YNHHS standardizes drug formularies, streamlines procedures

Gurinderpal Doad, PharmD (left), critical care pharmacy resident, and Rupangi Datta, PharmD, clinical pharmacist, Neurosciences, participate in rounds on the Neuroscience Intensive Care Unit. The pharmacy departments at Yale-New Haven, Bridgeport and Greenwich hospitals have standardized the medications on their formulary lists so physicians at all the hospitals have access to the same medications and same guidelines for use.
Gurinderpal Doad, PharmD (left), critical care pharmacy resident, and Rupangi Datta, PharmD, clinical pharmacist, Neurosciences, participate in rounds on the Neuroscience Intensive Care Unit. The pharmacy departments at Yale-New Haven, Bridgeport and Greenwich hospitals have standardized the medications on their formulary lists so physicians at all the hospitals have access to the same medications and same guidelines for use.

In the past, a Yale-New Haven Hospital physician treating a patient with an infection would prescribe one type of antibiotic, while a Bridgeport Hospital physician treating the same type of infection might choose a different, equally effective antibiotic.

Why? In part because Bridgeport, Greenwich and Yale-New Haven hospitals' pharmacies previously had different types of medications on their formulary lists, along with different guidelines for medication use.

"It didn't make sense for hospitals that are part of one healthcare system to have separate formularies," said Lee Ann Miller, associate director, Clinical Pharmacy Services, YNHH. "We realized that by working together across Yale New Haven Health System we could enhance the safety and quality of care, work more efficiently and generate cost savings."

In 2011, representatives from the three hospitals formed a Formulary Integration Committee to standardize formularies so all hospitals have the same medications and guidelines for use. Committee members worked with physicians and staff from Pharmacy, Nursing and other departments at each hospital to review research and ensure the medications they choose for the formularies are the safest and most cost-effective, based on evidence.

So far, formulary standardization is about 90 percent complete, but has already generated more than $2 million in savings. Standardization has eliminated "duplicate therapies" — using similar, but more costly medications to treat the same conditions. Purchasing greater quantities of medications as a large health system often means better pricing. Standardized formularies also make it easier for hospitals to manage medication inventories and more easily share drugs if shortages arise, Miller said.

The standardization project also includes a new, system-wide process for adding medications to, or removing them from, the formulary. A YNHHS clinical pharmacy group comprising representatives from the three hospitals combined their best practices to create one review process for formulary additions and deletions systemwide. This group also helps develop and review standardized order sets so physicians can use Epic to easily prescribe the medication or medications proven best for treating a particular condition, said Molly Leber, manager, Pharmacy Services.

In spring, YNHHS was recognized for its standardization work, receiving one of Baxter Healthcare Corp.'s Leadership Excellence Awards in Pharmacy. The project has also been recognized as part of an Excellence Award for Supply Chain Management from VHA Inc., a national network of not-for-profit healthcare organizations.