HMH Pharmacy Annual Report 2023

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HOUSTON METHODIST HOSPITAL DEPARTMENT OF PHARMACY

2023 Annual Report

Message from Alex C. Varkey, PharmD, MS, FAPhA

Director of Pharmacy Services, Houston Methodist Hospital

Pharmacy Leadership Team

Safety

Houston Methodist Hospital Department of Pharmacy

The Department of Pharmacy at Houston Methodist Hospital (HMH) collaborates with the health care team to provide innovative, personalized, cost-effective pharmaceutical care in a culture dedicated to quality and safety.

The pharmacy department’s vision is to be recognized as a global leader of pharmaceutical care in the health care setting. To that end, we strive to:

•Continuously improve the quality and safety of patient care and the medication management process

•Cultivate an environment of collaboration and teamwork

•Provide high-quality training and education to our technicians, student interns, residents and pharmacists

•Maximize the use of automation and information technology

•Maximize cost efficiencies and resource utilization

People Service Quality and
Finance Innovation
3 4 5 14 24 30 33 2
TABLE OF CONTENTS

MESSAGE FROM THE DIRECTOR OF PHARMACY SERVICES

2023 was another banner year for HMH Pharmacy!

Our commitment to the Houston Methodist I CARE values and the provision of unparalleled patient care comprise the foundation of HMH Department of Pharmacy Services. Our exceptional team of pharmacists, pharmacy technicians, student pharmacists, and support personnel continually show dedication to our patients and one another every day.

HMH Pharmacy continues to be recognized nationally for our commitment to patient care and training our profession’s future leaders.

Our PGY2 Critical Care Residency recently received the American Society of Health-System Pharmacists (ASHP) Foundation’s Pharmacy Residency Excellence Program Award –awarded to the nation’s top pharmacy residency program among 2,883 pharmacy residency programs accredited by ASHP. Our team members continue to showcase the great work being done at HMH via numerous national publications and presentations at state, national, and international meetings.

Our department positively positions Houston Methodist Hospital to receive its many accolades as well, including being recognized as a top performer in clinical quality and supply chain excellence in the academic medical center cohort by Vizient and as one of America’s Honor Roll hospitals by U.S. News & World Report Pharmacy’s presence through direct patient care, quality improvement strategies, and medication safety initiatives is a major component of our institution’s overall quality and safety strategies.

As we move ahead to 2024, we will continue with laser focus on what we do every day. That includes enhancing our medication distribution, clinical services, and regulatory/quality compliance efforts to provide unparalleled safety, quality, service, and innovation for our patients, and a fulfilling environment for our staff.

We want to take this moment to celebrate our team’s commitment to our patients. Sincere thanks to the HMH Pharmacy Team for their hard work and dedication to our patients and each other!

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Pharmacy Leadership Team

PHARMACY LEADERSHIP TEAM
PEOPLE Pharmacy Personnel 5 334 Pharmacy Staff 283 FTEs 8M+ Doses Dispensed 40K+ Admission 948 Operating Beds 48K+ ED Visit

Pharmacy Personnel

Years of Service

20+ Years of Service

Betty Brown, Bridgette Chandler, Aida Coralic, Claudia Fuentes, Zulma Guandique, Brian Hearn, Michelle Huyen, Joseph Mancini, Rubi Montoya, Nyoka Paul, Lynette Preston, Wendy Teague

30+ Years of Service

Lekan Giwa, Tyrone Moore, Khanh Pham, John Stodghill, Raul Turner

40+ Years of Service

Jenna Gin, Elias Guerra, Jane Scott

Employee Opinion Survey

Pharmacy continually ranks as a Tier 1 Department since 2009! Our department continues to score well above the national healthcare average in all categories.

PEOPLE
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PEOPLE

Pharmacy Personnel

Pharmacy Month

In 2023, we celebrated National Pharmacy Month in the month of October. The goal of celebrating Pharmacy Month is to recognize and appreciate the powerful impact that pharmacy employees make on the care of our patients and medication safety

• $3,415.01 donated to Houston Area Women's Center Fundraising

• 1,600 meals and snacks provided Food

• 1,620 gifts distributed across the HM system Gifts

•20 letters received Nursing Appreciation

•10 games and activities hosted Activities

Community Outreach

HMH Director of Pharmacy, Alex Varkey, getting a pie in the face by Pharmacy Manager, Engie Attia, for a charitable cause

The Department of Pharmacy participated in community outreach through a variety of events. Through Adopt-a-Family, Pharmacy supported a six-member family in need during the holidays with a record contribution of $3,000 in monetary contributions and donated items. Many thanks to our Adopt-aFamily coordinators: Aranzazu Calzado and Niaz Deyhim

Pharmacy also participated in I CARE in Action events to help the Greater Houston community. Our pharmacy residents volunteered with the Houston Food Bank to sort donated items and Memorial Assistance Ministries (MAM) Houston for donation sorting and improving storefront presence.

