Improving Pharmacy Outcomes at BAPS Pramukh Swami Hospital

This report examines strategies to improve pharmacy outcomes at BAPS Pramukh Swami Hospital, a multispecialty hospital facing challenges in drug administration and prescription practices. The report identifies the problem of pharmacist incompetency leading to poor patient outcomes, readmissions, and medication errors. It proposes a change management plan using Lewin's model, encompassing unfreezing, transition, and refreezing phases. The proposed changes involve proactive strategies, pharmacist involvement in multidisciplinary teams, and improved patient record access. Key interventions include patient-centered care, adherence to medication, and monitoring drug serum levels. Factors influencing success include adherence to pharmaceutical interventions, reduction in hospital admissions, and training for pharmacy professionals. The report emphasizes the importance of clinical pharmacy services, patient-centeredness, and the need for regulations to ensure successful implementation of change management strategies. The report also highlights the importance of monitoring the drug routine and increasing patient's quality of life. The report is intended to provide a comprehensive approach to improve pharmacy outcomes and enhance the quality of healthcare services.

Running head: IMPROVING PHARMACY OUTCOME 1
Improving pharmacy outcome in a Hospital
Student’s Name
Affiliate Intuition
Date

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Improving pharmacy outcome in a Hospital
Introduction
In the previous years, there have been problems which have been arising in the pharmacy
department in my current workplace. I currently work at BAPS Pramukh swami Hospital which
is a multispecialty hospital having a capacity of fifty beds with seven different departments. The
hospital is a 24 hour facility and has a pharmacy department which comprises of three qualified
pharmacists who carry out the work of prescribing and administering drugs to the patient after
being treated. The pharmacy also has one superintendent who oversees the work performed by
the pharmacists. The pharmacy has been involved in caring for patients but has faced some
numerous challenges. The problems which revolve around this sector in the hospital have led to
discussions on how they can be improved for better enhancement of health care. In the hospital,
there has been a problem which has been prevalent which has been related to drugs
administration and prescription to the patients. For better results in the pharmacy department,
different interventions should be made in order to tackle these problems. This paper will discuss
the change to be carried out in the hospital for a better outcome in the pharmacy outcome.
In order to come up with the change in the hospital, the pharmacists working on the
patient-care units need to assess different ways of improving the outcome through effectively
addressing the needs of the patients, health-care providers, and other hospital staff concerning
the drug services offered (Schumock et al., 2003). The internal factors such as the ways used in
drugs administration to patients and prescription services need to be assessed. Additionally, the
external factors such as the patient’s complaints and readmissions also are to be addressed in the
change in order to come with positive outcome of the pharmacy services in the hospital. The

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pharmacists need to come up with the appropriate use of drugs by identifying the problems and
bringing them to the attention of the providers who are involved in the processes (Nieva & Sorra,
2003).
In the hospital pharmacy services, reviewing of the medications administered to patients
has always been used by the clinical pharmacist as one of the interventions, however, this has not
yielded a positive outcome. The patients have been seen to be readmitted to the hospital due to
the incompetent pharmacy services offered to the patients who were discharged. Improving the
hospital pharmacy services have been challenging since the interventions have not been
successful in optimization and the usage of the medications, reduction of the medical risks and
improve the symptom control (Bond & Raehl, 2007). Consequently, the choices of the outcome
measures have been difficult; the other external factors include the patient population, study
design, quality of the study, and the type of interventions. A Donabedian framework comprising
of the three elements which are; structure, outcome, and process has occasionally been used in
the evaluation of the clinical pharmacy services (Carayon et al., 2014).
The problem
Incompetency of the pharmacists is one of the major problem encountered in the
pharmaceutical department. This has led to a decrease in the quality of life, morbidity and
premature deaths. The problem has led to poor drug prescription and administration to patients.
Consequently, troubles which have been related to drugs use among the patients due to poor
prescriptions which are given by the incompetent pharmacists have continually increased. The
medical pharmacist’s efforts to come with the change in the multispecialty hospital has bored no
fruits and thus the need to carry out the change management plan. Categorizing and stopping the

