medication use, public health, and the profession of pharmacy. - Thank you for joining us in this episode of Research and Pharmacy Practice. This series focuses on discussions for all things related to research, including fundamentals, best practices, and practical advice for all of us interested in contributing to the advancement of knowledge. My name is Becky Basiligat, and in today's episode, we'll be chatting with the ASHP Best Practice Award winning team from the Ohio State University Wexner Medical Center. For those of you unfamiliar with the ASHP Best Practices, this award recognizes outstanding pharmacy practitioners who have successfully implemented innovative systems that demonstrate best practices in pharmacy. This year, the ASHP Best Practices was sponsored by PAR Pharmaceuticals True Delivery. Thank you, and thanks for joining today. Let's start with a brief introduction. Can you each tell me a little bit about yourself, your team, and your practice location? - Thank you so much for having us. Julie Kennerley Shaw, I'm one of the associate directors of pharmacy here at Ohio State, where I oversee our inpatient and ambulatory oncology program. - And my name is Jen Booth, one of the assistant directors of pharmacy here at Ohio State, and I'm with a focus on our ambulatory oncology and fusion centers. - And my name is Athena Triglia, and I'm a recent graduate of the two-year health system pharmacy administration and leadership residency at the Ohio State University Wexner Medical Center. And during my time as a second year resident, I oversaw some of the operations of the program and worked to expand its formulary into non-oncology. - So your program advocated for and developed an oral drug repository program, whose primary goal was to redistribute medications to those in need, enhance medication adherence, minimize the wastage of unused drugs, and ultimately decrease the overall burden of healthcare expenses. This is amazing. Can you tell me how this project got started and what the goals of the program were? Since this is a very innovative approach to access and minimizing waste, how do you define success? - The program was really conceived after we had many oncology pharmacists who are on the front lines of taking care of our patients, come to us and say, I have these patients that are bringing back really expensive medications, asking how do I dispose of this safely or is there anything I can do with this medication? How can I use this medication to give potentially to another patient? And at the time, we didn't have any avenues in order to accept this medication and potentially help another patient. So the program was really conceived with one goal, and that was to benefit as many patients as possible while reducing waste in the system. We defined success of the program really with the number of patients that are impacted. We began in 2020 and started with two drugs, capsidobene and tomazoleimide, and have expanded to over 60 oral oncalytics. And in April of this year, we're able to expand into the non-oncology space with 14 oral medications, including antifungals and immunosuppressive medications, as well as low-binox, which is our first injectable medication. We've accepted over 20,000 tablets or capsules and been able to read a spend over 13,000 of those. The impact of this is widespread. Over 200 patients uniquely impacted by receiving medications that are valued at over $3 million. - So that's amazing. Can you tell me a little bit about the collection and redistribution process? How were the medications collected and verified? And then how did you pick patients to receive medications? And what were the barriers you saw? - So I think the easiest way to describe this is to kind of start through the entire medication use process for the repository. So that really starts at donation. So most of our donations are accepted from our decentralized pharmacists in the clinic, but they can also be donated in person at a centralized retail pharmacy. Every single medication that's donated is inspected via pharmacists to ensure it is the correct medication and it meets all eligibility requirements established by both our program and the Ohio Board of Pharmacy Law, which includes the expiration date and no physical signs of tampering. For inventory management, we've really been able to leverage our existing resources. We use pharmacy interns to complete a lot of the inventory related tasks, including adding all drugs to our perpetual inventory, which is really important because any pharmacist in our system is able to see all the medications that we have in our repository at any given time. That really aids us with the patient identification process for identifying eligible patients. This is often done by our clinical pharmacists. When they or the team identify that there's a patient who needs a medication and they're not able to get it due to financial needs, they're really able to look at that perpetual inventory, see if we have it in stock and then connect the patient to the repository and our medication assistance team if needed. And then finally, the dispensing occurs at a centralized retail pharmacy within our health system, using that infrastructure to ensure not only that we're safely dispensing the medication, but we're also able to use documentation within the electronic health record and barcode scanning to support medication safety. So some of the barriers we've identified are missing documentation. There are certain documentation that we have to get from the patients before the medication can be accepted. So an example would be a lack of a patient signature on the donation form, which is required both by our own repository program and the Board of Pharmacy Law. To address that barrier, we've really focused on education of all stakeholders involved in the process. So whether that be the pharmacist, collecting the donation in clinic, the provider identifying the patient, as well as our interns who are completing the inventory processes. And then resources is always a challenge when you're implementing a new service. So how we've overcome that barrier is really focusing on our existing resources and how we can leverage them. As I mentioned, we leverage the decentralized clinic pharmacists who accept the donations. When they accept the donation, they're able to complete that inspection at the clinic before sending it to our centralized dispensing pharmacy. And then leveraging the electronic health record and that centralized pharmacy for inventory management allows us to keep our inventory accounts accurate and visible to all members of the health system. And then lastly, we've identified a barrier of what do we do with surplus inventory, which is a good problem to have as these medications would be wasted if not accepted by the repository. So to overcome this barrier, we focus on evaluating setting paths for the medications, just like we do any other medication in our health system and what can we do with any medications that are and trying to figure out what external partnerships that we can develop to make sure that these medications that we're able to collect are being sent to patients in need as the goal of our program really is to benefit the most number of patients possible. So we're happy to announce we recently established a partnership with Serum, which is a nonprofit organization that helps do exactly that. And we're able to send our excess donations to them and they're able to help connect with patients even outside of our Ohio State scope. - That's wonderful. So you guys have also touched on this a little bit, but could you start out with two oncology drugs and have expanded outwards since? So what were your initial findings once you established the program and where do you see this program