Working at Home, Pharmacists Stay on the Job

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OPERATIONS & MANAGEMENT

ISSUE: 1/2010 | VOLUME: 37:01

Working at Home, Pharmacists Stay on the Job

Bruce and Joan Buckley

Las VegasWriters and artists and small-business entrepreneurs can all work productively at home, but for pharmacists its a different story. They need to be close to the center of pharmacy activitythe computers, the medication shelves, the automated dispensing cabinets and the flow of medicine to units throughout the hospital. That may be true for many institutions, but not The Cleveland Clinic. There, the pharmacy department has recruited a cadre of work-at-home pharmacists to verify and process medication orders. In doing so, the pharmacy has been able to free up many of its large staff of in-house pharmacists for more clinical tasks. As a secondary benefit, the work-at-home program has provided a boost to the pharmacys recruitment efforts, according to Samuel V. Calabrese, MBA, RPh, director of inpatient pharmacy services. I think weve been able to recruit more pharmacists because we could offer that clinical role. We were able to hire over 30 pharmacists the first year and about 25 this past year, Mr. Calabrese told Pharmacy Practice News at an ASHP Midyear Clinical Meeting poster presentation describing the work-at-home program (poster 3-006). In 2007, the national pharmacist shortage was posing serious staffing issues for the clinics pharmacy, Mr. Calabrese said. We had pharmacists working extra shifts and mandatory overtime, and we needed to do something, he explained. Thats when we thought about the stay-at-home moms and dads who had family issues but still wanted to keep up their clinical skills and practice. The pharmacy mailed out recruitment postcards to pharmacists who might be available for part-time work at home. On the bottom of the card were three little wordsWork at Home and it took off, Mr. Calabrese said. In a little over two years, the program has expanded to the point where 11 full- and part-time homebased pharmacists now provide around-the-clock verification and order entry services. Recruitment and retention were also part of the motive for another Cleveland Clinic initiativea pharmacist career ladder introduced by the pharmacy department about a year ago (poster 3-008). The idea, according to Morton P. Goldman, PharmD, BCPS, director of pharmacotherapy services, was to offer advancement opportunities and rewards based on the pharmacists varying levels of knowledge, skills and leadership. The career ladder has six rungs, going from Pharmacist 3, the lowest level, up to Pharmacist 1, and then from Clinical Specialist 3 up to 1. New staff pharmacists start at 3, said Dr. Goldman. If they go into a specialized satellite service or a nursing unit program, they can advance to level 2. If they show great skills in teaching and mentoring other pharmacists, they can reach the Pharmacist 1 level. Advancement has other requirements, including a robust portfolio application process and peer review by the Professional Practice of Pharmacy Council. The council, made up of pharmacy leadership, pharmacists and clinical specialists, determines if a candidate has the qualifications to advance if an opening develops. Not all possible advancements have taken place in the past year, but Dr. Goldman said, theoretically a Pharmacist 1 could become a Clinical Specialist 3, if they are able to train residents, if they are working on projects, and if they are performing the functions of a clinical pharmacist, he added. They can actually work their way all the way up to Clinical Specialist 1. Credentials like board certification and specialty residencies are also weighed in the evaluation process. During the initial phase of the program, four of 67 pharmacists reached level 1, while 33 and 30, respectively, were at levels 2 and 3. Of the 19 clinical specialists, 11 were at level 1, six at 2, and none at 3. Each advancement brings an incremental increase in income. At Cleveland Clinic, were a lot about recognition and reward, Dr. Goldman said, and this is really a great retention tool. Over the past year, weve had a pretty significant decline in our turnover.

http://www.pharmacypracticenews.com/printview.asp?article_id=14559&section_id=53&view=print

6/2/2010

Working at Home, Pharmacists Stay on the Job

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In the work-at-home program, telecommuting pharmacists are provided with computers, telephones and any reference material not available online, said Mr. Calabrese. The only thing the pharmacists have to supply is the DSL line. We dont pay for their Internet connection. Pharmacists who work at home are paid 2% less than those at the hospital, Mr. Calabrese said, because they dont have travel costs and other commuting expenses. We make sure productivity is monitored. We feel their productivity should be higher than that of pharmacists on site because they have fewer interruptions and they dont have to check final products. The goal for home-based pharmacists is approximately 45 orders per hour, compared to between 22 and 30 per hour for on-site pharmacists. That has been consistent over the years that the program has been implemented. Once each quarter, work-at-home pharmacists are brought in for an eight-hour education session. We do clinical pearls and any required informatics training, just so they are up to speed and we can see their faces once in a while, he said. Once a month, he added, the pharmacy schedules a conference call to go over any issues that might have arisen. Patient privacy was a concern at the outset. We contacted the State Board of Pharmacy, Mr. Calabrese said, and the board raised certain issues regarding compliance with the Health Insurance Portability and Accountability Act. For example, work-at-home pharmacists cant have a printer hooked up to the computer, and they need to sign on using fingerprint biometrics. If there is no online activity for a short period, the computer automatically shuts down. The pharmacy department also provided the telecommuters with Alltel wireless phones. We disabled their call waiting, phone messaging, e-mail and voice mail, Mr. Calabrese said. We also gave them fake six-digit internal numbers, so if the pharmacists paged physicians, the physicians thought they were calling an in-house number. Were now on CPOE [computerized prescriber order entry], so we dont need that connect system anymore. Mr. Calabrese said on-site pharmacists are happy with the program, because now they are able to do the clinical functions they were taught in school. They dont feel chained to the basement anymore, and that was a big improvement for pharmacy practice at The Cleveland Clinic. A Similar Strategy Domenic A. Caselnova III, BS, MHA, director of pharmacy at Benefis Health System, a 56-bed facility based in Great Falls, Mont., also has instituted an aggressive recruitment and retention program, with a multitiered career advancement plan similar to the one employed at The Cleveland Clinic. Coupled with other strategies, such as flex schedules and employee recognition, Benefis has virtually eliminated staff turnover over the past few years, Mr. Caselnova reported during a poster session at the 2009 ASHP Summer Meeting (July 2009 PPN, page 1). Before the program was initiated, turnover had peaked at 22%.

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http://www.pharmacypracticenews.com/printview.asp?article_id=14559&section_id=53&view=print

6/2/2010