The high-value pharmacy enterprise framework: Advancing

SPECIAL FEATURE

Address correspondence to Mr.

Vermeulen (Lee.Vermeulen@uky.edu).

For permissions, please e-mail: journals.

[email protected].

DOI 10.1093/ajhp/zxaa431

SteveRough, BSPharm, MS, FASHP,

Visante, Madison, WI

RitaShane, PharmD, FASHP, FCSHP, Cedars-

Sinai Medical Center, Los Angeles, CA, and

UCSF School of Pharmacy, San Francisco, CA

JohnA.Armitstead, BSPharm, MS, FASHP,

Lee Health, Fort Myers, FL

SylviaM.Belford, PharmD, MS, CPHIMS,

FASHP, Mayo Clinic, Rochester, MN

PhilipW.Brummond, PharmD, MS, FASHP,

Froedtert and the Medical College of Wisconsin,

Milwaukee, WI

DavidChen, BSPharm, MBA, American

Society of Health-System Pharmacists,

Bethesda, MD

ChristineM.Collins, BSPharm, MBA,

Lifespan, Providence, RI

HeatherDalton, PharmD, Wake Forest

Baptist Health, Winston-Salem, NC

AnnaLegreidDopp, PharmD, American

Society of Health-System Pharmacists,

Bethesda, MD

MichelleM.Estevez, PharmD, DPLA,

BCPS, Lee Health, Fort Myers, FL

DavidR.Hager, PharmD, BCPS, UW Health,

Madison, WI

BrookeHalbach, PharmD, BCPS, UW

Health, Madison, WI

RyanHays, PharmD, BCPS, Cedars-Sinai

Medical Center, Los Angeles, CA

ScottKnoer, PharmD, MS, FASHP, American

Pharmacists Association, Washington, DC

DesiKotis, PharmD, FASHP, University of

California San Francisco, San Francisco, CA,

and UCSF Health, San Francisco, CA

DerekMontgomery, PharmD, MS, Winston-

Salem, NC

BrooksPlummer, PharmD, Ochsner Health,

New Orleans, LA

MelissaR.Riester, PharmD, Brown University

School of Public Health, Providence, RI

DianaJ.Schreier, PharmD, MBA, BCPS,

Mayo Clinic, Rochester, MN

DeborahSimonson, PharmD, Ochsner

Health, New Orleans, LA

MarkH.Siska, BSPharm, MBA, FASHP,

Mayo Clinic, Rochester, MN

KelseyWaier, PharmD, University of

California San Francisco, San Francisco, CA,

and UCSF Health, San Francisco, CA

LeeC.Vermeulen, BSPharm, MS, FCCP,

FFIP, University of Kentucky, Lexington, KY,

and UK HealthCare, Lexington, KY

Purpose. The high-value pharmacy enterprise (HVPE) framework and

constituent best practice consensus statements are presented, and the

methods used to develop the framework’s 8 domains are described.

Summary. A panel of pharmacy leaders used an evidence- and expert

opinion–based approach to dene core and aspirational elements of

practice that should be established within contemporary health-system

pharmacy enterprises by calendar year 2025. Eight domains of an HVPE

were identied: Patient Care Services; Business Services; Ambulatory and

Specialty Pharmacy Services; Inpatient Operations; Safety and Quality;

Pharmacy Workforce; Information Technology, Data, and Information Man-

agement; and Leadership. Phase 1 of the project consisted of the develop-

ment of draft practice statements, performance elements, and supporting

evidence for each domain by panelists, followed by a phase 2 in-person

meeting for review and development of consensus for statements and per-

formance elements in each domain. During phase 3, the project cochairs

and panelists nalized the domain drafts and incorporated them into a full

technical report and this summary report.

Conclusion. The HVPE framework is a strategic roadmap to advance

pharmacy practice by ensuring safe, effective, and patient-centered medi-

cation management and business practices throughout the health-system

pharmacy enterprise. Grounded in evidence and expert recommenda-

tions, the statements and associated performance elements can be used

to identify strategic priorities to improve patient outcomes and add value

within health systems.

Keywords: best practices, consensus, high-value pharmacy enterprise,

leadership, pharmacists, pharmacy practice advancement

Am J Health-Syst Pharm. 2021; XX:0-0

ver the past 2 decades, important

initiatives galvanized advances in

the practice of pharmacy in the United

States as well as internationally. Within

ASHP, these initiatives were the 2010

Pharmacy Practice Model Summit

and 2014 Ambulatory Care Summit,

consolidated in 2015 as the Practice

Advancement Initiative and updated

recently as the Practice Advancement

Initiative (PAI) 2030 with recommenda

tions to reach by the year 2030.

1-3

Other

practice advancement initiatives during

this period included the 2007 High-

Performance Pharmacy initiative and

Global Conference on the Future of

Hospital Pharmacy.

4,5

Considering the

rapidly evolving healthcare landscape

and focus on value-based care, leaders

in health-system pharmacy identied

the need to supplement these initiatives

with a strategic and tactical framework

for advancing practice throughout the

pharmacy enterprise.

us was born

the High-Value Pharmacy Enterprise

(HVPE) project. e goal of the project

was to develop a strategic, evidence-

based tactical roadmap, grounded in re

commendations supported by literature

and expert consensus, for preserving

The high-value pharmacy enterprise framework:

Advancing pharmacy practice in health systems through

a consensus-based, strategic approach

applyparastyle “g//caption/p[1]” parastyle “FigCapt”

Supplementary material is

available with the full text of this

article at AJHP online.

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SPECIAL FEATURE

FRAMEWORK FOR ADVANCING PHARMACY PRACTICE

core elements of pharmacy practice

and advancing the pharmacy profession

to provide safe, eective, and patient-

centered medication management—

dening the nature of an HVPE. e

resultant HVPE framework is presented

in this article.

Intended for use in synergy with the

broad aspirational goals and recom-

mendations for pharmacy practice

detailed in PAI 2030 recommenda-

tions, the HVPE framework provides

a detailed roadmap for advancing the

profession by identifying 8 domains

of both fundamental and aspirational

elements of practice that should be

established within the contemporary

health-system pharmacy enterprise

by calendar year 2025—a time horizon

intended to motivate deliberate and

intentional action while recognizing

the impact of ongoing changes to the

healthcare environment. e HVPE

framework is intended to be achiev-

able and to inspire development of

the highest level of professional phar-

macy practice to meet the evolving

needs of patients and healthcare

organizations.

is report describes the HVPE

framework, an overview of the 8 do-

mains, and the methods used in their

development.

Developing the framework

An evidence- and expert opinion–

based approach was used to de-

velop the HVPE framework. This

well-established method is used by

the National Academies of Sciences,

Engineering, and Medicine (the

latter formerly known as the Institute

of Medicine) to address critical na-

tional health topics, such as pre-

venting medication errors, the

future of nursing, and the opioid

epidemic and pain management.

