Re-engineering: An opportunity to advance clinical practice in a communityhospital

A hospital pharmacy's efforts to advance clinical pharmacy practice and red uce pharmacy costs as part of a hospitalwide re-engineering program are des cribed. In 1995, a 321-bed community hospital in Wisconsin undertook a three-year r e-engineering program aimed at reducing operating expenses, primarily labor costs. The pharmacy department focused its efforts within the program on i mproving the efficiency of product-related functions, mainly through automa tion, and redeploying staff to value-added clinical functions. This involve d installation of a hospitalwide pneumatic-tube system, use of unit-based a utomated medication dispensing devices, and implementation of a dedicated c linical pharmacy services program. Implementation of this program was to oc cur incrementally, with the first 12 months to be used primarily in develop ing a service model, initiating a staff-development program, and hiring add itional clinical staff. Services added under the program included i.v. to o ral conversion, dosage adjustments for patients with renal impairment, adva nced patient counseling, development of care plans, and rounds in all areas of the hospital. After the first full year of implementation of the progra m, a cost-benefit analysis was undertaken; costs were composed primarily of pharmacists' salaries and benefits, and benefits were composed primarily o f drug cost savings. A benefit to cost ratio of 2.61:1 and a net saving of $227,551 were calculated. The introduction of clinical pharmacy services` a s part of a hospitalwide re-engineering program was associated with a posit ive benefit to cost ratio and a substantial net cost saving.