PEOPLE

Awards, Honors, and Recognitions

Beyond the Hospital Doors

Karen Abboud, PharmD, BCOP Lifesaver Award, Great Catch Award, obtained BCOP Certification, and appointed to ASHP New Practitioner Forum

May Achi, PharmD, BCPS, BCCP appointed to Pulmonary Hypertension Care Center Review Committee

Haley Blanck, PharmD, MS and Luna Shi, PharmD, BCPS Epic Willow Certification

Niaz Deyhim, PharmD, MS, BCPS appointed as TSHP New Practitioner Chair and ASHP Section of Pharmacy Practice Leaders

Cynthia El Rahi, PharmD, BCOP awarded ASHP Residency Expansion Grant

Breanna Hinman, PharmD, BCOP obtained BCOP Certification

Eleanor Hobaugh, PharmD, BCOP appointed as a panelist at BTF Best of ASH and SABCS

Jill Krisl, PharmD, BCPS, BCTXP appointed to International Society of Heart and Lung Transplant 2024 Planning Committee

Mozhgon Moaddab, PharmD, BCPS and Tatjana Ramos, PharmD, MPH, BCPS Great Catch Award

Tatjana Ramos, PharmD, MPH, BCPS appointed to Society of Pain and Palliative Care Pharmacy Development Committee

Carlos Sandoval, CPhT, Justin Chaney, CPhT, Michael George, PharmD, BCPS, and Varsha Patel, BS ASHP Investigational Drug Services Certification

PGY2 Critical Care Program

ASHP Foundation Pharmacy Residency Excellence Program Award

Culture of Safety Awards

Unparalleled Safety Team — LTAC UNIT

Amanda Beck, PharmD, MS

Niaz Deyhim, PharmD, MS, BCPS

Anita Saini, PharmD

Unparalleled Quality Team Antimicrobial Stewardship Program

Natalie Finch, PharmD, BCPS, BCIDP

Wesley Hoffman, PharmD, BCIDP

William Musick, PharmD, BCIDP

Unparalleled Safety Individuals

Mahmoud Sabawi, PharmD, Niha Zafar, PharmD, MS

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PEOPLE Publications 9 Number of Publications by Pharmacy Service Line 2 4 3 11 4 Internal Medicine Transplant Informatics & Administration Oncology Critical Care

Publications

Transplant:

• Rubido ED, Cooper MH, Donahue KR, Krisl J. Descriptive analysis evaluating the use of direct oral anticoagulation therapy in heart and lung transplant recipients. Clin Transplant. 2023 Feb;37(2):e14897. doi: 10.1111/ctr.14897. Epub 2023 Jan 11.

• Tu ZH, Pierce BJ, Pasley T, Hutchins A, Huang H. Immune outcomes of lung transplant recipients with different cytochrome P450 3A5 phenotypes after discontinuation of voriconazole antifungal prophylaxis. Clin Transplant. 2023;e15235.

• Connor AA, Huang HJ, Mobley CM, Graviss EA, Nguyen DT, Goodarzi A, Saharia A, Yau S, Hobeika MJ, Suarez EE, Moaddab M, et al. Progress in Combined Liver-lung Transplantation at a Single Center. Transplant Direct. 2023 Apr 20;9(5):e1482. doi: 10.1097/TXD.0000000000001482.

• Fida N, Yun A, Eagar T, Rogers AW, Krisl JC, et al. Effectiveness of combined plasma cell therapy and stimulation blockade based desensitization regimen in heart transplant candidates. Transplantation; in review.

Critical Care:

• Dreucean D, Donahue KR, Morton C, Succar L, Krisl J, et al. Bloodstream infections in prolonged use of axillary-placed, intra-aortic balloonpump support: A single-center study. Infect Control Hosp Epidemiol. 2023 Nov 10:1-3. doi: 10.1017/ice.2023.225.

• Halawi H, Harris JE, et al. Use of bivalirudin after initial heparin management among adult patients on longterm venovenous extracorporeal support as a bridge to lung transplant: A case series. Pharmacotherapy. Published online February 2, 2024. doi:10.1002/phar.2910

• Sigala MI, Dreucean D, Harris JE, et al. Comparison of Sedation and Analgesia Requirements in Patients With SARS-CoV-2 Versus Non-SARSCoV-2 Acute Respiratory Distress Syndrome on Veno-Venous ECMO. Annals of Pharmacotherapy. 2023;0(0). doi:10.1177/10600280221147695

• Sigala MI, Harris JE, Morton C, Donahue KR, Kim JH. A case series analysis of bicarbonate-based purge solution administration via Impella ventricular assist device. Am J Health Syst Pharm. Published online November 11, 2023. doi:10.1093/ajhp/zxad278

Oncology:

• Abboud K, Umoru G, et al. Immune Checkpoint Inhibitors for Solid Tumors in the Adjuvant Setting: Current Progress, Future Directions, and Role in Transplant Oncology. Cancers (Basel). 2023;15(5):1433. Published 2023 Feb 23. doi:10.3390/cancers15051433

• Abudayyeh, A., Esmail, A., Kaseb, A., Xu, J., Abboud, K., Umoru, G., et al. (2023). Outcomes with second-line treatment following first line atezolizumab plus bevacizumab in patients with unresectable hepatocellular carcinoma. HPB, 25, S321.