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problems which are related to medical clinics and the medical doctors should be made in order to
ensure smooth functioning of the hospital (Viktil & Blix, 2008; Blix). A pro‐active and not
reactive strategy are suitable to handling such problems and achieve the most optimal result. This
may comprise of the contribution of pharmacists in multidisciplinary group engagement in
making orders and prescriptions where complexities related to drugs and other potential
problems should be discussed (Viktil, Moger & Reikvam, 2006). This has not been the case in
my current place of work. This has been a big challenge.
As a result of pharmaceutical incompetency, there have been re-admissions of some
patients as a result of inaccurate prescriptions of the drugs and services offered. There ought to
be better pharmaceutical counselling on medication, discharge or follow up results for a better
outcome. Medical pharmacists can improve other results in positive ways such as improving
market levels for the use of drugs such as anticoagulation levels and blood pressure by a close
analysis of statistics related to patients (Fairbanks, Hildebrand, Kolstee, Schneider & Shah,
2007). According to Graabæk & Kjeldsen, (2013), the positive effects of outcomes of a clinic
such as shorter periods of stay, minimal readmissions, and a few events of diseases can only be
achieved by a close follow up on patients after discharge and proper record management.
However, there have been little studies carried out by pharmaceutical sector with a larger
population of patients inclusive of those admitted to other pharmaceutical sites. More knowledge
of specific factors relating to patients that determines improved care has not been looked into for
long in the hospital (Graabæk & Kjeldsen, 2013).

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The change
The change to be undertaken in the multispecialty hospital pharmacy will encompass a
more comprehensive degree of options which will be accepted and acted upon by the advisers in
order to resolve and prevent the problems in the pharmacy sector. The projected average rate of
change to be accounted for will be 41–96%. The pharmaceutical strategy for change in the
multispecialty hospital will thus improve the efficiency of the health facility and its service
delivery. The approximate overall percentage of change to bring about ultimate solutions to the
above problems to achieve the organizational change is expected to fall above average between
45-60% depending on how efficient they are applied. The Levin's change management model
will be used in addressing the change since it is easier to use and most of most of the
organizations prefer this model in enacting major changes in the organizations.
The Levin’s change management model will be carried out as follows;
Unfreeze
Since most of the pharmacists in the hospital have not been complying with the changes which
have been carried out in order to improve the patient services, the period of unfreezing will be
initiated by carrying out different change management strategies.
Transition
After the change has been initiated, the hospital will move to the period of transition which will
last for some period of time. Offering leadership for the change in the pharmacy sector and its
reassurance will be necessary in order for the process to be a success.

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Refreeze
After the change strategy for the pharmacy department in the multispecialty hospital has been
implemented and accepted successfully the institution will refreeze and then run their services
appropriately and run them under the new change plans implemented in order to make sure that
no complaints from the patients will be reported.
In order to carry out the change strategy, the pharmacy staff will work closely with the
worldwide pharmacy experts to know the best ways of improving the overall pharmacy outcome.
The highest acceptance rates will be achieved when pharmacists attend forums with medical
doctors and while trying to make proposals to intervene stages of ordering and prescriptions in a
proactive approach. The low acceptance rate is determined by the approach used, that is,
communication should be written and not by word of mouth during the discussion amongst
different stakeholders in the hospital (Kripalani, Jackson, Schnipper & Coleman, 2007). This will
help in further analyses and follow up of patients after discharge. Some survey carried out in the
hospital have shown that a low rate of acceptance about 47% is determined by the fact that
pharmacist has little or no access to records of patients.
Another possible remedy to resolve inappropriate prescriptions will be drawn from
reviews and discussions with medical practitioners. Other terms associated with problems related
to drugs such as inappropriate descriptions and suboptimal prescription has been utilized as
measuring parameters of outcomes (Hamilton, Gallagher & O'Mahony, 2009). Research which
was previously carried out in the hospital showed that the medical reviews that were undertaken
by the pharmaceutical stakeholders followed some conclusive discussions about the results to
administer the appropriate prescriptions to the patients. This would in turn help fix the problems

