The staff of the Transplant Pharmacy. Photo by Susan Urmy
A home-grown computer program developed by VUMC transplant pharmacists and pharmacy IT technicians saved a patient from rejecting a transplanted kidney — or worse.
Chris Hayes, PharmD, a transplant pharmacist, and Jake Bell, principal database administrator for VUMC Outpatient Pharmacies, worked together to develop a program to monitor Vanderbilt Transplant Pharmacy patients’ adherence to the often-strict medication regimens required after undergoing a transplant.
Non-adherence to immunosuppressant medications can have a significant impact on transplant patients, such as infections which lead to hospitalization or a higher risk of developing cancer.
The patient’s record was recently flagged in the system after she didn’t respond to calls about refilling her immunosuppressant medication.
The program developed by Hayes and Bell monitors approximately 1,400 transplant patients, and one recent case with a patient who will remain anonymous, demonstrated the value of the program.
The patient’s record was recently flagged in the system after she didn’t respond to calls about refilling her immunosuppressant medication. Thanks to Hayes’ and Bell’s adherence program, the pharmacy was alerted that the patient had not received medication, which sparked an investigation.
Through that investigation, the Transplant Pharmacy was able to reconnect with the patient and urge her to come in for an appointment. The appointment came just in time; the patient was in early stages of transplant rejection, and she was admitted to the hospital for treatment. The patient has now made a full recovery.
“With our transplant patients, it’s very important that they’re adherent to their medications — especially their immunosuppressants which keep them from rejecting their organs,” Hayes said. “We wanted to develop a better way to monitor and ensure that no patient is falling behind their medication regimens.”
“We think this is going to continue helping prevent adverse outcomes before they happen. Our goal at the Transplant Pharmacy is always to be proactive instead of reactive.”
The program Hayes and Bell developed flags Transplant Pharmacy personnel when patients have missed 20% of their medication days within a certain timeframe, which is set by the patients’ physicians.
There are, of course, many reasons a patient could miss a medication, from a change in dosage that was not reflected in their medical records to a long-term hospitalization. But in some cases, there is not a clinical reason the patient is missing medication, and pharmacists need to intervene.
“We think this is going to continue helping prevent adverse outcomes before they happen,” Hayes said. “Our goal at the Transplant Pharmacy is always to be proactive instead of reactive.”
Bell, who developed the adherence module used to identify patients at risk for medication non-adherence, says the program helps the Transplant Pharmacy team manage their patients’ individual needs and ensures better patient care.
“Our adherence model allows for gaps in patient medication to be observed and allows pharmacy technicians to identify trends in reasons for non-adherence. I’m thankful to have been part of something that helped a patient directly, and I hope our application continues to assist the Transplant Pharmacy team identify and help more patients,” Bell said.
“The Transplant Pharmacy already has a high touch patient care model, but we wanted to see how we could improve and help patients who need extra support and guidance,” said Rachel Chelewski, PharmD, CSP, who helped plan and test the program in its early stages.
“Our pharmacy is able to reach out to high-risk patients and take some extra time to make sure they are adherent with filling their medications, help mitigate financial barriers and try to facilitate resolution of any issues that may be causing medication non-compliance. This can make a huge impact for our patients, and it may prevent hospital readmittance, graft failure and numerous other complications.”