The HVPE project is an initiative of

the Vizient University Health System

Consortium Pharmacy Network

along with ASHP as a collaborating

partner.

e process for developing the

HVPE statements and performance

elements consisted of 3phases:

• Phase 1: development of draft state-

ments, performance elements, and

supporting evidence for each domain

by panelists

• Phase 2: an in-person meeting for re-

view and development of consensus

for statements and performance elem-

ents in each domain

• Phase 3: nalizing the domain drafts

and incorporating them into a technical

report titled “High-Value Pharmacy

Enterprise Project: Literature Review,

Consensus Statements, and Perfor-

mance Elements”

Phase 1 began in March 2019. e pro-

ject cochairs (SR and RS) identied 8

domains as critical for an HVPE based

on their years of experience in health-

system pharmacy and extensive ex-

pertise in health-system pharmacy

leadership. ey recruited a diverse

panel of strategic contemporary phar-

macy leaders (all are included as au-

thors of this paper) to serve as domain

authors. Panelists were encouraged to

engage a pharmacy resident to sup-

port their work (all residents who were

involved in this work are also included

as authors of this paper). An experi-

enced and respected facilitator (LV)

was selected to support the process and

facilitate the in-person meeting.

Each panelist was responsible for

performing a thorough review of the

literature and supporting professional

guidance documents pertaining to the

assigned domain, focusing on litera-

ture within the past 10years. e pro-

ject facilitator provided standardized

guidance on the literature search and

review process, which was followed by

each panelist. Based on this review and

personal experience, each panelist was

then responsible for writing a paper

containing proposed evidence-based

best practice consensus statements

and performance elements, including a

synthesis of the evidence, for full group

review and debate. For each domain,

the cochairs developed topic areas

and questions to stimulate panelists

in developing their initial literature re-

views, consensus statements, and asso-

ciated performance elements. ey also

provided written feedback on domain

drafts that the panelists subsequently

revised before the in-person meeting.

During phase 1, three virtual meetings

with all panelists were held, and these

served as opportunities to share feed-

back, identify gaps, discuss potential

overlap, and maintain momentum.

e phase 2 in-person meeting for

panelists and residents was held in

Chicago, IL, in August 2019. All partici-

pants received domain drafts for review

in advance, and panelists were assigned

to be lead reviewers for 2 domains they

had not authored. During the 2-day

meeting, the panelists debated all draft

consensus statement recommenda-

tions and through discussion reached

agreement on amended statements

and performance elements within each

domain. Vizient provided travel sup-

port for panelists (except for pharmacy

residents). Two reactor panelists, well

respected for their extensive contribu-

tions to the profession, attended the

meeting and provided feedback in the

closing session.

During phase 3, each domain draft

was revised by the lead author and fur-

ther edited by the project cochairs to

achieve aspirational and consistently

structured content. While eorts were

made to avoid redundancy among

KEYPOINTS

• The high-value pharmacy en-

terprise framework provides a

strategic roadmap to advance

pharmacy practice in health

systems.

• Core and aspirational elem

ents of health-system phar-

macy practice are articulated

in 94 consensus statements

across 8 domains.

• Health systems can assess their

achievement of high perform

ance using over 300 perform-

ance elements developed for

the consensus statements.

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SPECIAL FEATURE

FRAMEWORK FOR ADVANCING PHARMACY PRACTICE

domains, some redundancy was kept if

a concept was described from dierent

perspectives or its importance war-

ranted reinforcement.

HVPE framework

e nal HVPE framework has a

total of 94 statements (Box 1) and 336

performance elements (provided, along

with the 94 statements, in eTable 1)

in 8 domains:

1. Patient Care Services

2. Business Services

3. Ambulatory and Specialty Pharmacy

Services

4. Inpatient Operations

5. Safety and Quality

6. Pharmacy Workforce

7. Information Technology, Data, and

Information Management

8. Leadership

e following sections highlight some

of the most relevant and impactful

statements in each domain. e full

technical report containing all state-

ments, performance elements (PEs),

and the full text of each literature re-

view providing supporting evidence, is

available online.

Domain 1: Patient Care Services.

Domain 1 highlights essential aspects of

pharmacy patient care services that are

considered standard expectations of an

HVPE. One essential aspect is that phar-

macists serve as providers of compre-

hensive pharmacy patient care services

on the interprofessional care team in all

settings of care (statement 1.1a). For in-

stance, the pharmacy department is ac-

countable for drug therapy services and

outcomes independent of time, day,

holiday, or individual providing care

(PE 1.1a.b), and pharmacists prioritize

which patients receive their care, with

services not limited to a consult model

(PE 1.1a.d). In the HVPE, pharmacy is

accountable for comprehensive medica-

tion management across the continuum

of care to optimize drug therapy and pa-

tient safety (statement 1.2a), as well as

for clinical and nancial stewardship of

high-cost and high-risk medications to

ensure their appropriate use in all patient

care settings, thereby preventing the

consequences of overuse and underuse

(statement 1.3a). Aproposed list of com-

prehensive inpatient and transitional

care pharmacy services provided in a

contemporary pharmacy enterprise is

oered (eAppendix A).

e benets of including a pharma-

cist on a service can be applied to

a broad range of clinical specialties

requir ing complex medication manage-

ment. For example, including pharma-

cists on interprofessional rounding

teams in intensive care units is associ-

ated with avoidance of over 50 deaths

per hospital annually.

Similarly, a

pharmacy-managed vancomycin dos-

ing service was shown to more than

double the percentage of patients re-

ceiving optimal vancomycin therapy

(from 40% before implementation to

97% after implementation), with cor-

responding decreases in average length

of stay (8.4 days vs 10.0 days) and in-

cidence of nephrotoxicity (3.2% vs

8.7%).

ese and other evidence-based

pharmacist patient care services and

interventions associated with im-

proved patient care, safety, and/or -

nancial outcomes are highlighted in

the HVPE framework list of proposed

pharmacy-sensitive indicators (PSIs)

in eAppendix B.

While multicenter

studies are needed to validate these

and other proposed PSIs, they serve

as a starting point for the pharmacy to

establish a consistent, ongoing process

and key performance indicators for

comprehensive assessment and docu-

mentation of the impact of pharmacy

patient care services on quality, safety,

nancial outcomes, and other organiza-

tional goals (statement 1.4a, PE 1.4a.a,

PE 1.4a.c).

Domain 1 includes other statements

related to pharmacy services, continuity

of healthcare, and stewardship of re-

sources and programs, primarily as they

relate to inpatient services. Ambulatory

pharmacy patient care services are ad-

dressed in domain3.