• Abudayyeh, A., Esmail, A., Kaseb, A., Xu, J., Umoru, G., Abboud, K., et al. (2023). Utilization of atezolizumab plus bevacizumab as subsequentline therapy in patients with unresectable hepatocellular carcinoma. HPB, 25, S321–S322.

• Allen E, Brown EN, Torre R, Murthy A. Retrospective study on the efficacy and tolerability of dose modification of PD-1 and PD-L1 inhibitors in hospital-system community outpatient cancer clinics. J Oncol Pharm Pract. Published online May 22, 2023. doi:10.1177/10781552231177209

• Burns, E. A., Gee, K., Kieser, R. B., Xu, J., Zhang, Y., Crenshaw, A., Muhsen, I. N., Mylavarapu, C., Esmail, A., Shah, S., Umoru, G., et al. (2022). Impact of infections in patients receiving pembrolizumab-based therapies for non-small cell lung cancer. Cancers, 15(1), 81.

• Chung C, Umoru G, Abboud K, Hobaugh E. Sequencing and combination of current small-molecule inhibitors for chronic lymphocytic leukemia: Where is the evidence?. Eur J Haematol. 2023;111(1):15-28. doi:10.1111/ejh.13973

• Gong Z, Umoru G, et al. Adverse effects and non-relapse mortality of bcma-directed immunotherapies : an fda adverse event reporting system (Faers) database study. Blood. 2023;142(Supplement 1):358-358.

• Haque, E., Muhsen, I. N., Esmail, A., Umoru, G., Mylavarapu, C., Ajewole, V. B., et al. (2022). Case report: Efficacy and safety of regorafenib plus fluorouracil combination therapy in the treatment of refractory metastatic colorectal cancer. Frontiers in Oncology, 12, 992455.

• Hinman B, Cox J, Umoru G, Kamble R, Musick W. Extended duration letermovir in allogeneic hematopoietic stem cell transplant. Transpl Immunol. 2023;81:101936. doi:10.1016/j.trim.2023.101936

• Hinman B, Umoru G, Burns E, Rahi CE, Zhang J (2023) Utilization of dual immunotherapy for metastatic pulmonary pleomorphic giant cell carcinoma: a case report. Clin Oncol Case Rep 6:4

• Schneider C, Karimi S, Bears K. (2023). Literature Review: Role of Pharmacogenetics in the Treatment of HBV. J Pharmaceut Res, 8(1), 202-213.

Administration/Informatics:

• Deyhim N, Dunne IE, Nguyen PA, Fasoranti OO, Crew CM, Liebl MG. Process and outcomes from systemization of a longitudinal advanced pharmacy practice experience (LAPPE) program. Am J Health Syst Pharm. Published online December 9, 2023. doi:10.1093/ajhp/zxad307

• Luu A, Bui NA, Adeola M, Bhakta S, Fuentes A, Agarwal K. Impact of a passive clinical decision support tool on potentially inappropriate medications (PIM) use in older adult patients. J Am Geriatr Soc. 2023;71(11):3584-3594. doi:10.1111/jgs.18586

• Shi L, Wei W, Smith A, Abbasi G. Implementation and evaluation of an EHR-integrated perpetual inventory system in a large tertiary hospital oncology pharmacy. Am J Health Syst Pharm. Published online January 31, 2024. doi:10.1093/ajhp/zxae022

Internal Medicine:

• Gohil S, Deyhim N, Mgbere O, Essien EJ. Predictors of opioid prescription among outpatients with osteoarthritis in the United States. J Opioid Manag. 2023;19(3):205-223. doi:10.5055/jom.2023.0777

• Sullivan E, Ruegger M, et al. Comparison of effectiveness and safety of sodium polystyrene sulfonate and sodium zirconium cyclosilicate for treatment of hyperkalemia in hospitalized patients. Am J Health Syst Pharm. 2023;80(18):1238-1246. doi:10.1093/ajhp/zxad137

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PEOPLE

PEOPLE

New Initiatives and Expansion

Diversity, Equity and Inclusion (DEI) Initiatives

As part of Pharmacy’s DEI initiatives, we have developed a DEI display wall in the hallway by our Central Pharmacy breakroom. On this wall, Pharmacy team members can place a pin on a large world map to represent the various countries we are from. Our diverse team hails from over 24 different countries across the globe!

