1. of Patients with Acute Myocardial Infarction (AMI)
CPS Annual Meeting
2017
Demonstrating Value through
Medication Management
‘Best Practices’
The Effects Of Pharmacy Intervention as Part of a Multidisciplinary Team on 30-day Mortality
of Patients with Acute Myocardial Infarction (AMI)

2. Shelby Gaudet, Pharm.D., BCPS
Presenter
Shelby Gaudet, Pharm.D., BCPS
Health System Clinical Coordinator
Baptist Health Care
Comprehensive Pharmacy Services, Pensacola, FL

3. Faculty Disclosures
There are no conflicts of interest to declare.

4. Learning Objectives
State outcomes from a multidisciplinary effort to reduce 30-day mortality in acute myocardial infarction (AMI) patients
Outline the pharmacist role within the multidisciplinary team

5. Baptist Health Care
Area’s only not-for-profit, locally owned health care system
Main Campus
492-bed acute care inpatient facility
Level II trauma center
Clinical Pharmacy Services
Antimicrobial Stewardship
Internal Medicine
Intensive Care
Behavioral Medicine
Transitions of Care

6. Practice Challenge
To reduce 30-day AMI mortality by 3% from baseline of 6.69% in two years
In July of 2014, Baptist Hospital was selected by Yale Global Heath Institute to participate in a 2-year research initiative to focused on reduction of acute myocardial infarction (AMI) mortality through the deployment of evidence-based strategies and culture change

7. Solution/Procedure A multidisciplinary team was assembled:
Physician champion
Collaboration with Emergency Medical Services (EMS)
Pharmacy engagement
Discharge continuum of care
Discharge Continuum of Care – social workers case management

8. Solution/Procedure Pharmacy identification of patients:
Automatic pharmacy consult for medication therapy management (MTM) services added to electronic AMI admission orders
Patients added to our patient worklist and review/intervention performed daily until discharge
Pharmacist intervention data:
MedKeeper intervention Software
Discharge Continuum of Care – social workers case management

9. Solution/Procedure Pharmacy resources:
Utilized current clinical pharmacy FTEs (4)
Education and resources were provided to clinical staff regarding appropriate evidence-based management and interventions
In-services, Competencies, Shared Drive

10. Solution/Procedure
MTM services were provided beginning the time of admission, throughout hospitalization, and upon discharge:
Medication optimization
CORE measure compliance and documentation
Medication counseling
Lifestyle modification reinforcement
Discharge medication reconciliation
Optimization of patient access to medications
Cost-effective alternative medication recommendations
Patient assistance programs
Bedside delivery

11. Barriers to Care Patient identification Pharmacist coverage
Inpatient clinical services
Outpatient bedside delivery
Case management access
Physician acceptance
Delayed / expedited discharge

12. Two-Year Documented Pharmacy Interventions and Financial Impact
Intervention Type
# Of Interventions
# Of Patients With At Least 1 Intervention
% Of Patients
Cost Avoidance
Generated Revenue
Evidence-Based Med Compliance
Interventions 81 71
22%
$8,100
Medication Error Detection/Resolution 99 84
26%
$4,950
Prevention of
Adverse Drug Reaction 98
$4,900
Patient Counseling
416
284
87%
$10,400
Assistance with Access to Meds
(not including
bedside-delivery service) 33
10%
$3,300
RPh Intervention After Discharge 10 9 3%
$200
Bedside-Delivery Service
$533,043
Total Financial Impact
$564,893
Total AMI patients during time period: October 2014 Through April 2016 is = 326
Additional $90k gross revenue BSD
Time Period: October 2014 – April 2016

13. Two-Year Impact on 30-Day AMI Mortality
Unadjusted 30 day AMI Mortality

14. Conclusion/Applications
Through a multidisciplinary approach, we successfully implemented strategies to reduce 30-day AMI mortality rate into below the targeted goal
The success of this initiative resulted in expansion of our medication therapy management program to include other high risk patient populations
Additional 1.5 FTEs to expand pharmacy medication therapy management services to other high risk disease states
Chronic obstructive pulmonary disease
Pneumonia
Heart failure

15. Polling Question 1
What services can pharmacy provide to impact mortality in AMI patients?
A. Bed-side delivery
B. Medication counseling
C. CORE measure compliance review and intervention
D. All of the above
Answer: D

16. Polling Question 2
At what point during a hospitalization should the pharmacy team become engaged in medication therapy management?
A. Admission
B. Day prior to discharge
C. At time of discharge
D. Post-discharge follow up
Answer: A

17. Questions/Discussion
Shelby Gaudet, PharmD, BCPS
Health System Clinical Coordinator
Baptist Health Care, Pensacola FL