Domain 2: Business Services.

Domain 2 highlights the pharmacy

enterprise’s critical role in develop ing

innovative business solutions for

delivering patient care and creating

value for the health system, including

essential business services to im-

prove medication revenue cycle per-

formance, capture pharmacy-related

business, and establish expertise in

payer-contracting processes. Asystem-

wide formulary management system

(statement 2.1a) forms the base of

medication cost management, with

management of medication contract-

ing, procurement, and distribution

by the pharmacy for all sites of care

(statement2.1e).

In an HVPE, pharmacy is account-

able for ensuring eective and e-

cient patient access to medications,

including benets review, prior author-

ization, and prescription rell services,

to support patients and providers and

to optimize revenue (statement 2.2a).

e number and complexity of medica-

tion prior authorizations that providers

and patients must manage have steadily

increased over time and will likely con-

tinue to increase. Multiple studies have

demonstrated the value of centralizing

prescription management services. For

example, a centralized, pharmacy-led

prior authorization process was found

to result in a higher prior authorization

approval rate, faster times to prescrip-

tion lling, shorter order processing

times, and reduced sta time relative

to a clinic-led process.

Centralizing

the medication rell process through

collaborative practice agreements can

save provider time, which can then be

reallocated to seeing more clinic pa-

tients.

e medication revenue cycle

is unique and highly complex. In an

HVPE, pharmacy is accountable for

ensuring optimal medication revenue

integrity, limiting medication-related

nancial liability, and ensuring appro-

priate site-of-care selection for high-

cost medications (statement 2.3a).

Steps that the health-system pharmacy

enterprise can take to improve billing

processes include implementing a col-

laborative pharmacy revenue integrity

team (PE 2.3a.a), using revenue cycle

monitoring tools (PE 2.3a.b), and re-

viewing trends in denials and billing

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FRAMEWORK FOR ADVANCING PHARMACY PRACTICE

Box 1.

Consensus Statements in Domains of the High-Value Pharmacy Enterprise

Framework

Domain 1—Patient Care Services

Topic 1: Pharmacy services

1.1a. Pharmacists provide comprehensive pharmacy patient care services as providers on the interprofessional

care team in all settings of care.

1.1b. Pharmacists are accountable for all patient medication-use needs to support safe and effective drug therapy

management.

1.1c. Pharmacists ensure appropriate use of pharmacogenomic information and biomarkers to optimize drug therapy

selection, prevent adverse events, and reduce the total cost of care.

Topic 2: Continuity of healthcare

1.2a. Pharmacy is accountable for comprehensive medication management across the continuum of care to opti-

mize drug therapy and patient safety.

1.2b. Pharmacists are responsible for ensuring that patients understand and are procient in using their high-risk

medications.

1.2c. Pharmacy staff coordinates transitional and post-discharge drug therapy management for patients at high risk of

readmission.

Topic 3: Stewardship of resources and programs

1.3a. Pharmacy is accountable for clinical and nancial stewardship of high-cost and high-risk medications to en-

sure their appropriate use in all patient care settings, including inpatient, outpatient, and procedure settings,

preventing the consequences of overuse and underuse.

1.3b. Pharmacists serve on organization-wide patient care committees to promote patient-centered, value-based care.

Topic 4: Clinical data analytics

1.4a. Pharmacy establishes a consistent, ongoing process and key performance indicators for comprehensive assess-

ment and documentation of the impact of pharmacy patient care services on quality, safety, nancial outcomes

and other organizational goals.

Domain 2—Business Services

Topic 1: Medication cost management

2.1a. A system-wide formulary management system is implemented.

2.1b. Strategies for cost-effective, coordinated medication management are implemented that take into consider

ation patient care, patient satisfaction, and evolving payer requirements.

2.1c. Systems are established to reduce medication waste in all phases of the medication-use process.

2.1d. Medication inventory management systems are documented and implemented across the health system.

2.1e. Medication contracting, procurement, and distribution is managed by the pharmacy for all sites of care.

2.1f. For qualifying 340B-covered entities, the 340B program is effectively managed to assure compliance, with sav

ings optimized across the health system.

Topic 2: Medicationaccess

2.2a. Pharmacy is accountable for ensuring effective and efcient patient access to medications, including bene-

ts review, prior authorization, and prescription rell services, to support patients and providers and to opti-

mize revenue.

2.2b. Pharmacy is accountable for ensuring effective and efcient patient access to medications, including provision of

comprehensive medication assistance program services to assist uninsured and underinsured patients in access

ing free medications.

Topic 3: Revenue integrity

2.3a. Pharmacy is accountable for ensuring optimal medication revenue integrity, limiting medication-related nancial

liability, and ensuring appropriate site of care selection for high-cost medications.

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FRAMEWORK FOR ADVANCING PHARMACY PRACTICE

Topic 4: Businessgrowth

2.4a. Pharmacy identies, evaluates, and implements new business ventures.

Domain 3—Ambulatory and Specialty Pharmacy Services

Topic 1: Pharmacy services that beneﬁt population health and improve access tocare

3.1a. Pharmacists collaborate with care providers across the health-system continuum to optimize patient health

and well-being.

3.1b. Pharmacists have an active role in managing pharmacotherapy in all care settings and share responsibility

and accountability for medication-related outcomes.

3.1c. Pharmacists provide comprehensive medication management services for patients with complex medical

regimens and patients on high-risk therapies across the continuum.

3.1d. Pharmacists are actively involved in de-prescribing efforts for patients with polypharmacy or taking inappropriate

high-risk medications.

Topic 2: Retail pharmacy services

3.2a. Retail pharmacy services are established to ensure patient access to medications and improve medication regi-

men adherence and affordability.

Topic 3: Specialty pharmacy and infusion care services

3.3a. Health system offers a comprehensive dual-accredited specialty pharmacy program to support optimal pa-

tient care and strong organizational nancial performance.

3.3b. Pharmacy participates in comprehensive medication management services for patients receiving infusions and

other high-cost, clinic-administered medications throughout the health system and afliate locations.

Topic 4: Employer-funded healthplans

3.4a. Pharmacy helps lead and oversee employer-funded health plan medication management practices to ensure

formulary alignment, coordination with pharmacy benet managers (PBMs), plan design, and use of health-

system-owned specialty and retail pharmacies.

3.4b. The health plan uses pharmacists to provide preventive services through employer-sponsored wellness and

disease state management programs.

3.4c. The health plan supports employees with complex diseases and conditions through comprehensive medication

management services.

Domain 4—Inpatient Operations

Topic 1: Medication-use systems and operations pharmacists

4.1a. Inpatient operations employ pharmacists who are specially trained and credentialed in medication-use systems

and operations.

