Freeman Health System Pharmacy Uses VigiLanz to Improve Care, Workflows, and Costs
Freeman Health System, a 485-bed, three-hospital system in Joplin, Missouri, serves a population of 450,000 people across Missouri, Arkansas, Kansas, and Oklahoma. Ranked one of the top hospitals in Missouri by U.S. News & World Report, Freeman continually seeks out new and innovative ways to improve patient care.
Within Freeman, the pharmacy department is known for its commitment to exploring new tools that improve efficiency as well as patient safety. Since implementing VigiLanz in 2018, Freeman’s pharmacy team has created over 650 VigiLanz rules that aid in pharmacy department interventions. These rules use dashboards and real-time notifications to alert team members whenever information pulled from the electronic health record (EHR) meets rule criteria.
“This approach has made a significant impact on patient care, pharmacy workflows, and costs,” said Adrienne Carey, PharmD, BCPS, Clinical Pharmacist and Data Mining Program Manager at Freeman Health System. “Because of the improved capabilities within VigiLanz’s rule engine, we’ve been able to identify more opportunities for intervention more quickly than before.”
Here are five examples of how the Freeman team used VigiLanz’s pharmacy workflow solutions to support key initiatives that improved patient care and safety while reducing costs.
Initiative #1: Rule-building to inform discharge counseling
Each year, Freeman Health System residents use VigiLanz to build rules or create data mining searches to identify patient populations and gather data for a 12-month research project. This year, residents used VigiLanz rules to identify cardiology patients who were being discharged with a new medication not listed on their home medication list.
When the rule was triggered, pharmacists received a real-time alert. Pharmacists then educated patients about their new medication(s), documented them in the activation, and followed up with patients to assess the effectiveness of the education and its impact on readmission rates. Since these cardiology patients typically had a short length of stay, the VigiLanz rules were especially helpful in quickly identifying appropriate patients for education.
The patients who received education from pharmacy were 11% more likely to remember their counseling than those who received education through other discharge processes. Patients with the pharmacy education also had a 30-day readmission rate of 5.25% (compared to a rate of 21.25% among those who did not receive the education).
Initiative #2: Validation studies to support antibiotic discontinuation
A negative Methicillin-resistant Staphylococcus aureus (MRSA) nasal screening can help providers determine when to safely discontinue vancomycin, an antibiotic commonly used in patients with MRSA. However, since some providers are reluctant to discontinue the drug based on this test, another Freeman resident used VigiLanz to quantify the probability of disease based on screening results.
The resident created VigiLanz data mining searches to capture MRSA+ screens with positive cultures, MRSA+ screens with negative cultures, MRSA- screens with positive cultures, and MRSA- screens with negative cultures. Results showed a 97.2% correlation that a negative MRSA screen resulted in no MRSA infection. This enhanced providers’ confidence in using the screen to safely discontinue vancomycin, and therefore, reduced the risk of antimicrobial resistance and adverse events.
Initiative #3: Alerts to decolonize patients with positive MRSA screens
Studies indicate that MRSA colonization in the nose could increase the risk of MRSA infection, and that nasal administration of Mupirocin ointment reduces infections in patients with positive MRSA nasal screens. Based on this information, Freeman created a new protocol that authorized pharmacists to order Mupirocin ointment nasally when a patient has a positive MRSA nasal screen.
Freeman then used VigiLanz rules to identify patients with positive MRSA screens and alert pharmacists in real time. Since implementing this rule in January 2022, the facility has ordered Mupirocin decolonization for 162 patients, resulting in $98,000 in estimated cost savings due to less time spent in isolation, lowered risk of infection, and fewer readmissions.
Initiative #4: Tools to monitor drugs and prevent drug shortages
Freeman’s pharmacy team uses VigiLanz to quickly and efficiently search for pharmacy orders (a functionality not included in their health information system). Examples include:
- Central staff and buyers use VigiLanz to identify patients on medications in short supply so that pharmacists can alert providers and help prevent drug shortages.
- Pharmacists use VigiLanz to search for high alert drugs to monitor proactively. Floor pharmacists run a system-wide kinetics search each morning—including vancomycin, heparin, and aminoglycosides—to identify the patients they are expected to manage.
- Night shift pharmacists use pharmacy orders to identify heparin patients that need to be monitored.
Initiative #5: Rules to guide and decrease antibiotic use
A Freeman pharmacy resident used VigiLanz to conduct a research project comparing Freeman providers’ antibiotic orders (including Zithromax, Aztreonam, Cefepime, Ceftriaxone, Ciprofloxacin, Levofloxacin, Meropenem, Zosyn, and vancomycin) for treating pneumonia according to professional guidelines. The study found that, for each type of pneumonia, some antibiotics were prescribed for longer than recommended. As a result, Freeman created order sets to guide providers about the appropriate number of days to prescribe each antibiotic.
Freeman also created a “Pneumonia Pathway Hard Stop” rule in VigiLanz to ensure the hard stop stays with the antibiotic order, regardless of any dosage changes made that could inadvertently remove the initial hard stop.
As a result, floor pharmacists can more easily determine when patients complete their therapies, and Freeman can reduce its usage of antibiotics consistent with professional guidelines.
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