Frear solves medication problems at the systems level

Elisabeth Fall

Meghan Frear, PharmD

Meghan Frear, PharmD ’12

UC Davis Medical Center, Sacramento
Medication-use systems and technology safety pharmacist

Beyond the PharmD: Two year-long pharmacy residencies at UC Davis Medical Center in Sacramento, California

Expertise: Medication systems and safety

Meghan on systems-level pharmacy: “I can’t see a problem that multiple patients have and not think, ‘There’s got to be a better way to tackle this.’”

“I loved health insurance”

With a pharmacist dad and a degree in biochemistry, Meghan Frear was certain that pharmacy school was a perfect fit for her.

However, she says, “When I first entered UCSF, I could not have articulated for you that I wanted to be a systems-level pharmacist.”

“In undergrad I took an economics of health care course, which sounds so nerdy,” Frear recalls. “But that's what really got me excited—there are these big problems and there are ways that we can solve them [despite] limited resources, and I can do this with pharmacy.”

Her father was working as a prescription benefits manager for an insurance company at the time, so Frear was familiar with that realm: “I wanted to do managed care, and I loved health insurance.”

The Medicare Part D Outreach and Peer Educator Program at UC San Francisco were her first opportunities to put those passions into practice.

Taking it up a level: Peer Educator

As part of the elective course, Medicare Part D Outreach, Frear worked as a patient advocate, counseling underserved seniors. The goal was to help them choose the most affordable plan that covered their current and expected medications.

“I get excited about the systems part, but there’s nothing like seeing someone across from you who is in the thick of it and needing help, and then having the ability to actually help them while still a student,” says Frear.

She remembers one community outreach event where the students were told the dollar amounts that they had saved for individuals via their work.

“It was really great to get that number—showing you saved that person thousands of dollars,” Frear says. Such savings were achieved by enrolling patients in a low-income subsidy plan, which lowers or eliminates deductibles and co-pays for those earning less than 150 percent of federal poverty levels. “But really, what does that mean? It’s that person sitting across from you, smiling, with tears in their eyes. You don’t know everything about their lives, but it’s a huge impact for so many.”

She adds, “I can’t see a problem that multiple patients have and not think, ‘There’s got to be a better way to tackle this.’ You have to go up a level in order to reach more people, right? And so, the Peer Educator Program was the next level up. Here was information that I could share with the right health care practitioners to hopefully make them able to help all of their patients—so I’ve multiplied the impact of my knowledge.”

In fact, Frear increased her impact still further by coauthoring a study of the program in the Journal of Managed Care Pharmacy, along with her School of Pharmacy faculty mentors, Marilyn Stebbins, PharmD; Helene Lipton, PhD (now emeritus); and Timothy Cutler, PharmD. The paper describes the Peer Educator model and provides objective measures of its effectiveness: Clinicians and students both gained knowledge of strategies to lower patients’ out-of-pocket prescription drug costs and increased their likelihood of collaborating with pharmacists in that effort.

“That’s the beauty of the program that Marilyn, Helene, and Tim created, because they’re putting pharmacy front and center as the face of the solution to this issue,” says Frear.

Elisabeth Fall

Frear outside UC Davis Medical Center, Sacramento

Beyond the PharmD

After earning her PharmD degree at UCSF, Frear completed two year-long residencies at UC Davis Medical Center in Sacramento—the first specializing in medication use management and the second in medication safety and administration. Frear became so intrigued by how those aspects of patient care could be made more safe and efficient that she created her own unique job at the medical center: medication-use systems and technology safety pharmacist.

Part of Frear’s position involves improving medical center drug distribution. That includes helping to implement the installation of a $1.5 million robotic pharmacy like the one at UCSF’s Mission Bay Campus, and “dealing with all the change management and changing staff positions, rewriting policies and procedures,” says Frear. “And most of all, making sure that once we get this really expensive robot in place, that we are indeed delivering safer, more efficient care for our patients.”

Evidence-based improvements

Most of Frear’s work varies by project and day. It often involves collecting and analyzing data on medication-related aspects of patient care and safety, then working to make measureable improvements, all while routinely drawing on her pharmacy school model of interdisciplinary peer education.

For example, Frear coordinates a nursing–pharmacy medication safety committee. In this role, she may start with self-education, much as she once learned about Medicare Part D: first in class, then via volunteer fieldwork, and then delivering peer education lectures.

As a second-year resident, she studied the use and programming of smart infusion pumps—computer-controlled devices that deliver intravenous drug doses at controlled rates to maximize efficacy and safety: “If something needs to take an hour to infuse because it causes less irritation to the vein or causes fewer adverse reactions for the patient, we need to make sure it actually infuses over the course of an hour,” she says.

“The ‘smart’ part is the programmed drug limits,” she explains. “We have something called the drug library, where all the different medications that are available are listed and you select the medication to give to the patient. And what someone on the back end has done is to say, ‘For this medication, it’s only safe to infuse at this rate or between these ranges of rates, and that if you give it too fast it’s going to cause problems, or if you give it too slow it’s not going to be effective.’ I actually helped write the limits for those drug programs, and I update the library.”

Combating Medication Errors

When analyzing her data, Frear found that use of the smart infusion technology wasn’t working as well as it should. “My biggest challenge was that I didn’t have 100 percent of drugs being infused using the programmed library,” she says.

“I think the important first step was showing that there was actually a problem,” she continues. “This is something where you really have to go out and collect the data. Then I did a targeted campaign, putting up flyers around a specific unit—and they have been increasing their compliance rates pretty steadily ever since.”

“This nitty-gritty information definitely gives me credibility,” says Frear, who has delivered this case study in various settings, including a quality improvement course for nursing staff called “Combating Medication Errors.” She regularly generates and analyzes new data on smart pump compliance rates, which she shares with four different hospital oversight committees.

“It’s just like Peer Educator—it’s getting out the message in as many different ways and venues as you possibly can,” says Frear.

Also akin to the School’s Peer Educator lecture, Frear’s analyses delved into the underlying causes of the problem. Sometimes the library of programmed infusion rates was not being used, “because it’s a new drug, it wasn’t added to the library yet, so I need to add it. Sometimes it’s that the programming isn’t working and it’s giving an alert that makes no sense.”

Thus, Frear’s efforts at cross-disciplinary communication on this medication delivery technology involve ensuring that pharmacists can provide expertise when there’s an issue. “I need to go back one step,” she says, “and make sure that everyone in the system that should know does know about how to use this technology, and what to do when there’s a problem.”