Agent of change: Promoting medication safety from coast to coast

Premier's Bruce Gordon links pharmacist ROI with med safety

Bruce M. Gordon, PharmD, enjoys a challenge. He’s a marathon runner and a clinical pharmacist with a passion for promoting medication safety. As a Principal Consultant for the Charlotte, NC–based Premier health care alliance, Gordon capitalizes on his pharmacy expertise and deep understanding of health care to help hospitals and health systems minimize pharmaceutical expenses and maximize clinical outcomes. He is also a recognized leader in advancing medication safety. “I like the excitement of health care and enjoy trying to keep pace with its changes,” said Gordon.

Evaluating best strategies

Premier is a collaborative health care alliance of more than 2,715 member hospitals and health systems and more than 90,000 other health care sites. The focus of the alliance is to improve the health of communities.

Based in Maryland, Gordon serves as the interface between the pharmacy team at Premier and member hospitals and health systems. “I spend most of my time working directly with pharmacists and other pharmacy staff to investigate and evaluate best strategies to reduce cost and improve safety,” said Gordon, who has served as a consultant for 15 years. “As clinical pharmacists, consulting is what we do every day, all day. Although this is a different type of clinical practice, the questions are often the same.”

As a consultant, Gordon is charged with evaluating health systems as a whole. Although Gordon might be asked to look at or reduce drug costs, “we certainly want to be cognizant of whether reducing a drug cost may negatively affect patient outcomes or cause costs to go up in another area,” Gordon said in an interview with Pharmacy Today.

Data assessment

Historically, it has been difficult to make a solid link between the cost of a drug, the amount of time a pharmacist puts into a clinical initiative, and quality outcomes. It wasn’t easy “to generate a solid return on investment for [the pharmacist’s] effort,” said Gordon.

Pharmacists were limited to using comparative purchase data to identify potential cost-saving opportunities, but getting a clear picture could be difficult. When looking at purchase data that appeared high, one couldn’t tell if this was because of high patient volume, a particular patient population, or a variation in practice patterns. “We now have the ability to mine data from multiple data sources and this enables us to determine whether the increased spending is due to a variance in utilization or a special patient population,” said Gordon.

Data from Premier’s QualityAdvisor may be used to analyze and compare drug consumption and patient outcomes. SafetyAdvisor allows Gordon to look at the specific drug utilization and practices and the corresponding laboratory data. By combining this data, “we are able to look at quality outcomes so we can determine whether the drug usage has produced the desired outcomes in terms of length of stay, readmission, complications, and costs,” Gordon explained.

Being able to link together data systems will be a “huge strength” moving forward, noted Gordon. Now when a pharmacist is included in discharge planning and transition of care issues to reduce readmission rates, “though the reduction in drug costs will be minimal, pharmacists will be able to measure their impact using clinical outcomes and hospital reimbursement,” he said. This allows pharmacists to create a new and different way to “analyze and present data that tells a compelling story in a single picture,” he added.

Partnership for Patients

In addition to more sophisticated data mining and analysis, Gordon helps advance clinical outcomes in patient safety through the Partnership for Patients initiative, a public–private partnership with the goal of improving the quality, safety, and affordability of health care.

With more than 450 hospitals participating, Premier is the largest national Hospital Engagement Network approved by CMS to participate in the initiative. “Being involved with the Partnership for Patients initiative gives us a tremendous amount of impact and visibility in improving health care for our communities,” said Gordon. “As opportunity allows, I provide subject matter expertise on avoiding preventable harm relating to drug therapy.”

As a consultant, Gordon offers different levels of engagement for Premier’s members. Sometimes a hospital asks him to dig deep and find every last penny, every clinical opportunity, and every possible way to improve quality or safety. Other times Gordon will receive emails or phone calls from pharmacists asking for simple, straightforward answers to specific questions.

“One of the great values of the work that I do is that I go to many different hospitals,” said Gordon. This experience allows him to see what is happening in hospitals across the country to provide pharmacists with answers to their questions.

Safety and leadership

Gordon’s interest in safety began nearly 2 decades ago. He taught medication safety and then launched a medication safety program at the University of Maryland School of Pharmacy. This program has developed and expanded, and is now a regular elective course called Medication Safety in Health Care.

“The pharmacy curriculum today has more safety built into it than at any point in history,” Gordon told Today. He has worked with other schools of pharmacy and with state boards of pharmacy to promote patient safety initiatives. He also travels throughout the United States to speak about the importance of safety awareness. More recently, many of his presentations have been about the impact of drug shortages on patient safety and how to make hospitals more resilient to potential risks.

Gordon has been recognized for his leadership and contributions to the pharmacy profession. In 2009, he was the recipient of the W. Arthur Purdum Award from the Maryland Society of Health-System Pharmacists (MSHP) for sustained and significant contributions to the profession. In 2002, he was named Pharmacist of the Year by MSHP. He is also a past-president of MSHP.

“What I do in the practice of pharmacy is considerably broader than as it relates to Premier,” Gordon explained. “Pharmacy is so much larger, and working with the American Society of Health-System Pharmacists, MSHP, and other organizations allows me to bring about change in health care at both a macro level and a micro level.”

The whole picture

Gordon has a keen interest in shaping health care from a 30,000-foot view all the way down to a pharmacy at a specific hospital. “I understand the challenges, the benefits, and the things that drive and motivate health-system pharmacists on a day-to-day basis,” said Gordon. “When I speak to a hospital pharmacist or senior leadership, I speak from the heart as well as the mind.”

He pointed out that pharmacists often don’t market themselves well to senior leadership, and this creates a distorted perception of the pharmacist’s role and value. Pharmacists are frequently valued based upon how much we save in drug costs, noted Gordon. “Among pharmacists, we talk about clinical processes that create tremendous value to the organization, such as monitoring drug therapy, rounding on patient care units, and avoiding adverse events, but often that doesn’t translate well to the health care executive,” he added.

Gordon believes that taking some responsibility for shaping young professionals is a significant part of shaping health care. Gordon has been involved as a preceptor, teaching, and mentoring student pharmacists for his entire professional career. “It is difficult, given the remote nature of my work, but I believe it is important for young professionals to be able to see a broader scope of health care as part of their academic experience,” said Gordon.

Pharmacy transformation

In the past, the boundaries of health system pharmacy were confined to acute care practice. Pharmacy then expanded into ambulatory care practice. Today, the changes in health care and technology provide more opportunities than ever before for pharmacists to take an active role in patient care. For example, pharmacists are getting more involved in the transition from acute care practice to a patient’s home, the physician office, or a clinic. “The profession of pharmacy is ideally modeled to support a more seamless transition in taking care of these patients,” said Gordon.

The biggest items Gordon sees on the to-do list for pharmacists are being able to evolve rapidly to take advantage of the changes in health care and to create an accurate return on investment model.

Even though pharmacists are moving in the right direction, in the future, pharmacists need to be able to create a financial model “so that we can tell health care leadership about the extraordinary value that pharmacists bring to so many areas of patient care,” said Gordon.