Case Study: Dayton Children's Hospital's Commitment to Pharmacy Excellence

A Strategic, Long-Term Partnership With CPS

INTRODUCTION AND INTENDED OUTCOME

Dayton Children’s Hospital is one of eight children’s hospitals in Ohio. As a regional referral center, they serve patients from a 20-county area, which includes Ohio and eastern Indiana. The hospital’s more than 200 physicians include primary care pediatricians and subspecialists in over 35 areas of pediatric medicine. Working as a team with the medical staff are more than 3,500 employees and volunteers who share a commitment to quality care. This, combined with Dayton Children’s affiliation with Wright State Boonshoft School of Medicine and accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), supports their mission to provide the local patient population access to the finest pediatric care available.

“We consider this access to care to be our edge in the world’s most competitive market for children’s hospitals,” says Dayton Children’s Vice President & Chief Ambulatory Officer; President, Specialty Physicians Inc., Benjamin Goodstein. “And a critical part of that is access to quality pharmaceutical care.”

This commitment to quality pharmaceutical care was foundational to the growth of the hospital’s relationship with CPS, which has evolved into a rewarding strategic partnership. CPS has helped Dayton Children’s strengthen its inpatient pharmacy and build out its outpatient services with a highly successful specialty pharmacy.

THE ORIGINAL CHALLENGE

In 2017, a JCAHO survey uncovered some compliance issues, explains Ben. “The survey flagged concerns around policies, procedures, and workflows in a range of areas — from 340B to supply chain to the way we were handling sterile compounding.” 

Dayton and CPS collaborated to help address the Joint Commission issues. A leader in hospital pharmacy services, CPS was equipped to help their stakeholders overcome challenges impeding pharmacy performance excellence — such as purchasing practices, compliance, accreditation survey readiness, sterile compounding, and more.

INPATIENT PHARMACY SOLUTIONS

- Compliance

Through CPS’ Pharmacy Management services, Dayton Children’s brought an expert CPS interim director of pharmacy on board. The first order of business? Establishing trust.

“Within four or five months, our CPS director had turned the relationship between leadership and the inpatient pharmacy team completely around,” says Ben. “With that trust, she was able to go to work changing the culture — adjusting policies and procedures for compliance and implementing proper workflows for the emergency department and inpatient units.”

- Decentralized Pharmacy

Once the inpatient pharmacy transformation was well underway, Dayton Children’s CPS director began to decentralize the pharmacy — which turned out to be a crucial and valuable course of action.

The initiative focused on placing clinical pharmacists on all floors, including inside neonatal intensive care units, pediatric intensive care units, and the emergency department. “Our engagement with healthcare providers throughout the hospital skyrocketed almost immediately.”

Ben and his team found that having clinical pharmacists available for rounds gave the nursing staff a greater sense of support. “The move to decentralize really changed  the relationship with our pharmacy across the entire system.” Plus, having a pharmacy partner right there meant that compliance of the medications being delivered was better managed. “That was pretty powerful,” says Ben.

- Clinical Initiatives

The partnership with CPS has also helped Dayton Children’s bolster the clinical profile

of its staff. For instance, by leveraging the company’s range of clinical services and programs — which includes access to the nation’s largest peer network of pharmacy professionals — the hospital now has more board-certified staff. They’ve also set up a successful residency program, allowing the hospital to attract and educate promising new pharmacists who can eventually help build and strengthen the pharmacy’s services.

- Drug Diversion Program

Dayton Children’s current inpatient pharmacy director was the clinical coordinator when the hospital partnered with CPS to build their Drug Diversion Program. “We didn’t have

a lot of infrastructure around drug diversion from a compliance standpoint,” says Ben. Dayton Children's prioritized performance excellence within their Drug Diversion Program. Their coordinator then implemented a systematic process to help control drug diversions and make sure they are handled consistently across a wide range of perspectives — public safety, clinical, nursing, compliance, and legal.