2023 DEI Goals

• Enhance DEI education & awareness for pharmacy staff, including ACPEaccredited continuing education and preceptor development workshops

• Engage pharmacy staff in additional DEI programming and events

• Coordinate specialized DEI training for residency programs and pharmacy leaders

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PEOPLE

Educating Tomorrow’s Health Care Leaders

Pharmacy Residency and Fellowship Programs

Since 1987, Houston Methodist’s pharmacy residency and fellowship programs have educated pharmacy graduates on the knowledge and skills needed to become pharmacy practice and research leaders. Houston Methodist combines didactic, practical, and research experiences to train residents and fellows to navigate and lead in tomorrow’s health care landscape.

Houston Methodist Postgraduate Pharmacy Residency & Fellowship Class 2022-2023

PEOPLE

Education, Onboarding, and Training

Onboarding and Training Mission: To empower pharmacists, technicians, interns, and students through comprehensive onboarding and training programs. We strive to cultivate a culture of continuous learning and professional development, equipping our team with the knowledge, skills, and resources necessary to excel in their roles and deliver exceptional pharmaceutical care.

Department of Pharmacy Onboarding and Training Program 2023 Achievements

Assessed employee turnover and retention data and developed recommendations

Established the Pharmacy Training Committee

Revamped and standardized the employee onboarding program for all pharmacy staff

Standardized and converted all pharmacy training checklists to an electronic format

Developing strategies to standardize training across entire pharmacy department

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SERVICE Pharmacy Service Lines HMH Pharmacy’s Impact on Service Lines and Patient Throughput Antimicrobial Stewardship Cardiology Critical Care Emergency Medicine Medication Histories 24/7 Clinical Coverage Internal Medicine Long-Term Acute Care (LTAC) Medication Safety Neonatal Neurology Oncology & Bone Marrow Transplant (BMT) Pain Management Psychiatry Skilled Nursing Facility (SNF)/Rehab Solid Organ Transplant Surgery Transitions of Care

Operational Data and Metrics

Medication Dispense Data Summary

ANNUAL TREND

From 2019 to 2023, our dispense volume has continued to rise with our unit of service (equivalent patient days).

2023 ended with 8,226,850 doses (8.74% increase from 2019) sent from our pharmacy teams. January 2024 shows roughly 737,948 doses being dispensed from our pharmacy teams, representing the highest amount in the past five years.

SERVICE
15 7,565,386 7,140,532 8,132,241 7,960,801 8,226,850 6,400,000 6,600,000 6,800,000 7,000,000 7,200,000 7,400,000 7,600,000 7,800,000 8,000,000 8,200,000 8,400,000 2019 2020 2021 2022 2023

Operational Data and Metrics

Medication Distribution

Since 2015, we have expanded utilization of Pyxis automated dispensing cabinets to improve medication turnaround time for critical patient care initiatives including STAT doses, sepsis response, antimicrobial stewardship, and pain management.

Continuing this strategic trend, we increased our total medication dispense from Pyxis from 70.3% to 74.88% in 2023.

Despite the greater necessity for staff needed for medication deliveries to Pyxis , this expansion was achieved with skill mix updates versus staff additions.

SERVICE
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12.56% 74.88% 5.94% 4.47% 2.15% Carousel Pyxis Robot IV
Other

Operational Data and Metrics

Order Verification Turnaround time

The pharmacy department is committed to expeditiously and safely processing all medication orders (average 5,500/day) from the time of receipt to availability. Approximately 95% of all medication orders were verified within turnaround goals set by policy in 2023, including processing of STAT orders within 10 minutes. The other 5% of total orders typically require clarification due to drug-drug interactions, allergies, dosage adjustment, delays, etc.

Order Verification Volume

SERVICE
17 14 14 13 14 14 15 13 15 14 14 14 14 6 6 6 6 6 7 6 6 6 7 7 7 0 5 10 15 20 25 30 35 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Minutes Routine STAT 199376 184901 205066 193448 209278 209395 201652 219607 206922 219711 210878 216904 160000 170000 180000 190000 200000 210000 220000 230000 January February March April May June July August September October November December

Operational Areas

Central Pharmacy Operations

Dose Distribution and Operational Support

Innovation and Growth

• Converted to Intelligent Locations for Environmental Monitoring of 200+ Cold Storage, Ambient, and Controlled Compounding Areas

• Implemented Real Time Dispense Status Dashboard to drive performance goals

• Conducted IV re-use project allowing recycling of 2,000+ IV doses

• Bi-annual certification of cleanrooms were 100% successful – ensuring high-quality production for patient care without microbial or non-viable failures

People and Environments

• Triage Pharmacist role expansion to electronic Prior Authorization (ePA), IV-to-oral (IVPO) conversions, and daily department-wide huddle

• Refreshed Physical Environment: Wall paint, carousel rebuild, IV-hood replacements, Pyxis operations area refresh

SERVICE
18 1.1M doses dispensed from medication carousel technology 90,000 oral syringes prepared using barcoded medication preparation technology Provision of over 140,000+ compounded sterile products 400,000+ Epic medication messages managed Over 60,000 phone calls triaged Optimized decentralized distribution from Automated Dispensing Cabinets to over 74% Expanded chain of custody digital dose tracking by expanding use of Epic Rover by Pharmacy, Couriers, and Nursing
members
Central Pharmacy team

SERVICE

Operational Areas

Walter Tower ICU Satellite Pharmacy

The ICU operations team is located in Walter Tower on the 10th floor. The WT10 ICU satellite pharmacy operates 24/7 and primarily services five ICUs (medical, surgical liver, neuro, cardiovascular, and cardiac) and the Alkek 9 IMU.

