The ASCP Foundation conducted a landmark three-phase research initiative — The Fleetwood Project® — to demonstrate the impact of consultant pharmacy services on patient outcomes and health care costs and to improve quality of care for nursing facility residents. The Fleetwood Project® may be the most important research initiative ever undertaken on behalf of pharmacy practice, and its significance and relevance has been validated by the private foundation funding obtained to conduct Phase III. The first two phases of the Fleetwood Project® were funded by the ASCP Foundation through contributions from ASCP, its members, chapters and affiliates, long-term care pharmacy providers, and pharmaceutical companies. Two internationally recognized private foundations — The Commonwealth Fund and the Retirement Research Foundation — provided grants totaling more than $750,000 to fund Phase III.
- The first pharmacoeconomic study to quantify the cost of medication-related problems in nursing facilities and the value of consultant pharmacist services.
- The study found that consultant pharmacist-conducted drug regimen review increases the number of patients who experience optimal therapeutic outcomes by 43%.
- The study found that consultant pharmacist-conducted drug regimen review saves $3.6 billion annually in costs from avoided medication-related problems.
- The principal investigator was J. Lyle Bootman, PhD, Center for Pharmaceutical Economics, University of Arizona.
- Results were published in the October 13, 1997 issue of Archives of Internal Medicine.
- A feasibility study of a new model for long-term care pharmacy, the Fleetwood Model, which includes
- prospective review
- direct communication with the prescriber
- pharmacist assessment of the patient
- formalized pharmaceutical care planning for elderly patients at highest risk for medication-related problems
- Additional information about the Fleetwood Model was published in the December 1998 issue of ASCP’s journal The Consultant Pharmacist.
- The study was conducted over a six-month period in 1998 in cooperation with Vitalink Pharmacy Services and six nursing facilities (three intervention and three comparison facilities) serviced by Vitalink’s pharmacy in Appleton, Wisconsin.
- The study demonstrated that this revolutionary new model of pharmaceutical care in nursing facilities could be successfully integrated into long-term care pharmacy practice. Most importantly, the new model allows the internal pharmacists and consultant pharmacist to play a much more active role in resident care through greater interaction with other members of the health care team, the residents, and caregivers.
- Phase II is of critical importance to the pharmacy profession, because it demonstrates that long-term care pharmacy practice can be re-engineered while also improving workflow efficiencies.
- Complete operational results were published in the October 2000 issue of The Consultant Pharmacist (PDF).
- A three-year demonstration project to test the effectiveness of the Fleetwood Model in reducing potentially inappropriate medication use, adverse drug events, and the undertreatment of common diseases experienced by nursing facility residents in twenty-six nursing facilities in North Carolina. A complete description of Fleetwood Phase III was published in the March 2002 issue of The Consultant Pharmacist (PDF).
- The study will quantify the impact of the Fleetwood Model on the efficiency, productivity, workload, and satisfaction of the pharmacists. Baseline information was published in the November 2004 issue of The Consultant Pharmacist. (PDF)
- The partners in Phase III are the Center for Gerontology and Health Care Research at Brown University, which serves as the principal investigator, and Neil Medical Group, a long-term care pharmacy provider based in Kinston, North Carolina.
- The intervention phase was conducted January 1, 2004 through December 31, 2004. Publication of the results is expected in 2006.
- Risk Screen — A risk screen was integrated into the pharmacy’s software system to identify patients at highest risk for adverse drug events and those receiving potentially inappropriate medications. The risk screen was adapted from published research on risk factors for preventable adverse drug events in nursing facilities.
- Prospective Intervention — As part of the Fleetwood Model, internal pharmacists review high risk patients and those receiving potentially inappropriate medications during order verification and intervene prospectively to address medication problems identified. All interventions are documented in the pharmacy system.
- Treatment Algorithms — Algorithms for alternatives to potentially inappropriate medications and intervention letters for specific drugs were developed for use by the internal pharmacists. The treatment algorithms were published in the November 2004 issue of The Consultant Pharmacist. (PDF)
- Nursing Alert Cards — were developed for propoxyphene and medications with anticholinergic effects to foster early recognition of potential adverse drug effects. The Alert Cards contain recommendations for monitoring for potential adverse medication effects that should be observed for and reported, as well as RAP problems that may be caused or aggravated by the medication effects. The cards are sent with the medication order and are placed on the front of the patient’s medication administration record.
- Web-based Pharmaceutical Care Software — was developed and serves as the repository for the documentation of all interventions made by internal and external pharmacists and the main conduit of information exchange between internal and external pharmacists. Automated data extracts, including medication records and interventions, are uploaded from the pharmacy software to the web site daily. Consultant pharmacists download the information to a laptop before each facility visit, enter all interventions for high-risk patients and those receiving inappropriate medications and upload the data at the end of the day. This shared system allows the internal and consultant pharmacists to work from the same patient information and see all interventions and outcomes.
- Procedure Manual and Intervention Coding Guidelines — were developed to ensure consistency in coding of interventions and outcomes.
- ASCP Council of Presidents Task Force on Payment for Pharmacists Services — was established to assist in developing a methodology for payment for pharmacist services based on the data collected in Fleetwood Phase III.
- In November 2005, the ASCP Foundation released the Fleetwood Toolkit v.1.0, which contains the intervention tools developed for Phase III and reprints of relevant articles.