going? - One of our initial findings that we saw with the oncology program specifically was actually how quickly we were able to expand our formulary to include additional oral oncology agents and how engaged our stakeholders were in that process. As we mentioned earlier, our oncology program started with just two and over time, we were able to expand to include over 60 oral oncology agents. Following the success, we planned our expansion into non-oncology and utilized a very similar approach. We sent a survey out to our providers at Ohio State and asked them to provide a list of medications that they felt would provide the most benefit to their patients by being included within the program. And following that survey, we also looked at the cost of these medications, whether or not there was a manufacturer assistance program and if there were any specific storage requirements associated with those medications to ensure compliance with repository state laws. And as Julie mentioned earlier, we expanded our formulary just this year to include 14 additional medications in the non-oncology space. We have a majority of them being oral medications that we did at our first subcutaneous injection as lobonox and those medications span across a variety of disease states, including solid organ transplant and HIV. - So what were the lessons you've learned along the way when you were developing this program? What was the easiest part? What was the hardest and what surprised you the most? - The big lesson that I learned is the importance that the repository has played in supplying patients with a bridge therapy of medication. When we launched, we specifically excluded bridge therapy because we wanted to make sure that patients had a long-term plan in place before initiating them on a new therapy. However, we found that there is a significant role for bridge therapy. We have patients that are mid-therapy and have an insurance change. The repository has been able to assist. We have patients that have been approved to start a medication via their insurance or via a patient assistance program, but there's some type of delay in receiving that medication such as shipping time from an external pharmacy. And so we've really been able to leverage the repository as an additional option for bridge therapy, which we definitely did not expect when we launched the program. - One of the things that surprised me the most was really some of the unintended benefits of the program. So at the inception of the repository, when we thought of who the program would benefit, obviously the first stakeholder that came to mind is the patient who would be receiving the donated drug. But what's been really interesting and rewarding for us to see is the unintended benefit, which is the joy and gratitude we've seen from cancer patients and their loved ones when they're able to donate their drug to help another patient in need. So just being able to pay it forward, I've been able to see that and experience that interaction both personally and hear about it anecdotally from our clinicians and our retail pharmacists. And we look forward to seeing this impact expand our non-oncology patient population and their loved ones as well. - One of the biggest lessons learned for me as well was probably the hardest part with the expansion was surrounding the selection of medications to include within the expanded formulary. And that was really based on the fact that we had a surplus of recommendations from our stakeholders with support for the expansion. We wanted to be sure to define a standardized approach when making the selection of medications to ensure that we didn't exceed our program resources at the time. And it was great to have the amount of emails on a daily basis from our teams at Ohio State that we're providing recommendations for medications to be included. But our team really had a difficult time selecting only a few of those to include within our first phase into non-oncology. But again, like John mentioned earlier, it's a very good problem to have. - Yeah, that's a very, very great problem to have. So we talked about phases. First were oncology medications that I've expanded into a couple or more, non-oncology medications. What are the next steps for this program and what would you like to see in the next five years? - We're excited to continue to expand the programs, starting with a designated physical space for the repository. Currently it has a small section of one of our retail pharmacies and we're space limited in what we can accomplish with that space. So that's number one. Number two would be continued advocacy for medications with rent requirements. Currently those are excluded by Ohio law. And we think there could be a lot of benefit to including medications that do have a rent requirement in the repository with the correct safeguards in place. And then lastly, just creating additional sustainable partnerships for external donations to widen the impact of the program, both in Ohio and nationally. - So finally, what advice do you have for hospitals and health systems who would seek to replicate this practice model for their patients? - This repository has sincerely been one of the most rewarding projects that I've worked with in my career just due to the altruistic nature and the patient contact that we have with the program and our ability to really make an impact. My advice would be just get started, start small and let the energy and the momentum help you grow. - My advice would be to leverage existing infrastructure as much as possible. An example is where we've been successful with that at our program is looking at our current SAFE model and how we could leverage them. So using those decentralized pharmacists who are already in the clinic with the patients to identify both donors and recipients of the repository program. Leveraging that outpatient pharmacy infrastructure for dispensing and including all of the safeguards that come along with that including barcode scanning, the perpetual inventory, and then finally the electronic health record which is really important to ensure that we are supporting transitions of care for these patients and that their treatment is visible to all members of the healthcare team. - My biggest piece of advice for hospitals and health systems is to identify pharmacists, both clinical and operational and physician champions to support the program and its growth. We've been very lucky at Ohio State to have extremely supportive stakeholder support from everyone involved in the expansion process and we would not have been as successful without that. So that's definitely my biggest piece of advice for our programs looking to replicate this process. - Unfortunately, this is all the time we have today. I want to thank the team from the Ohio State University of Wexner Medical Center for joining us today to discuss their ASHP Best Practice Award from 2023, the development and implementation of an oral, drug repository program. If you haven't before, I encourage you all to check out ASHP and the ASHP Foundation's Research Resources. You can find member exclusive offerings such as the Preceptor Toolkit, the Research Resource Center, and exchange ideas with your peers on the ASHP Education Connect community. If you've enjoyed today's episode and want to hear more, be sure to subscribe to the ASHP official podcast for more great content from ASHP. - Thank you for listening to ASHP official, the Voice of Pharmacists Advancing Healthcare. Be sure to visit ashp.org/podcast to discover more great episodes, access show notes, and download the episode transcript. If you loved the episode and want to hear more, be sure to subscribe, rate, or leave a review. Join us next time on ASHP official. 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