- Sterile Compounding

The inpatient pharmacy director and ambulatory pharmacy services director rebuilt the entire sterile compounding program in about a year and a half. Their goal from the start was to maintain compliance with USP 797 while implementing a compliance plan to satisfy USP 800, which provides standards for safe handling of hazardous drugs to minimize the risk of exposure to healthcare workers, patients, and the environment. This approach positions Dayton Children's to pivot as needed as the final rules

for satisfying USP 800 become more clear. To do that, they worked with nursing, environmental services, and employee health stakeholders to establish hazardous handling policies. They also engaged with facilities, quality, and infectious disease teams in the hospital to ensure the infrastructure was correct.

Now, Dayton Children’s has a supervisor of sterile compounding who is also a pharmacist, and techs are trained regularly on policies that go above and beyond USP 800. They also ensure compliance with new regulations, installing the correct hoods for hazardous compounding, for instance, which became the rule in 2021.

OUTPATIENT PHARMACY SOLUTIONS

“From early on in our relationship, CPS’ specialty division, Azina, System VP of Pharmacy Services, John Petts, had been talking to me about elevating our pharmacy manager to lead the outpatient pharmacy,” says Ben. They ultimately took the recommendation, and today that person works for CPS — serving as Dayton Children’s ambulatory pharmacy services director, overseeing the outpatient, specialty, and home care pharmacies.

- Specialty Pharmacy

With all these successes, the ambulatory pharmacy services director recommended having CPS Azina manage Dayton Children’s Specialty Pharmacy. “We had been wanting to build out a specialty pharmacy, but at the time, CPS’ program wasn’t quite what I was looking for,” Ben explains. When they circled back around to discuss it again later, however, he found that CPS had added some world-class leadership, and the program fit their needs much better. “I’m a metrics person. I want to see the data — and that’s exactly what they showed me.”

As a result of the partnership with CPS, the hospital’s specialty pharmacy ended up being highly profitable during its first year. This was partly due to its achieving dual accreditation, which gave them increased access to specialty networks. Since August 2020, specialty pharmacy revenue has grown by 61%. In addition, volume in the first quarter of 2022 increased from 12 per day to 16.5 per day compared to the same time frame in 2021. 

- 340B Compliance

Once the specialty pharmacy was built, the ambulatory pharmacy services director started working on 340B compliance. This involved bringing on a 340B compliance specialist and expanding contract pharmacy agreements. Now, 82% of their prescriptions qualify as 340B, which leads to lower overall drug spend. CPS’ annual Comprehensive Pharmacy Assessment, a proprietary tool consisting of a 450+ point audit of pharmacy operations health, verified that overall compliance oversight of the 340B program has improved.

THE RESULT — A STRATEGIC PARTNER DAYTON CHILDREN’S CAN COUNT ON

“I expect the people in leadership positions to understand the ‘why’ behind what Dayton Children’s does and how the pharmacy relationship relates to our mission — the relentless pursuit of optimal health for every child within our reach,” says Ben. That means keeping teams engaged and making sure they are aligned and feel supported, he adds. He expects the same from CPS.

That’s because Ben doesn’t see CPS as a vendor. “They’re part of the team — they have to be in order for our pharmacy to be successful,” he says. “And for them to be successful, they’ve got to hit my metrics — which they’ve done, time and time again.”

The promise CPS made from the beginning was that Dayton Children’s would earn back the fee they pay for services in revenue every year. That has held. “I don’t think there’s been a project or a program we’ve done with CPS that hasn’t been successful,” says Ben. “It’s fantastic to have a partner who understands we’re not just a small children’s hospital wedged in Ohio and that we’re fiercely independent.” It’s not just the local leadership from past and present directors, but the senior leadership who also understands the importance of Dayton Children’s in the market. 

CONCLUSION

Today, Dayton Children’s has the most engaged, reliable, quality-focused pharmacy the hospital has ever had. As a result, the pharmacy program is the second-highest revenue source for the entire hospital.