Implementation of Clinical Pharmacists in a Cardiac Ambulatory Care Setting to Decrease Nursing Workload

Patients with comorbid conditions such as coronary artery disease, hypertension, hyperlipidemia, and heart failure require the expertise of cardiologists and advanced practice providers to provide complex personalized care. The complexity of these conditions demands medical oversight by the provider and care coordination by the registered nurse in the ambulatory care setting.
Purpose: To evaluate the impact of the implementation of clinical pharmacists in the ambulatory care setting of a large academic heart and vascular institute on the nursing workload associated with medications.
Description: The ambulatory care nurses were surveyed to understand the workload associated with medications. The nurses reported spending 10-20 hours per week with patients on medication counseling, addressed an average of 50 messages per week related to medication questions from patients, and completed approximately ten medication prior authorizations per week with payors. The nurses reported inadequate resources to meet the demand of the insurance authorizations and reported having no supportive resources available from pharmacy staff. Therefore, two clinical pharmacists were added to the ambulatory care clinical staff to assist nurses and providers with the high demand for medication-related work. After nine months of implementation in general cardiology and heart failure clinical specialties, the nurses and providers were surveyed post-implementation.
Evaluation/outcome: Post-implementation of clinical pharmacists in the ambulatory care setting, the nurses stated that they had gained time in their day for other clinical work due to a decrease in medication insurance authorizations, a reduction in message basket volume, and an increase in pharmacist-assisted medication counseling. Additionally, the providers reported that medication adherence, affordability, and patient access to medications had greatly improved.