UC San Diego Health's chief pharmacy officer: Who knew there'd be a saline shortage?

Charles Daniels, BS Pharm, PhD, chief pharmacy officer and associate dean of UC San Diego Health and Skaggs School of Pharmacy and Pharmaceutical Sciences, spoke with Becker's Hospital Review about the key challenges pharmacy leaders must overcome and major changes in the industry he never saw coming.

Editor's Note: Responses were lightly edited for length and clarity.

Question: What are some of the key challenges pharmacy leaders must overcome?

Dr. Charles Daniels: The growing complexity of the organizations we work in create many pharmacy opportunities.  Trying to keep track of all the moving parts challenges me every day.  With all the opportunities, it becomes even more important to have a well-understood mission and pharmacy philosophy. This can lead to goals that generate the support of the medical and hospital executive leaders. You can't do everything right away, so stay focused on what you have strategically selected. Respond to the others as resources or priority allow.

Q: When it comes to managing drug spend, what advice would you offer other pharmacy leaders? 

CD: Find or create the tools in your organization to identify high-cost drugs patients use every day.  The sooner those patients are identified, the sooner you can begin to de-escalate the costs. Looking at month-end numbers that come from finance are a fine way to look at the big picture, but much too late to intervene. An example of that is finding patients on blood-clotting factors instantly.  An extra day or two of use is very impactful on a pharmaceuticals budget.  Working with our hematologists on a patient- specific basis can often optimize use quickly and discontinue use as soon as possible.  We can reduce our costs by thousands of dollars if we get to them immediately.

Q:  What major changes in healthcare have you seen in recent years that you would have never expected when you started in the industry? 

CD: The impact of the consumer movement in hospitalized care is an interesting conundrum.  It is certainly good to have patient and family engagement, but in some cases, they push beyond the limits of evidence-based medicine.  It is difficult to encourage them to participate, and then say they are wrong, even when there is no clinical evidence to support adding another agent. I also would have never predicted that we would have difficulty finding normal saline and sodium bicarbonate to buy.  Shortages of these essential drugs and many others are a reality of this decade.

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