MEDICATION STEWARDSHIP PROGRAMS

To advocate that pharmacists are foundational members of any medication stewardship program; further,

To affirm that pharmacists bring unique clinical, operational, safety, and financial expertise to help organizations develop and manage medication stewardship programs; further,

To promote pharmacist leadership in medication stewardship teams; further,

To encourage healthcare organizations to develop comprehensive medication stewardship programs that align with applicable laws, regulations, and accreditation standards; further,

To support incorporation and development of the pharmacy workforce in medication stewardship efforts; further,

To enhance awareness that medication stewardship includes disease state management across all levels of care and addresses barriers at the patient and system levels in order to improve the quality, safety, and value of patient care.

Rationale

Stewardship is an approach to patient care whose goals are to improve the quality, safety, and value of care. These goals are achieved through evidence-based therapy to achieve optimal patient outcomes, with selection of the correct drug, appropriate dose, and subsequent optimization, and by reducing costs and barriers to the patient, healthcare system, and payers. The most well-known and successful stewardship programs are those for antimicrobial agents and opioids, because these programs are required by the Centers for Medicare & Medicaid Services. The Joint Commission also requires hospitals or health systems to allocate financial resources for staffing and information technology to support an antimicrobial stewardship program (ASP) and that a pharmacist be a part of the ASP.

As hospitals and health systems transition to value-based care and become more conscious of outcomes data, stewardship has become even more important. Clinical areas that could benefit from stewardship programs include anticoagulation, oncology/anti-cancer therapies, fluid management, pharmacogenomics, and psychiatry; all demonstrate the potential for and necessity of stewardship programs. Additionally, research has firmly demonstrated that programs with pharmacist involvement result in the most improvement in costs, patient outcomes, and safety. Drug selection is typically a collaborative decision between the prescriber and the pharmacist, but pharmacists can add recommendations using several additional lenses. Pharmacists assess the drug to ensure an evidence-based approach is used, ensure the correct dose, assess for drug interactions or comorbidities, and help with dose adjustments, monitoring, and adherence. They also assist with identifying which drugs are restricted by formulary, which biosimilars are preferred, which high-cost drugs have patient-assistance programs, and with other patient-specific insurance issues. Stewardship takes a comprehensive approach to drug management that crosses multiple phases of care. ASHP believes that members of the pharmacy workforce have the clinical skills, training, and financial and operational knowledge that make them foundational members of any new stewardship program and leaders in established programs.

As stewardship programs evolve, so do their needs. The integration of pharmacy technicians is a logical next step for stewardship programs. In the United Kingdom, pharmacy technicians play a large role in ASPs. They conduct antimicrobial virtual chart reviews for de-escalation, review and flag penicillin allergies for the pharmacist, participate in audits, and more. The number of pharmacy technicians that perform clinical roles continues to grow in the United States, and incorporating them into stewardship programs is a natural extension of their evolving roles.