2023 Dispense Volume:

• 213,000 doses dispensed, in addition to compounding and placing 915 dexmedetomidine and 2,495 vasopressin bags in Pyxis!

2023 Initiatives:

• Cost-savings with vasopressin: the ICU satellite compounded vasopressin IV bags to place in Pyxis machines instead of purchasing the premix. This initiative savings equate to approximately $500,000 per year!

• ICU Green Initiative: the ICU Satellite started loading vasopressin and dexmedetomidine compounded bags into Pyxis refrigerators across all ICU units to improve patient care, nursing and pharmacy workflow efficiencies, and preventing returned waste.

ED Satellite Pharmacy

The Emergency Department (ED) satellite pharmacy processes orders for the HMH Main ED, in addition to three community Emergency Care Centers (Kirby, Voss, and Pearland). The team performs 55% of medication histories for patients coming in from the HMH Main Emergency Department.

ICU satellite pharmacy operations team ED satellite pharmacy operations and medication history team Location Number of Patients in 2023 HMH Main ED 48, 644 Kirby ED 17,595 Pearland ED 17,246 Voss ED 14,134 19

Operational Areas

Perioperative Pharmacy Services

The perioperative pharmacy services team operates out of six different pharmacy satellite locations throughout our seven procedural suites at HMH. The average number of medications administered in the operating room spaces in 2023 was 61,492 per month.

2023 HMH Operating Room Medication Administrations

2023 Initiatives:

• Pyxis Anesthesia Implementation

• Surgical Prophylaxis Guidelines

SERVICE
20 0 10000 20000 30000 40000 50000 60000 70000 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
HMH
OR HMH MAIN OR HMH OPC
OR HMH
OR HMH Walter OR HMH DUNN 6 OR OR Pharmacy team members
HMH AV OR
DUNN
18
OPC 19

SERVICE

Operational Areas

Outpatient Center (OPC) Satellite Pharmacy

The oncology operations team is in the Outpatient Center tower on the 22nd floor. The OPC 22 pharmacy serves as the primary United States Pharmacopeia (USP) <800> compliant compounding space supporting preparation of hazardous infusions and injections, microbial vector therapies, and intrathecal/intraperitoneal/intravesical therapies for procedural patients. The team primarily services the inpatient and outpatient hematology/oncology patient population, but also supports all non-oncology outpatient infusions. The team is comprised of 11.6 pharmacy technician FTEs and 10.6 pharmacist FTEs to provide services.

Volume by Area

OPC21

IP Non-Oncology Units

IP WT14

IP BMT

Non-Oncology Infusion

OP BMT

OP Transplant

2023 volume breakdown

62,470 total doses dispensed

195 doses per day 29796, 48%

31,000+ hazardous doses dispensed

5,206 total doses per month 171

2023 Achievement Highlights

• OPC 21 Outpatient Cancer Infusion Clinic expansion

• Staffing model optimization and oncology-specific assignment to improve workflow

• 2022-2023 USP <800> refresh

• Creation of Pharmacy Administrative Specialist for Oncology Operations

• Implementation of Loccioni Apoteca Chemo robot

• Implementation of (4) Biological Safety Cabinets (BSCs)

• Implementation of HD wipe sampling program

• Implementation of Epic dose status dashboard for dose awareness and communication

• Reopening of WT10 chemo room for inpatient oncology operations

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8884,
7841, 12% 6046, 10% 5450, 9% 2709, 4% 1744, 3%
14%

SERVICE

Clinical Pharmacy Services

Clinical Pharmacy Services

In 2023, the clinical pharmacy team completed more than 50,000 pharmacy consults related to patient care. The pharmacy department supported approximately 9,300 hospital discharges with medication reconciliation and prior authorization support The team identified ~300 medication discrepancies at discharge that were optimized.

The pharmacy department completed approximately 21,000 medication histories for patient encounters The majority of this activity is performed by the medication history team of pharmacists and technicians in the emergency department.