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facing pharmaceutical my current place of work. The clinical pharmacy service results in the
reduction of sub-optimal prescriptions among the patients in wards.
Patience centeredness in service delivery can be another solution. Although the scoring
systems for pharmaceutical significance are inconsistent between researchers, many of the
interventions are patient-centered (Kaboli, Hoth, McClimon & Schnipper, 2006). There will be
possible proposals for the interventions by clinical specialists as to the importance of problems
related to drugs, and the acceptance of the same responses by prescribers are among the few
evidence of the contribution of the pharmaceutical clinics in minimizing issues related to drugs.
This implies a better pharmacotherapy for the hospitalized. Interventions to reduce occurrences
of such are oblique measures of their impacts on patients.
Factors influencing success
One of the change strategies which will give successful change is ensuring that the
patients adhere to different pharmaceutical interventions is coming up with regulations for low
hospital admissions, reducing the length of stay and less admission of patients to the emergency
rooms will help implement the change management model. Factors such as developing the
possible means to improve the outcome will depend on the observations on the clinical outcomes
of the patients. According to Viktil & Blix, (2008), the hard end‐points include the mortality and
the disease events and their prevention. Other easier end‐points to be used will include the
coming up with regulations for low hospital admissions, reducing the length of stay and less
admission of patients to the emergency rooms (Viktil & Blix, 2008).
Another change strategy which will help in the ensuring the plan is a success is the
monitoring of the concentration levels of serum in various drugs, and the achievement of the

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most favorable drug effects such as assessing the levels of anticoagulation, blood pressure, lipids,
and blood glucose (Nissen, 2009; Menéndez-Conde, Vicedo, Silveira & Accame, 2011).
Additionally, the adherence to the drug routine will ensure success, and also the reduction in
various drug reactions. Other aspects of the pharmacy clinical outcome will include increasing
and maintaining the patient’s quality of life (Ng et al., 2008). This will help in achieving the
success in the pharmacy outcome in the hospital.
In addition, to ensure the success of the change management model, the pharmacy
professionals should be identified on their weaknesses and regulation made on individuals who
oppose the change. This is another way which would ensure any effort to resolve the pending
complexities in the pharmacy bears positive results. Training those who have been ineffective in
performing their mandate in the sector will ensure the problems are minimized. Additionally,
regulations will be made to govern the recruitment of the pharmacy attendants to ensure those
who are not capable of handling different tasks in the hospital are limited (Stowasser, Allinson &
O'Leary, 2004). Carrying out of this will ensure there is the success in the pharmacy outcome
and delivering effective services to the patients.
Change management strategies

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After the unfreeze process in the Levin’s change model has been carried out, the change
management strategies will be carried out in order to improve the pharmacy outcome sure that
the patients adhere to the pharmaceutical interventions. Provided that the prescriptions are
optimal for any patient, there will be efforts to enhance the adherence to the medications (Pintor‐
Mármol et al., 2012). Compliance and adherence to the change strategy will be used extensively.
Adherence which includes the aspects of following the recommendations made by the physician,
it will consist of the agreements of the patient to their suggestions. The hospital pharmacist
intervention carried among the patients with the chronic airways, the disease was found not to be
having major differences with the medication compliance between the interventions and the
control groups. It is difficult to enhance the adherence in most of the patients with the chronic
health problems; the interventions meant to increase the short‐term adherence, however, have
been comparatively successful (Rommers, Teepe‐Twiss & Guchelaar, 2007; Kaushal, Bates,
Abramson, Soukup & Goldmann, 2008).
Another change strategy will be finding out the ways to manage the hospitalization of
patients, their re‐admissions, and the length they take for their stay in hospitals due to the
pharmacy outcome. A study carried among the patients in the hospital found that most of the
patients who were discharged from the medical departments had to follow up a counsel by the
clinical pharmacists (Kripalani, Jackson, Schnipper & Coleman, 2007). The drug-related
problems which were identified in post‐discharge periods were solved by the patients and
referred to their primary physicians (Walker et al., 2009). The overall result would result to
fewer admissions to the rooms of emergency within at least thirty days in the intervention group
in comparison to the control groups. A study among the old patients who got counsel from the
clinical pharmacist during discharge had had significantly low unplanned visits to their main

