Letter from the Chief Pharmacy Officer
Indu Lew, PharmD
Senior Vice President and Chief Pharmacy Officer
I am honored to present the 2021 Annual Report for the RWJBarnabas Health Pharmacy Enterprise. This annual report highlights the outstanding work our team achieves daily and the successful initiatives that transform the quality of care for our patients. These exceptional accomplishments are attributed to the philosophy of our group, “Actively Seeking Excellence.”
Overview and Philosophy
The Pharmacy Enterprise is an integrated system of divisions with accountability for clinical, quality, safety, social and financial outcomes related to medication use across the continuum of care in our health system. The Pharmacy Enterprise has 25 divisions across two distinct service lines, Acute Care Services and Integrated Services. Our Acute Care Service Line is comprised of 13 hospital divisions and our Integrated Service Line is comprised of 12 divisions: 340B Drug Pricing, Ambulatory Care, Rutgers Cancer Institute of New Jersey, Corporate Pharmacy, Informatics, Pharmacy Reimbursement Division, Retail Pharmacy Network, and Qualitas, our wholly owned pharmacy services company. Qualitas provides five unique services: Home Infusion, Hospital Services [Centralized Warehouse and Hospital Compounding/Repacking], Employee Mail Order Prescriptions and Specialty Pharmacy.
Effective leadership is predicated on clear communication. The Pharmacy Enterprise leadership has taken this fundamental tenet and distilled it to one word that is chosen each year to guide performance. Asking a diverse group of pharmacy stakeholders to focus their annual priorities through one word is a strategy that has accelerated unity and execution of goals and tactics. The Pharmacy Enterprise chose the word “Resiliency” for 2021. Resilience is the ability to bounce back and recover from difficult life events, the ability to grow despite challenges encountered. Resiliency is not being on a trampoline, where one minute you are up and the next minute you are down. It’s more like climbing a mountain without a guide map. It takes strength and help from the people around you, but at some point, when looking back, the thoughts are, “I don’t know how we did it, but look how far we’ve gone.” Every facet of pharmacy has been impacted by the pandemic, yet the Pharmacy Enterprise has continued to maintain balance, provide optimal and safe patient care, all while ensuring operational efficiency in the face of uncertainty – that is resiliency.
COVID-19 Vaccine
Beginning in late 2020, the Pharmacy Enterprise began working on an administration and distribution plan for COVID-19 vaccines. Corporate Pharmacy led the charge, coordinating multiple divisions and facilities across the system to create a registration, screening and administration platform that would meet the regulatory requirements associated with the vaccines approved under an Emergency Use Authorization (EUA). After the COVID-19 vaccines were approved and delivered to our sites, pharmacists, technicians and pharmacy leaders in every division of our health system joined together in tackling logistical challenges never before encountered with any other vaccination roll out. Members of the Pharmacy Enterprise were and continue to be, actively engaged in ensuring that state vaccination records are correct and up-to-date for those who have received a vaccine in our organization. With the combined efforts of so many, our hospital pods and the mega center, over 500,000 vaccine doses have been administered in 2021.
COVID-19 Therapeutics
The COVID-19 pandemic led to therapeutic innovation for not only the prevention, but also treatment of COVID-19. The Pharmacy Enterprise worked with industry partners, state, and federal government liaisons along with subject matter experts within our organization to allow for the administration of COVID-19 therapeutics as soon as they were available. Because of these proactive efforts prior to and immediately after the EUA, RWJBarnabas Health was one of the first sites in NJ to offer monoclonal antibodies (MAB) for COVID-19. Pharmacy worked closely with its partners in Infectious Diseases, the Emergency Department, and the Combined Medical Group to provide a safe and streamlined approach for patients who met criteria to receive MABs. With these new treatments’ ability for patients to recover from COVID-19 safely at home and the close telemedicine follow-up from providers in our medical group, our inpatient units were able to provide care to patients who were at a higher acuity level. At the time of the writing of this document, RWJBH facilities have administered MABs to 11,600 patients, preventing hospitalizations in 96 percent of recipients.
Plan for Epic
The Pharmacy Enterprise has been integrally involved with the Epic Together project. Over the course of 2021, the team logged thousands of hours collaborating with other divisions and approached their involvement in each element of the Epic project with a patient safety focus. Throughout the entire process, the team always advocated those systems be in place that align with our High Reliability principles. They partnered with subject matter experts across multiple specialties, informatics, billing, reimbursement, and external vendors. Over 300 order sets were carefully reviewed with teams of experts which led to formulary standardization and policy updates to ensure we provide evidence-based care for our patients. In 2021, the Pharmacy Enterprise also participated in the conversion of RWJ-Somerset to Epic. Pharmacists from across the enterprise worked diligently to re-enter all medication orders in Epic and support the Somerset team as they transitioned workflows and processes associated with the Epic installation.