•Renal

•Heparin

•Apixaban

•TPN

•Vancomycin

•Medication Reconciliation

•Warfarin

•Medicare Shared Savings (MSSP)

•Rivaroxaban

•Bivalirudin

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4286 3982 4421 3960 4289 41384188 4275 4152 4318 41834217 3700 3800 3900 4000 4100 4200 4300 4400 4500 Pharmacy Consults 0 100 200 300 400 500 600 700 800 900 1000 Discharge Support 2023 Discrepancy at Discharge High Risk Medication Prescription Meds to Bed Prescription Generation Prior Authorization
Top 10 Consulted Pharmacy Services in 2023

A LOOK AHEAD TO 2024

2024 Strategic Plan Initiatives

Finance

• Implement oncology stewardship initiative to avoid IP days

• Reduce medication waste

• Optimize inventory control by improving cycle count adherence rate and minimizing inventory variance

• Implement a refrigerated carousel to increase visibility and control transfer of refrigerated medications

• Fully implement CPOV to achieve a 90% order verification rate

• Implement innovative ABB robot to eliminate the manual medication credit return process

• Increase electronic tracking and visibility of medication use from Pyxis Anesthesia Stations in OR spaces

• Implement and optimize chemo robot to improve dose preparation efficiencies

• Implement ePA and CoverMyMeds Epic integration to improve turnaround time for prescription approvals upon discharge

• Continue expanding medication education videos and establish metrics for measuring effectiveness

People

• Expand the charge pharmacist program to improve integration of clinical and operational responsibilities

• Promote DEI initiatives by hosting departmental DEI activities

Quality & Safety

• Improve Pyxis Service TAT from ticket request

• Increase electronic diversion prevention auditing and waste reconciliation percentage in operating rooms post-Pyxis Anesthesia

• Increase number of transactions audited with implementation of new controlled substance auditing software

• Ensure compliance with various USP chapters in sterile compounding areas

Innovation & Growth Service

• Continue expanding medication education videos and establish metrics for measuring effectiveness

• Develop and finalize collaborative practice agreements within clinical services

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QUALITY & SAFETY

Medication Use Safety, Policy, and Quality Assurance

The multidisciplinary Medication Safety Committee was able to successfully achieve their 2023 goals through collaboration. Amongst them included:

• Reduction in medications removed from Pyxis via override by 18%

• Improvement in VigiLanz® alert acknowledgement by 33%, with 60% improvement in time to rule acknowledgement

• Monitor timely medication administration of 3 different medication classes

46% of medication-related TAPS reports were submitted by pharmacy personnel. 60% of system improvement (IT modifications, workflow optimization, policy changes, and staff education) resulted from pharmacy reported events.

Additional educational opportunities provided by the Medication Safety team include: ISMP Safety Alerts, monthly pharmacy safety huddles, and collaboration with CNREP to provide nursing education.

CMPI Great Catch Award Pharmacy Recipients 7 Medication safety policies developed and/or updated 4 Student and resident rotations 12 Continuous quality improvement (CQI) projects 22 Failure modes and effects analysis (FMEA)
Medicationrelated event reports reviewed >1,200 24
1

QUALITY & SAFETY

Medication Use Safety, Policy, and Quality Assurance

Pyxis Override Removal Rate

In 2023, the Medication Safety Committee aimed to achieve a 10% reduction in the medication override rate. Through a collaborative effort involving the Controlled Substances Diversion Prevention Team, System Medication Safety Committee, and HMH Medication Safety Committee, the overall medication override rate saw a significant decrease of 18%. This reduction comprised a 35% decrease in controlled substances override and a 21% decrease in non-controlled substances override.

Barcode Medication Administration (BCMA)

The HMH nursing and pharmacy teams work together to achieve and maintain BCMA compliance above 99%

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82.0% 84.0% 86.0% 90.4% 89.9% 90.9%90.7% 96.1% 97.1%97.4%97.3%97.8%98.4%98.2%98.1%98.4%98.5%98.7%98.7%98.7%98.8%98.9%98.9%98.8%99.0%99.1% 82% 83% 83% 84% 84% 85% 86% 86% 87% 87% 88% 89% 89% 90% 90% 91% 92% 92% 93% 93% 94% 95% 95% 96% 96% 97% 98% 98% 99% 99% 100% Q1 2017 Q2 2017 Q3 2017 Q4 2017 Q1 2018 Q2 2019 Q3 2018 Q4 2018 Q1 2019 Q2 2019 Q3 2019 Q4 2019 Q1 2020 Q2 2020 Q3 2020 Q4 2020 Q1 2021 Q2 2021 Q3 2021 Q4 2021 Q1 2022 Q2 2022 Q3 2022 Q4 2022 Q1 2023 QTD 2023 BCMA COMPLIANCE QUARTER/YEAR Houston Methodist Hospital Leapfrog BCMA Quarterly Compliance LF BCMA Compliance Superior Target Q1 2023 Q4 2023 Total Pyxis Transactions Override Transactions % Override Total Pyxis Transactions Override Transactions % Override % Change Controlled Med 175933 3803 2.16% 183521 2569 1.40% 35% Non-Controlled Meds 1277035 19007 1.49% 1339902 15718 1.17% 21% All Medications 1452968 22810 1.57% 1523423 19563 1.28% 18%

QUALITY & SAFETY

Medication Use Safety, Policy, and Quality Assurance

Controlled Substance Diversion Prevention Program (CSDPP)

