Pharmacy managers must be knowledgeable of health systems, health policy, the policies of their organization, and epidemiological issues surrounding patient care. With burgeoning health care costs for all stakeholders, organizations and payers are looking to streamline operations, keep patients health, and prioritize resources. One of the elements continuing to confound our system and resources is the prospect of patients being either at-risk for harm, sometimes treated ineffectively. This can occur in any venue, but is especially problematic in the hospital setting given the complicated types of care provided to patients who are generally suffering from serious conditions.

Falconer et al. examined how hospital pharmacists prioritize patients at high risk for harm.¹ They attest that approximately 30% of patients experience medication harm, of which 7% is severe. Their study used mixed methods (qualitative interviews and a survey) and found 3 central themes underlying this phenomenon: (1) prioritization criteria; (2) barriers to; and (3) facilitators of patient prioritization. The prioritization criteria included clinical factors (eg, comborbidities, high-risk medications, multiple medications, high-risk transfer) and patient factors (age, frailty, social risk, length of stay, frequent presenter). Barriers to prioritization included competing priorities (eg, time pressures, mismatched expectations, handover information) and practical considerations (eg, specialist review, patient availability). Facilitators were technology, communication, and mentoring. The study authors concluded that the findings can assist in the development of risk scores for the hospital organization and for pharmacy managers.

The above study also concluded that it is essential to find effective and efficient methods to identify those at high-risk for targeted pharmacist services. If high-risk patients are identified in a time manner and drug-related problems are prevented or mitigated, this will optimize medication safety and ensure the best outcomes. They also found a key barrier to prioritization was the lack of handover information, which was further exacerbated by communication gaps or mishaps between pharmacists and other health professionals. Pharmacy managers must be proactive in identifying strategies that elevate the practice of pharmacy personnel, minimize patient risks, and save their employing organizations money. Doing so is good for the profession but also good for the manager adept at doing so.

Additional information about Operational Management and Risk Management in Contemporary Pharmacy Practice can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

¹Falconer N, Barras M, Cottrell N. How hospital pharmacists prioritize patients for high risk of medication harm. Res Social Adm Pharm. 2019;15(10):1266-1273.