Topic 2: Drug shortage management

4.2a. A system to prevent, manage, and mitigate medication shortages is implemented to reduce patient harm.

Topic 3: Drug diversion prevention

4.3a. Maintain an effective drug diversion prevention plan for controlled substances and high-cost medications.

Topic 4: Safety of medication storage, preparation, distribution, administration and disposal

4.4a. Pharmacy ensures drugs are procured, stored, prepared, dispensed, distributed and disposed in the safest

possible manner.

4.4b. Systems are in place to monitor and evaluate the storage and distribution of medications across the organ

ization to minimize waste, and to ensure they are delivered as close to due time as possible.

4.4c. Barcode scanning is used throughout the medication stocking, preparation, distribution, dispensing, delivery,

and administration processes.

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SPECIAL FEATURE

FRAMEWORK FOR ADVANCING PHARMACY PRACTICE

4.4d. Technologies such as IV workflow management systems, picture taking, gravimetric technology, and

robotics, in conjunction with barcode scanning, are used to support safe, efficient medication sterile

compounding.

4.4e. Contemporary quality improvement principles are leveraged to ensure the ongoing safe, timely, efcient, and

effective provision of pharmacy services.

4.4f. When self-administered medication processes are implemented, robust systems are in place to ensure patient

safety.

Topic 5: Efﬁciency within a multihospital system

4.5a. Multihospital systems evaluate and implement strategies to improve the operational performance, efciency, and

integration of its internal pharmacy programs and services.

Domain 5—Safety andQuality

Topic 1: Cultural and organizational characteristics that deﬁne safety andquality

5.1a. A dedicated pharmacist medication safety ofcer is responsible for maintaining the organization’s medication

safety strategic plan and continuously evaluating its effectiveness.

5.1b. Routine monitoring of national and local evidence-based best practices and gathering inter-organizational

shared experiences related to medication safety and quality are routinely performed to maximize organiza

tional engagement and improve safety.

5.1c. Organization demonstrates a commitment to routine collection and analysis of medication-related adverse

events and “near-misses” using provider reporting, data analytics, and reporting from other organizations to

continuously and proactively improve patient safety and outcomes.

5.1d. Organization cultivates a learning healthcare system as a framework to provide safe and effective care.

Topic 2: Role of pharmacy and therapeutics committees in ensuring evidence-basedcare

5.2a. Leverage the pharmacy and therapeutics (P&T) committee to promote evidence-based formulary manage-

ment, drug use policy, and stewardship.

5.2b. The pharmacy department leads stewardship efforts to optimize safety and quality of medications.

5.2c. Pharmacy departments engage with the P&T committee for accountability over the routine evaluation of the

safety and quality of the organization’s medication-use process.

Topic 3: Accountability and monitoring for patientsafety

5.3a. Align medication safety strategy and priorities with patient safety goals and objectives of the organization.

5.3b. Leverage real-time reporting and alerting tools to monitor and support medication safety.

Topic 4: Accountability for monitoring for quality and value

5.4a. Pharmacy practice leaders engage with hospital and health-system safety and quality executives to identify

continuous quality improvement priorities and opportunities.

5.4b. A robust medication safety and quality dashboard is maintained and routinely shared with key stakeholders and

staff to improve patient care.

Topic 5: Special considerations for patient and healthcare workersafety

5.5a. Implement strategies to support workforce resilience and well-being.

Domain 6—Pharmacy Workforce

Topic 1: Pharmacy education

6.1a. The health system engages in a collaborative relationship with associated schools of pharmacy.

6.1b. Learners at each level of training (e.g., IPPE, intern, APPE, PGY1 Resident and PGY2 Resident) engage in

activities at the highest level of their competence.

6.1c. Interprofessional education occurs at all levels of learner education and training within the health system.

6.1d. Pharmacy residency training programs advance the organization’s patient care model.

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SPECIAL FEATURE

FRAMEWORK FOR ADVANCING PHARMACY PRACTICE

Topic 2: Pharmacist scope of practice, stafﬁng, and practicemodel

6.2a. The pharmacists’ scope of practice is as a provider and is continuously expanding.

6.2b. Performance metrics and productivity measures are developed and maintained to ensure appropriate

stafng models.

6.2c. The health system only hires and retains pharmacists competent for top of license practice.

6.2d. Innovative pharmacy positions are created to meet contemporary healthcare opportunities.

Topic 3: Pharmacy technicians

6.3a. Pharmacy technicians participate in advanced roles in all practice settings to expand the scope of pharma-

cist practice, promote efciency and improve patients’ access to care.

6.3b. Health systems attract new entrants into pharmacy technician careers and only employ competent technicians

that are certied.

Topic 4: Scholarship

6.4a. Pharmacy-led scholarship is a highly valued output of the department.

6.4b. Pharmacists engage in the design, implementation, and evaluation of quality improvement initiatives.

Topic 5: Professional development

6.5a. Career ladders and other professional advancement programs are used to maximize growth and engagement of

pharmacy personnel.

Domain 7—Information Technology, Data, and Information Management

Topic 1: Fundamental medication management supporting technologies

7.1a. Proven medication management technologies are leveraged to maximize patient safety and clinical practice

effectiveness.

7.1b. Proven medication-system technologies are leveraged to support safe and efcient pharmacy operations.

7.1c. Employ available technologies to engage patients beyond the walls of healthcare facilities to allow them to

be active owners in their care.

7.1d. Deploy real-time point-of-care technologies to assist clinicians in evaluating and managing patient care,

such as clinical decision support, articial intelligence, machine learning, and other algorithms.

7.1e. Prepare and participate in business continuity best practices for data integrity, security, and availability during

technology downtimes.

Topic 2: Pharmacy workforce competency

7.2a. Maintain a medication management informatics team with accountability to pharmacy to support safe and

effective use of medications.

7.2b. Engage in active workforce planning to ensure readiness for adoption of emerging medication-related technolo

gies and ongoing workforce development needs.

Topic 3: Data, information, and analytic platform management

7.3a. Integrate and capitalize on existing big data and predictive analytics tools to measure and improve out-

comes and efciency.

7.3b. Pharmacists should have access to real-time aggregated inpatient and outpatient data to assist with care

management.

7.3c. Dashboards are used to support patient care services, operations, and organizational initiatives.

Domain 8—Leadership

Topic 1: Attributes of the pharmacy leadershipteam

8.1a. A pharmacy leadership team is accountable for all aspects of the pharmacy enterprise.

8.1b. Members of the leadership team exhibit executive presence as an essential characteristic necessary to

succeed in advancing pharmacy practice.

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SPECIAL FEATURE

FRAMEWORK FOR ADVANCING PHARMACY PRACTICE

errors and implementing action plans

for prevention or improvement (PE

2.3a.d).