Daily discrepancy notifications and resolution

Appropriate wasting

Security of controlled substances

Daily reconciliation of EPIC vs. Pyxis with follow-up emails

Weekly Pyxis controlled substance inventory counts

Monthly proactive diversion detection

CSDPP activities

2023-2024 CSDPP Committee Members:

Executives: Gail Vozzella & Jeff Carr

Anesthesia: Dr. Randy Steadman & Dr. Derek Schoppa

Nursing: Terry Clark, Matthew Freeman, Daniel Kerr, Kathryn Materre, Susan Teer, Travis Tingle, Blair Gerken, Nikolas Ellis, Ashley Eugene

POWER WEEK

Business Practices: Julie Lewis

Security: Robert Gomez

HR: Andrew “Drew” Taulton & Edda Tinis

Employee Health: Maisie Mok

Pharmacy/CSDPP Team: Amanda Beck, Angela Blueitt, Linda Haines, Theresa Miller, Michell Nguyen, Tatjana

Ramos, Alex Varkey

Pharmacy IT: Emmanuel Njigha

Quality & Safety: Vidya Saldivar

Accreditation: Karen Ward

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2023 CSDPP Committee Members

2023 CSDPP Accomplishments

• Execute PharmID Expansion

• 18% Increase in Waste Audits

• Added CS Banner in Pyxis

• Modified M14.9 Override Policy

• RTLS Tracking On CS Delivery

• Ethics Hotline for Reporting

• Pyxis A-Station Implementation

• ASHP CS Gap Analysis

• PTOM Process Revision

• Participated in Nursing Training

• External PCA Key Policy

• Modified M6.3 CS Delivery Policy

QUALITY & SAFETY

Medication Use Safety, Policy, and Quality Assurance

Methodist Internship Longitudinal Experience (MILE) Program

The MILE Program is an exclusive three-year opportunity available to a select number of highly qualified students in the second semester of their first professional year of pharmacy school. The first two years of the internship focus on learning the intricacies of pharmacy operations and leading longitudinal pharmacy initiatives under the mentorship of department leaders. The final year of the internship transitions into clinically focused activities and longitudinal projects.

POWER WEEK

HMH Power Week is a week-long shadowing program that invites students from pharmacy schools across Texas to tour the HMH Central Pharmacy and shadow clinicians of various specialties for one day. Between 2017-2023, approximately 260 pharmacy students have participated in Power Week. In 2023, the program received 48 applications from across 7 pharmacy schools in Texas. 31 students were selected for 2023.

2023 MILE Interns and Pharmacy Administration Residents 28 133 104 101 74 61 57 100 96 101 90 87 102 0 20 40 60 80 100 120 140 Number of Interventions Month
MILE Intern
(N=1,106) 828, 83% 174, 17% Type of Interventions Documented (N=1,106) Medication History Education
2023
Interventions Documented

QUALITY & SAFETY

Medication Supply Chain

Pharmacy Drug Shortage Management

Pharmacy intervention plays a crucial role in managing drug shortages, focusing on identifying alternative therapies, implementing strategic purchasing to prevent supply disruptions, and ensuring fair resource allocation. Pharmacists also enhance communication about drug shortages within the health care team and with patients, utilizing Electronic Health Record (EHR) systems to guide prescriber behavior through soft and hard stops These interventions are essential in maintaining patient care quality and safety during drug shortages, reflecting the indispensable role pharmacy personnel play in navigating care.

29 Select Drug Shortages Managed Heparin Infusion Amphotericin Epoetin alfa Ketamine Sodium Phosphate Lorazepam Methohexital Methylprednisolone Nalbuphine Promethazine Sodium Acetate Vinblastine

FINANCE

Finance Performance Operating Expense

The Department of Pharmacy’s actual operating expense for 2023 totaled $274.6 million against a flex budget of $271.6 million and a fixed budget of $267.5 million.

$274,621,464 $267,486,577 $271,559,182 $10,000,000

Revenue

In 2023, the pharmacy department experienced a notable increase in total charges from $3.092 billion in 2022 to $3.625 billion.

$3,092,270,148 $3,624,508,799

$1,600,000,000

$600,000,000 $1,100,000,000

$100,000,000

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$160,000,000 $210,000,000
2023 Actual Fixed Flex
$60,000,000 $110,000,000
$260,000,000 $310,000,000
$2,100,000,000 $2,600,000,000 $3,100,000,000
$3,600,000,000 $4,100,000,000 Revenue 2022 2023
FINANCE 31 Initiatives Cost Saving Alteplase to Tenecteplase $105,406.08 Mozobil to Plerixafor $1,289,031.50 Lexiscan to Regadenoson $100,866.11 MMR to Priorix Vaccine $216.44 Sugammadex Syringes $1,028,609.00 Abraxane to Paclitaxel NA Mepron/Carafate UD $150,000.00 Total $1,718,173.82 Total Drug Expense $$50,000,000.00 $100,000,000.00 $150,000,000.00 $200,000,000.00 $250,000,000.00 2019 2020 2021 2022 2023 Total Drug Expense Infusion Center Pharmacy Drug Cost Inpatient and Other Outpatient Pharmacy Drug Cost Medication Cost Savings Initiatives Pharmaceutical Expense

FINANCE

Technology & Quality Control (TQC) Operations

Chas

KUDOS TO OUR TQC TEAM!

