2020 ACCC Innovator Awards: Pharmacists Expand Role in Collaborative Practice Agreement

This blog is the sixth of an eight-post ACCCBuzz series highlighting the achievements of the 2020 ACCC Innovator Award Winners. You can learn more about the innovations being recognized this year and the people who pioneered them by joining us at the ACCC 37th [Virtual] National Oncology Conference, September 14-18. 

Before 2019, oncology pharmacists at St. Luke’s Cancer Institute’s medically integrated pharmacy often spent considerable time awaiting physician approval for recommended medication adjustments to oral oncolytic prescriptions. Time spent issuing reminders, checking approval status, and fielding patient questions about their prescriptions ate into the productivity of St. Luke’s oncology pharmacists. Delays in obtaining physician approvals led, on occasion, to delays in starting patient treatment, introducing more anxiety into an already-fraught situation.

“Sometimes we would have to wait several days for prescriptions to be approved,” explains Amanda Wright, a clinical oncology pharmacist with St. Luke’s. “When a patient is starting a new therapy, this can delay other components of the patient’s treatment plan. And some prescriptions need to be renewed every single month, so we had to wait for approval in those cases too.”  

To streamline the medication approval process, St. Luke's Cancer Institute implemented a pilot program to test the efficacy of a collaborative practice agreement (CPA) between the institute’s medical oncologists and oncology pharmacists. The healthcare system formulated an oral oncolytic CPA that empowered its oncology pharmacists to sign prescriptions on behalf of providers in several situations, including renewal of refills, dose adjustments, dose rounding, and adjustments for toxicities. 

“CPAs are super-helpful for pharmacists who want to be able to expand their range of practice,” says Wright. “And doing medication management in collaboration with providers ensures that someone else has eyes on what patients are prescribed.” 

Wright says St. Luke’s already had success with a pharmacist CPA elsewhere in the health system. In that case, pharmacists had been empowered to prescribe antiemetic medications after meeting with patients and reviewing their treatment plans. “Since that worked so well, and since we have such a great relationship with our providers here, we decided that a CPA would be a great way to address this problem,” says Wright. “It would create a better workflow for both pharmacists and providers and result in fewer interruptions for both.” 

The pilot, which ran from November 2018 to January 2019, involved four of the 15 medical oncologists working at St. Luke’s Cancer Institute. During the pilot, St. Luke’s tracked the time elapsed from when a pharmacist sent a notification to a physician requesting review of an adjustment to the time the physician approved that adjustment. That was compared to the time it took the pharmacists in the pilot who were empowered by the CPA to personally sign off on an adjustment. 

“When we got to the end of the pilot, we found that the turnaround time was vastly different,” says Wright. “We spent a total of 365 minutes on 54 prescriptions in our pilot group, compared to 400,000 minutes on 87 prescriptions in our control group. It took an average of seven minutes for the pilot group to turn around one medication adjustment, compared to 3,311 minutes for the control group. It was a no-brainer after that.” 

Two months into the pilot, St. Luke’s Cancer Institute approved the CPA for site-wide implementation.    

Wright says that since the CPA was implemented, oncology pharmacists at St. Luke’s have higher job satisfaction, and 20 minutes have been shaved off their workday. Workflow for both pharmacists and physicians has improved due to fewer interruptions.  

Amanda Wright will share details about how St. Luke's medically integrated pharmacy’s collaborative practice agreement was implemented and the benefits realized at the ACCC 37th [Virtual] National Oncology Conference, September 14-18. Register for the session, "Improve Oral Oncolytic Workflow and Reduce Treatment Delays with a Pharmacist Collaborative Practice Agreement."

Attend the ACCC 37th [Virtual] National Oncology Conference to learn about the accomplishments of the other 2020 ACCC Innovator Award winners on topics ranging from onboarding experienced non-oncology nurses, to address staffing shortages, to the origins of an oncology residency program for physical therapists.