Integral to domain 2 is business

growth. In the HVPE, pharmacy iden-

ties, evaluates, and implements new

business ventures (statement 2.4a). It

is necessary to have a leadership that

identies, implements, and monitors

entrepreneurial opportunities for the

pharmacy enterprise and develops

the necessary processes and support,

such as organizational business plan-

ning and strategic planning processes

(PE 2.4a.a-c). As US healthcare tran-

sitions from acute care management

to management of patients across the

continuum of care, pharmacy-related

8.1c. Pharmacy leaders demonstrate a high level of emotional intelligence.

8.1d. Pharmacy leaders actively pursue productive and vibrant individual continuing professional development (CPD)

plans.

Topic 2: Organizing for maximum effectiveness

8.2a. The most senior pharmacy leader reports to the highest level of organizational leadership (e.g., chief execu-

tive ofcer, chief operating ofcer).

8.2b. Pharmacy maintains an organizational structure that supports its leaders’ focus on strategy, priorities, tac

tics, and timely and effective decision making.

8.2c. All pharmacists and pharmacy technicians in pharmacy practice roles report to leaders that report into the

pharmacy leadership team.

8.2d. Members of the pharmacy leadership team maintain effective working and personal relationships with leaders

from other areas throughout the organization.

Topic 3: Strategy and innovation

8.3a. The pharmacy leadership team creates and maintains a contemporary strategic plan for pharmacy practice,

aligned with organizational goals and strategic priorities.

8.3b. Pharmacy leaders monitor the healthcare environment for new opportunities, take calculated risks, and encour

age innovation that advances practice.

Topic 4: Leading forresults

8.4a. Pharmacy leaders demonstrate business acumen to ensure the effective use of organizational and pharmacy

resources to optimize patient outcomes.

8.4b. Pharmacy leaders advocate for pharmacy services on an ongoing basis by inuencing and demonstrating

the positive impact of the pharmacy enterprise on achieving organizational goals and strategic priorities,

including patient care outcomes and nancial performance.

8.4c. Pharmacy leaders are actively engaged in contributing to the profession by sharing successful practices with

colleagues.

8.4d. Pharmacy leaders share pharmacy department and team member successes within the department to en-

gage and motivate pharmacy staff.

8.4e. Pharmacy leaders actively participate, serve in leadership roles, and support staff involvement in local, state, and/

or national pharmacy organizations.

Topic 5: Developing futureleaders

8.5a. Pharmacy leaders inspire the development and success of future pharmacy leaders by teaching, modeling,

coaching, facilitating, and mentoring in college of pharmacy curricula.

8.5b. Pharmacy leaders engage in developing the leadership skills of future pharmacy leaders.

8.5c. Pharmacy team members serve as leaders within the organization via effectively contributing to interdiscip

linary teams and committees.

8.5d. Leaders maintain a pipeline of future employees by connecting with local colleges of pharmacy to establish

contemporary education and rotational sites for pharmacy students.

8.5e. Pharmacy leaders have a dynamic succession plan that evolves to meet the needs of the organization and phar

macy enterprise.

Abbreviations: 340B, 340B Drug Pricing Program; APPE, advanced pharmacy practice experience; IPPE, introduc-

tory pharmacy practice experience; PGY1, postgraduate year 1; PGY2, postgraduate year 2.

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SPECIAL FEATURE

FRAMEWORK FOR ADVANCING PHARMACY PRACTICE

ambulatory business growth opportun-

ities should be routinely evaluated and

maximized (PE 2.4a.g). See domain 3

for growth opportunities in ambulatory

and specialty pharmacy services and

domain 8 for attributes of successful

leaders.

Domain 3: ambulatory and

specialty pharmacy services. As

the pharmacy enterprise expands its

ambulatory and specialty pharmacy

practice as outlined in domain 3, it is

important to focus on improving ad-

herence, aordability of medications,

and enhancing access to clinical re-

sources to achieve optimal nancial,

quality, and satisfaction outcomes.

Examples of programs and services

documenting the positive impact of

pharmacist collaborative practice

on disease state management in the

ambulatory care setting are oered

(eAppendix C).

In an HVPE, the health system oers

a comprehensive dual-accredited spe-

cialty pharmacy program to support

optimal patient care and strong or-

ganizational nancial performance

(statement 3.3a). Specialty pharmacies

build on the foundation of a strong re-

tail pharmacy infrastructure. Although

sole ownership of a specialty pharmacy

is preferred (PE 3.3a.a), in some cases

it may be advantageous to partner with

other hospitals to ensure adequate pre-

scription volume.

Specialty pharmacy

accreditation is increasingly required

to access certain payer networks or

medications, and dual accreditation

provides a competitive advantage.

Insourcing a specialty pharmacy can

reduce fragmentation of care, particu-

larly through use of pharmacists in

the health system’s specialty clinics,

providing a 24/7 drug therapy man-

agement call center, and leveraging ad-

vanced pharmacy technician roles (PE

3.3a.b-d; roles listed in eAppendix D).

is integrated model may increase

specialty pharmacy prescription vol-

ume, decrease time to medication ap-

proval, and provide nancial aid for

patients who require assistance.

also supports prospective drug-use re-

view, concurrent benets investigation,

patient education, and follow-up for

tolerability and ecacy.

Another topic addressed in domain

3 is employer-funded health plans. In

an HVPE, the pharmacy helps lead

and oversee employer-funded health

plan medication management prac-

tices to ensure formulary alignment,

coordination with pharmacy benet

managers (PBMs), plan design, and

use of health system–owned specialty

and retail pharmacies (statement 3.4a).

To do this, PBM services for direct-to-

employer plans are separately carved

out from the health plan third-party

administrator contract, with pharmacy

leadership participation in PBM selec-

tion and PBM agreement oversight (PE

3.4a.a-b). e carve-out approach has

many advantages, including greater

ability to manage pharmacy benets

costs separately from the rest of the

medical plan. Including strategies to

maximize employee use of employer-

owned retail and specialty pharmacy

services in the health plan design (PE

3.4a.d) can generate dramatic savings

for the health system and help ensure

employee medication appropriateness

and adherence.

Domain 3 also addresses the topics

of retail pharmacy services, infusion

care services, and pharmacy services

that benet population health and im-

prove access to care.

Domain 4: Inpatient Operations.

Domain 4 addresses the scope of in-

patient pharmacy operations in the

HVPE. Inpatient pharmacy operations

are increasingly complex, regulated,

and automated, requiring a highly

specialized pharmacist and technical

workforce to ensure safe and ecient

delivery of medications for patients

within the health system.