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physicians and fewer readmissions to the hospital than the control group which did not have the
pharmacist counselling (Hanlon et al., 1996; Lenander, Elfsson, Danielsson, Midlöv &
Hasselström, 2014). It is therefore essential for the older patients to seek the pharmacists
counselling before discharge to prevent further readmissions in the hospital (Hodgkinson, Koch,
Nay & Nichols, 2006).
Team productivity in the pharmacy will also be reinforced in order to promote the
pharmacy outcome. Through having a productive staff, it would mean that there would be low
refill time and quicker fulfilment of orders given by patients, this has been playing a major part
in improving patient care in most hospitals in the world (Christensen et al., 2011). If the staff is
slow in fulfilling their orders, it will be essential to relook into the schedules and make
appropriate adjustments in the orders they have been given. The changes which are to be
considered will include the addition of technicians to provide the pharmacists with breathing
space to prevent them from suffering exhaustion (Viktil & Blix, 2008). After the evaluation of
the productivity of the team, some of the staff which has not been well trained in the
administering of drugs to patients should be replaced by a group of professionals. Evaluating
each of the performances of everyone in the team and determine the skills need to be polished
and the areas of the operations in the businesses operations will require a much-experienced team
member. Investing in the training of the team will help improve the overall pharmaceutical
outcome in the hospital (Murray, Ritchey, Wu & Tu, 2009).
Inventory Control Optimization will also be carried out to ensure the appropriate
pharmaceutical outcome is carried out in the hospital. The improved efficiencies may be carried
out through reducing the time taken for the inventory management through the reduction of
costs, controlling and limiting the touch points (American College of Clinical Pharmacy et al.,

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2003). Some of the best practices which may improve the inventory process include; the creation
of the baseline inventory, developing a minimum and the maximum reorders points on the
prescribed medications, training of buyers about the controls of inventory such as updating the
minimum and maximum levels to avoid the stock delays, obtaining all the credits from the
returned products in excess and creating the advanced inventory control system which adjusts the
drug levels based on the demands of the patients (Egger et al., 2003; Kane, Weber & Dasta,
2003).
At the period of transition in the Levin’s change model, it will be important to question
the health professionals and the clinical pharmacists if they can perform their services optimally
and deliver the best to their patients with regards to the problems which are drug‐related.
Rewarding the pharmacists who play a critical role in giving quality pharmacy services will help
in making the change strategy to be a success (Doucette, McDonough, Klepser & McCarthy,
2005). The extended providers of the patient care such as nurses should be trained by the
pharmacists about giving appropriate education to the patients, social support and behavioral
changes such as taking the prescribed drugs as recommended for the patients who have chronic
illnesses (Kongkaew, Noyce & Ashcroft, 2008).
Conclusion
After refreeze in the Levin’s change model has been carried out, the change is to be
assessed through finding out the problem in the pharmacy outcome in the multispecialty hospital

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has been addressed. The change will, therefore, solve the problems which were associated with
the incompetence of the pharmacists in terms of drugs prescription and medication. The positive
results from the change model will thus realize the improvements in the pharmacy outcome of
the hospital. With the change model, the observed interventions by the clinical pharmacists in
improving the clinical outcomes, will include the improvements in the levels of makers of drug
use which will lead to reduced lengths of stay in hospitals, fewer re‐admissions, and also
reduction in the disease events for instance heart failure and thromboembolism (Clavenna &
Bonati, 2009). There has been evident with regards to the involvement on the intervention of the
hospital pharmacists in health care which have led to adverse effects in the improving of
pharmaceutical outcome in hospitals.
References
American College of Clinical Pharmacy, Hammond, R. W., Schwartz, A. H., Campbell, M. J.,
Remington, T. L., Chuck, S., ... & Webb, C. E. (2003). Collaborative drug therapy