System/HMH Shortage Mitigation

• Erythromycin Eye Ointment

• Emergency Syringes – Dextrose 50%

• Oxytocin Tera Rubio

Strategic Growth and Support Outcomes Unit Dosing Program

• Increased unit dosing support for oral solids and oral liquids while maximizing cost savings

• Expanded use of innovative high-speed blister packaging (Pentapack HP 550) to produce over 150,000 units in 2023

• Expanded to liquids and HD solids for anticipatory volume needs

Sterile (Complex)

• Cardioplegia Strategic Insourcing

Sterile (Repackaging)

• 2023 Sugammadex RTA Syringe Implementation Service Expansion

• Systemwide support for key products

o Vitamin K suspension, Liquid PPI, OR Syringes (Norepinephrine, Nitroglycerin), Buffered Lidocaine, LET topical, Lactulose Enema

• HMPO Allergy Clinic Desensitization and Challenge Support

o Increased volume of patient encounters

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Norma Abassi Brandy Robinson Dina Curtin
Sheila Miller
Rubi Montoya
Anna Ngo
Gray

INNOVATION

Pharmacy Technology & Research Advancements Through Technology

Maximum Security and Safety

The clinical validation of APOTECAchemo was made through rigorous protocols including the monitoring and measuring of:

• Minimizing operator exposure

• Dosing precision

• Correct identification of drugs

• Execution times and productivity

• Integrity of HEPA filtration

• Validation of performance, reliability of technical devices and the computer system governing the flow of data

The Apoteca Chemo robot prepares hazardous drugs/chemotherapies while keeping our staff safe by preventing exposure.

The robot also creates an innovative opportunity to increase capacity as our team continues to support the growing Houston Methodist Neal Cancer Center.

The first dose was dispensed to a patient in early 2024!

• Minimizing the contamination of the preparation area, materials used, and the final preparations

• Using barcodes to identify all the intermediate and final products used

• Automated waste management

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OPC satellite pharmacy operations team members

INNOVATION

Pharmacy Technology & Research

Innovation Through Investigational Drug Services

$28.8M Product Development Funds

530 Clinical Trails Conducted

$264.1M Research and Education Expenditures

150 Current Open Studies Managed by IDS Pharmacy

2,852 Investigation Prescriptions Dispensed in 2023

Innovation Through Research

Each year, the Department of Pharmacy conducts over 20 research projects with our pharmacy residents to evaluate opportunities to improve in the care of our patients. Information about each of these projects can be found in the Department of Pharmacy Annual Research Reports. Additionally, over 20 continuous quality improvement (CQI) projects are conducted by our residents each year.

External visibility during 2023 produced an amazing demonstration in outreach from our department:

• Celebrated 28 publications from the pharmacy department

• Represented 21 poster presentations at national meetings

• Delivered 23 platform presentations at national and local organizations

• Elected to 8 committee or board positions

• Served as judges in 2 competitions

• Taught 9 lectures at various colleges of pharmacy

• Provided expertise in 5 manuscript reviews

• Represented 125 out of 153 relative visibility units produced for the HM System

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Pharmacy Technology & Research

Virtual Pharmacy Services

Virtual pharmacy services, including centralized pharmacy order verification (CPOV), presents the next phase for pharmacy to utilize technology to deliver unparalleled safety, quality, and service for our patients.

2023 was the first full year for all Houston Methodist entities to be included in CPOV services, involving a team of remote pharmacists processing a portion of inpatient orders 24/7. Centralizing order verification workload, with greater efficiency, allows for on-site pharmacy personnel at each individual entity to dedicate more time to direct patient care and essential operational tasks.

As a result of the CPOV team capturing ~25% of inpatient orders for HMH, a new clinical triage/charge pharmacist role was developed to focus on addressing clinical surveillance alerts and submitting electronic prior authorization requests for patients. In 2024, the CPOV team will expand to process a majority of inpatient orders (~90%) for Houston Methodist.

In the future, the program will expand in offering additional virtual pharmacy services!

INNOVATION
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23% 24% 25% 26% 24% 25% 23% 22% 24% 23% 24% 23% 77% 76% 75% 74% 76% 75% 77% 78% 76% 77% 76% 77% 0% 20% 40% 60% 80% 100% 120% Percent of Orders Verified Month CPOV Order Verficiation Capture - HMH Onsite Team CPOV Team
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HOUSTON METHODIST
houstonmethodist.org/pharmacy
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