18,19

Inpatient

operations should employ pharmacists

who are specialty trained and creden-

tialed in medication-use systems and

operations (statement 4.1a). Because

many schools of pharmacy do not

prepare pharmacy students for these

roles, nor do most postgraduate year

1 residency training programs, these

pharmacists should have advanced

training in medication-use systems and

operations (PE 4.1a.a). Certication

in sterile compounding and/or other

areas pertaining to pharmacy oper-

ations should be required as certi-

cations become available (PE 4.1a.b).

Maintaining a highly trained and com-

petent pharmacy technician workforce

is also vital to inpatient pharmacy oper-

ations, and the discussion of pharmacy

technicians has been centralized in do-

main 6 (Pharmacy Workforce).

In multihospital systems, central-

izing select aspects of inpatient phar-

macy operations can lead to decreased

operating costs, ecient use of re-

sources, and greater investment in phar-

macy technology to improve patient

care and safety.

Multihospital systems

should evaluate and implement strat-

egies to improve the operational per-

formance, eciency, and integration

of internal pharmacy programs and

services (statement 4.5a). One strategy

is to develop a centralized consolidated

pharmacy services center (CPSC) to

meet the needs of the health system

(PE 4.5a.a). Many factors go into the

decision to develop a CPSC, including

current inventory, medications fre-

quently acquired and compounded in

large quantities, ability to create a new

space, the need for a backup supply

plan to be implemented in the event

of facility outages and shortages, and

availability of personnel to comply

with compounding standards, good

manufacturing practices, and legal and

regulatory requirements.

Other topics in domain 6 include

innovative roles for pharmacists, schol-

arship, and professional development.

Domain 7: Information Tech-

nology, Data, and Information

Management. Domain 7 focuses on

core technology expectations of the

HVPE, including data management

and technological requirements im-

portant for succeeding in thefuture.

In high-value pharmacies, proven

medication management technolo-

gies are leveraged to maximize patient

safety and clinical practice eective-

ness (statement 7.1a) and to support

safe and ecient pharmacy operations

(statement 7.1b). ese best prac-

tices have been previously described.

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SPECIAL FEATURE

FRAMEWORK FOR ADVANCING PHARMACY PRACTICE

Deployment of standard technology at

an enterprise level across multiple sites

within the same health system further

strengthens benets achieved at a local

level while also maximizing eciencies

and fostering standardization.

Real-

time point-of-care technologies, such

as clinical decision support, articial

intelligence, and machine learning,

are also used to assist clinicians in

evaluating and managing patient care

(statement 7.1d), with attention to

interdisciplinary processes for devel-

opment, oversight, and quality control

(PE 7.1d.a-c).

Central to the success of all

technology-driven performance elem-

ents in a high-value pharmacy is a

medication management informatics

team, with accountability to pharmacy

personnel, to support safe and eective

use of medications (statement 7.2a).

is pharmacist-led team must oversee

medication-use systems in all areas

of the organization, and it is expected

that both pharmacists and pharmacy

technicians are members of the team

and receive benets supporting con-

tinuing professional development (PE

7.2a.a,c). To lead technology-associated

healthcare redesign and support the

initiatives and integration activities

proactively, medication management

informatics leaders must be located at

the highest level of the department in

which they reside, with accountability

to the pharmacy executive (PE 7.2a.e).

Strong relationships within and outside

pharmacy are the key to success for the

informaticsteam.

Adoption of electronic health re-

cords has been instrumental in the gen-

eration and storage of large amounts

of healthcare data, which can be used

for clinical practice, quality improve-

ment, research initiatives, and business

oversight. In the high-value pharmacy,

pharmacists should have access to

real-time aggregated inpatient and out-

patient data to assist with care manage-

ment (statement 7.3b). For instance,

pharmacists should have access to pre-

dictive analytics models to identify and

manage hospitalized patients who are

at high risk for hospital readmissions,

specic diseases, or both (PE 7.3b.b).

Similarly, patient registries are useful

to identify outpatients eligible for inter-

ventions and target high-risk popula-

tions (PE 7.3b.b).

e need to develop a workforce

with the skill set to use emerging tech-

nologies and big data as outlined in do-

main 7 is further addressed in domains

6 and8.

Domain 8: Leadership.Domain

8 highlights essential attributes of the

leadership of the HVPE, building on

leadership skills previously outlined for

a high-performance pharmacy.

Only

through eective pharmacy leadership

will the HVPE vision and consensus

statements in the other 7 domains be

achieved.

In the HVPE, a pharmacy leader-

ship team is accountable for all aspects

of the pharmacy enterprise (statement

8.1a), including organization-wide re-

sponsibility for all aspects of medica-

tion management performance and

for motivating all pharmacy sta to

improve patient outcomes through

medication management (PE 8.1a.a-b).

A single governing structure respon-

sible for both clinical and business ob-

jectives is essential to ensure optimal

patient care and nancial viability and

to support the broader healthcare de-

livery system.

e most senior pharmacy leader

in the enterprise reports to the highest

level of the organizational leadership,

such as the chief executive ocer or

chief operation ocer (statement

8.2a). In this way, the senior pharmacy

leader is part of the highest governing,

decision-making, and policy-making

bodies of the organization (PE 8.2a.a)

and can promote the pharmacy vision

and strategic plan in alignment with the

health system’s goals for improving out-

comes, quality, and patient satisfaction

and for meeting nancial objectives.

In tandem with creating and main-

taining a contemporary strategic plan

for pharmacy practice (statement

8.3a), pharmacy leaders monitor the

healthcare environment for new op-

portunities, take calculated risks, and

encourage innovation that advances

practice (statement 8.3b), exhibiting

unselsh commitment and refusal to

make excuses.

To ensure the eective use of or-

ganizational and pharmacy resources

to optimize patient outcomes, it is es-

sential that pharmacy leaders dem-

onstrate business acumen (statement

8.4a). Leaders must be prepared to

monitor, interpret, and act based upon

the pharmacy’s nancial performance

while also being transparent in sharing

the organization’s budget, scal goals,

and nancial forecasts with sta.

Using clinical quality outcome meas-

ures (as described in other domains}

in addition to nancial performance,

pharmacy leaders routinely advocate

for pharmacy services by inuencing

and demonstrating the positive im-

pact of the pharmacy enterprise on

achieving organizational goals and

strategic priorities (statement 8.4b).

Pharmacy leaders facilitate this advo-

cacy by serving on multidisciplinary

committees and sharing pharmacy’s

impact with senior health-system ex-

ecutives (PE 8.4b.a-b).

Domain 8 includes other aspects

of the pharmacy leadership team, or-

ganizing for maximum eectiveness,

leading for results, and developing fu-

ture leaders.

Discussion

is article captures the essence

of the HVPE framework as detailed in

the list of almost 100 consensus state-

ments (Box 1), and the descriptions of

each domain provide a glimpse of how

the statements are integrated with per-

formance elements and evidence in

the full HVPE technical report.