Acute Care and Ambulatory Care Division
The pharmacists and technicians across the enterprise performed over 2.72 million and 532,394 clinical activities respectively. These activities resulted in better care for our patients and a cost avoidance of over $8,617,550. Our team aspires to provide the safest environment for our patients by recognizing the potential for adverse medication events and preventing them before they occur. More than 89,041 adverse drug reactions and over 207,921 medication errors were prevented. Mitigating errors and harm were accomplished by several strategies, including clarification of orders, performing accurate medication histories and medication reconciliations ensuring patients are receiving the five rights of medications: the patient, drug, dose, route and time. The team also performed over 25,910 medication reconciliations and 16,649 medication histories. Additionally, the Pharmacy Enterprise provided over 288 community outreach programs.
Retail Pharmacy
The Retail Pharmacy Division dispensed nearly 173,165 prescriptions. Ensuring patients leave our hospitals with prescriptions may decrease medication-related readmissions and improve medication adherence. The “Meds to Beds” program of the Retail Pharmacy Division processed over 13,098 prescriptions for 6,457 patients prior to discharge.
Pharmacists can help ensure that patients without insurance in the community continue to have access to medications. The Retail Pharmacy Division has provided over 1,789, 30-day prescriptions to approximately 575 patients. This was possible through the partnership with the Dispensary of Hope, a charitable medication distributor. The division also generated a net benefit of over $902,000 to the system.
Qualitas
The Qualitas Home Infusion Division continues to provide safe and quality care to the community. Our nurse colleagues performed more than 25,894 home visits, maintaining over 79,172 line days and administering approximately 106,848 IV medications. While the national average for line infection rates is 3.5 per 1,000 patient days, Qualitas continues to over perform by decreasing its line infection rates from 0.1, 019, 0.01 and <.01 in 2018, 2019, 2020 and 2021, respectively. The division provided over $4.4 million in net benefit to the health system.
Eighty percent of new drug approvals are specialty medications. Specialty medications expect to increase to 50 percent of drug costs and grow to $500 billion by 2022. The Specialty Pharmacy team at Qualitas filled more than 89,032 prescriptions for our patients, generating a net benefit of over $12.5 million to the system.
Medication shortages continue to burden health systems. In 2019, in order to mitigate the shortage supply, a centralized warehouse was established. The centralized warehouse strategies further evolved to leverage the buying power of the system. These combined initiatives have realized over $ 9.5 million savings to the health system. The central warehouse was also instrumental in our system’s COVID-19 vaccination efforts with the Mass vaccination centers in Edison and Bridgewater.
Pharmacy focuses not only on the patients of the community, but on the employees as well. The Employee Mail Order Division filled more than 73,983 prescriptions for employees and their families. They coordinated more than 3,163 medication deliveries, averaging nine prescriptions per day to employees’ homes. Due to leveraging own use pricing, the Division has saved the health system over $2 million. In addition, the co-pay card optimization program generated over $2.7 million in savings to our employees.
Focus on Academics
As the largest academic health system in NJ, education is a cornerstone for the Pharmacy Enterprise. The partnership with Rutgers continues to foster the importance of education, research, and publications. This is evidenced by our education efforts and dedication to training pharmacy students and residents. The team provided advanced clinical clerkship rotations for over 651 students. The Pharmacy Residency Program has continued sustainability and growth with 9 Post Graduate Year 1 programs and six Post Graduate Year 2 programs.
The Pharmacy Enterprise team is nationally and internationally recognized as educators and presenters. In 2021, they completed over 91 formal lectures, locally, regionally and nationally. The team completed 42 peer- reviewed manuscripts, book chapters, guidelines and articles. A total of 20 abstracts were presented at local and national meetings.
Additional Milestones
The 340B Division optimized the automated system for patient eligibility resulting in an annualized net benefit of $ 92 million dollars, an increase of 21 % from 2020.
Our Pharmacy Informatics Division performed over 3,400 safety enhancements to our Enterprise Clinical Information Systems which serves as a foundation for all care providers when treating our patients. Many of the projects involved information technology changes toward the goals of standardizing builds, processes, and workflows for the Pharmacy Enterprise.
Our Pharmacy Reimbursement Division (PRD) recovered over $4.3 million in 2021 and $46.5 million since program inception (2009) for the Acute Care Service Line. PRD reviewed and ensured medication billing on almost 5,200 billing, coding, charge capture and reconciliation activities.
Building on Excellence
Pharmacy leadership has chosen the word “Unify” for 2022. “Unify” centers on the essential principles of harmonized health system workflows in anticipation to the migration to Epic and the integration with Trinitas Regional Medical Center.