In the

technical report, statements for each

domain are grouped by topic area,

and each statement has at least one

PE that can be used to operationalize

it (ie, identies specic elements that a

pharmacy enterprise needs to have or

do to satisfy that statement). Text fol-

lowing each topic puts the statements

and PEs into context, with support

from the literature or expert consensus

insights provided, as well as the avail-

able evidence showing their value to

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SPECIAL FEATURE

FRAMEWORK FOR ADVANCING PHARMACY PRACTICE

patient care and the health system

and a description of what a pharmacy

enterprise must do to meet each con-

sensus statement.

is format makes the content

easily digestible, oering the oppor-

tunity to tackle one domain and one

topic at a time, or several domains

and topics concurrently, within an or-

ganization. e literature review also

provides evidence and other justica-

tion that can serve as a starting point

for new program development and

implementation. e statements with

PEs for each domain topic (eTable 1)

constitute a useful checklist to record

PEs already met and identify prior-

ities for next steps in fullling the

expert-identied statements and PEs

of an HVPE. For example, domain

7 (Information Technology, Data,

and Information Management), has

3 topics with a total of 10 consensus

statements and 36 PEs supported by

concise literature reviews. Used in

synergy with the 11 consensus re-

commendations in the Technology

and Data Science domain of PAI 2030,

this tactical road map for HVPE do-

main 7 will be very useful in advancing

practice throughout the pharmacy

enterprise.

As elements of the HVPE framework

are implemented, not to be forgotten is

the need to collect and analyze quality,

safety, and nancial outcomes data that

demonstrate the value of HVPE services

and then disseminate the results within

the organization and through pub-

lication. is will contribute to the

development of pharmacy-sensitive in-

dicators associated with improved pa-

tient outcomes, such as those included

in eAppendix C, which could ultimately

be used to dene and measure excel-

lence for pharmacy services through

HVPE status, just as the nursing pro-

fession created nursing-sensitive in-

dicators and the Magnet Recognition

Program.

11,36,37

Having an ongoing pro-

cess for assessing and documenting the

pharmacy’s value can also serve as a

catalyst for justifying additional services

within the pharmacy enterprise,

improving recruitment and retention

of talented sta, and strengthening the

health system’sbrand.

While most HVPE framework

statements and performance elem-

ents are supported by literature,

some were derived primarily through

panelist consensus based on pro-

fessional experience. Achieving con-

sensus required respectful debate and

compromise, and the collective con-

tributions of all panelists resulted in a

signicant step in the journey toward

dening an HVPE. e involvement

of administrative residents not only

assisted panelists in developing their

domains but also enabled aspiring

pharmacy leaders to be witness to the

birth of the HVPE framework. As we

move through the 2020s, especially

with the uncertainties and challenges

posed by the coronavirus disease 2019

pandemic, pharma cists, pharmacy

leaders, and health systems can look

to the HVPE framework as a roadmap

for developing high-value pharmacy

services throughout the enterprise.

Conclusion

e HVPE framework is a strategic

roadmap to advance pharmacy prac-

tice by ensuring safe, eective, and

patient-centered medication manage-

ment throughout the health-system

pharmacy enterprise. Grounded in

evidence and expert recommenda-

tions, the statements and associated

performance elements can be used to

identify strategic priorities to improve

patient outcomes and add value for the

healthsystem.

Acknowledgments

e authors acknowledge Carla J. Brink,

BSPharm, MS, CHCP, who served as tech

nical writer for this project, as well as Bill

Churchill, BSPharm, MS, and David Zilz,

BSPharm, MS, who served as reactor panelists

during the consensus meeting. e support of

Vizient, and in particular the contributions of

Karl Matuszewski, PharmD, MS, and Lynda

Stencel, is also acknowledged.

Disclosures

Vizient provided nancial support for this

project (travel and meeting costs, support

for technical writer), but none of the authors

received nancial compensation for their

contributions. e authors have declared no

potential conicts of interest.

References

1. Proceedings of the ASHP pharmacy

practice model summit. Am J Health-

Syst Pharm. 2011;68:1079-1160.

doi:10.2146/ajhp110060

2. Proceedings of the ASHP ambulatory-

care summit. Am J Health-Syst Pharm.

2014;71:1345-1394. doi:10.2146/

ajhp140299

3. ASHP Practice Advancement Initiative

2030: new recommendations for

advancing pharmacy practice in health

systems. Am J Health-Syst Pharm.

2020;77:113-121. doi:10.1093/ajhp/

zxz271

4. VermeulenLC, RoughSS, ielkeTS,

etal. Strategic approach for improving

the medication-use process in health

systems: the high-performance phar-

macy practice framework. Am J Health-

Syst Pharm. 2007;64(16):1699-1710.

doi:10.2146/ajhp060558

5. VermeulenLC, MolesRJ, CollinsJC,

etal. Revision of the International

Pharmaceutical Federation’s Basel

statements on the future of hospital

pharmacy: from Basel to Bangkok. Am

J Health-Syst Pharm. 2016;73(14):1077-

1086. doi:10.2146/ajhp150641

6. ShaneR, RoughS, ChenD. It’s time for

a “beyond-use date” for designating

health-system pharmacy as a center of

excellence. Am J Health-Syst Pharm.

2021;78(6):xxx-xxx.

7. National Academies of Sciences,

Engineering, and Medicine. Our study

process. Accessed July 23, 2020. https://

www.nationalacademies.org/about/

our-study-process

8. High-Value Pharmacy Enterprise

Project: Literature Review, Consensus

Statements, and Performance

Elements. Vizient, Inc.; 2020, Accessed

January 20, 2021. https://www.

vizientinc.com/-/media/documents/

sitecorepublishingdocuments/public/

Pharmacy_HVPE_Report_2020_Public.

pdf

9. PreslaskiCR, LatI, MacLarenR,

PostonJ. Pharmacist contributions as

members of the multidisciplinary ICU

team. Chest. 2013;144(5):1687-1695.

doi:10.1378/chest.12-1615

10. MarquisKA, DeGradoJR, LabonvilleS,

KubiakDW, SzumitaPM. Evaluation

of a pharmacist-directed vancomycin

dosing and monitoring pilot program at

a tertiary academic medical center. Ann

Pharmacother. 2015;49(9):1009-1014.

doi:10.1177/1060028015587900

12 AM J HEALTH-SYST PHARM | VOLUME XX | NUMBER XX | XXXX XX, 2021

Downloaded from https://academic.oup.com/ajhp/advance-article/doi/10.1093/ajhp/zxaa431/6128832 by guest on 09 February 2021

SPECIAL FEATURE

FRAMEWORK FOR ADVANCING PHARMACY PRACTICE

11. ShaneRR. Translating health care im-

peratives and evidence into practice:

e “Institute of Pharmacy” report. Am

J Health-Syst Pharm. 2012;69(16):1373-

1383. doi:10.2146/ajhp120292

12. CutlerT, SheY, BarcaJ, etal. Impact

of pharmacy intervention on prior au-

thorization success and eciency at a

university medical center. J Manag Care

Spec Pharm. 2016;22(10):1167-1171.

doi:10.18553/jmcp.2016.22.10.1167

13. RimMH, omasKC, HatchB, KellyM,

TylerLS. Development and imple-

mentation of a centralized compre-

hensive rell authorization program

in an academic health system. Am J

Health-Syst Pharm. 2018;75(3):132-138.

doi:10.2146/ajhp170333

14. HanuscakT. Building a pharmacy rev-

enue integrity team. Pharm Purch Prod.

2017;14(5):20-24.

15. ShayB, LoudenL, KirschenbaumB.

Specialty pharmacy services: preparing

for a new era in health-system phar-

macy. Hosp Pharm. 2015;50(9):834-839.

doi:10.1310/hpj5009-834

16. BagwellA, KelleyT, CarverA, LeeJB,

NewmanB. Advancing patient care

through specialty pharmacy services

in an academic health system. J Manag

Care Spec Pharm. 2017;23(8):815-820.

doi:10.18553/jmcp.2017.23.8.815

17. AguilarKM, HouQ, MillerRM. Impact

of employer-sponsored onsite phar-

macy and condition management

programs on medication adher-

ence. J Manag Care Spec Pharm.

2015;21(8):670-677. doi:10.18553/

jmcp.2015.21.8.670

18. RoughS, ShaneR, PhelpsP, etal. A

solution to an unmet need: pharmacy

specialists in medication use systems

and technology. Am J Health-Syst

Pharm. 2012;69:1687-1693. doi:10.2146/

ajhp110399

19. ShaneR. Need for pharmacist ex-

pertise in medication operations and

systems. Am J Health-Syst Pharm.

2009;66(16):1489-1491. doi:10.2146/

ajhp090061

20. SchenkatD, RoughS, HansenA,

ChenD, KnoerS. Creating organ-

izational value by leveraging the

multihospital pharmacy enter-

prise. Am J Health-Syst Pharm.

2018;75(7):437-449. doi:10.2146/

ajhp170375

21. KvanczDA, BlankenshipC, RocheK.

Practical considerations for a health

system-based 503B sterile com-

pounding program. Pharmacy

Practice News. Published August

31, 2017. Accessed July 23, 2020.

https://www.pharmacypracticenews.

com/Monographs-Whitepapers/

Article/08-17/Practical-Considerations-

for-a-Health-System—Based-503B-

Sterile-Compounding-Program/44438

22. Institute of Medicine Committee on

Quality of Health Care in America.

Creating safety systems in health care

organizations. In: KohnLT, CorriganJM,

DonaldsonMS, eds. To Err Is Human:

Building a Safer Health System. National

Academies Press; 2000. https://www.

ncbi.nlm.nih.gov/books/NBK225188/

23. VaidaAJ, LamisRL, SmetzerJL, etal.

Assessing the state of safe medication

practices using the ISMP Medication

Safety Self Assessment for hospitals:

2000 and 2011. Jt Comm J Qual Patient

Saf. 2014;40(2):51-67. doi:10.1016/

s1553-7250(14)40007-2

24. AndrawisM, EllisonC, RiddleS, etal.

Recommended quality measures for

health-system pharmacy: 2019 update

from the Pharmacy Accountability

Measures Work Group. Am J Health-

Syst Pharm. 2019;76(12):874-888.

doi:10.1093/ajhp/zxz069

25. BatesJS, BuieLW, AmerineLB, etal.

Expanding care through a layered

learning practice model. Am J Health-

Syst Pharm. 2016;73(22):1869-1875.

doi:10.2146/ajhp150593

26. SoricMM, GlowczewskiJE, LermanRM.

Economic and patient satisfaction

outcomes of a layered learning model

in a small community hospital. Am J

Health-Syst Pharm. 2016;73(7):456-462.

doi:10.2146/ajhp150359

27. SowellAJ, PhersonEC, AlmueteVI,

etal. Expansion of inpatient clinical

pharmacy services through reallocation

of pharmacists. Am J Health-Syst Pharm.

2017;74(21):1806-1813. doi:10.2146/

ajhp160231

28. JordanTA, HennenfentJA, LewinJJ,

NesbitTW, WeberR. Elevating phar-

macists’ scope of practice through

a health-system clinical privileging

process. Am J Health-Syst Pharm.

2016;73(18):1395-1405. doi:10.2146/

ajhp150820

29. SiskaMH, TribbleD. Opportunities

and challenges related to technology

in supporting optimal pharmacy prac-

tice models in hospitals and health

systems. Am J Health-Syst Pharm.

2011;68(12):1116-1126. doi:10.2146/

ajhp110059

30. ChalmersJ, SiskaM, LeT, KnoerS.

Pharmacy informatics in multihospital

health systems: opportunities and

challenges. Am J Health-Syst Pharm.

2018;75(7):457-464. doi:10.2146/

ajhp170580

31. VermeulenLC, EddingtonND,

GourdineMA, etal. ASHP Foundation

pharmacy forecast 2019: strategic plan-

ning advice for pharmacy departments

in hospitals and health systems. Am J

Health Syst Pharm. 2019;76(2):71-100.

doi: 10.2146/sp180010

32. MurrayME, BarnerJC, PopeND,

ComfortMD. Impact and feasi-

bility of implementing a systematic

approach for medication therapy

management in the community

pharmacy setting: a pilot study.

J Pharm Pract. 2019;32:664-670.

doi:10.1177/0897190018779847

33. ZilzDA, WoodwardBW, ielkeTS,

ShaneRR, ScottB. Leadership skills

for a high-performance pharmacy

practice. Am J Health-Syst Pharm.

2004;61(23):2562-2574. doi:10.1093/

ajhp/61.23.2562

34. KnoerS. Stewardship of the pharmacy

enterprise. Am J Health-Syst Pharm.

2014;71(14):1204-1209. doi:10.2146/

ajhp140170

35. RoughS. Unselsh commitment. Am J

Health-Syst Pharm. 2017;74(19):1558-

1569. doi:10.2146/ajhp170354

36. GallagherR, RowellP. Claiming

the future of nursing through

nursing-sensitive quality indicators.

Nurs Adm Q. 2003;27(4):273-284.

doi:10.1097/00006216-200310000-00004

37. American Nurses Credentialing

Center. ANCC Magnet Recognition

Program. Accessed July 23, 2020.

https://www.nursingworld.org/

organizational-programs/magnet/

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