Improved Pharmacogenomic Testing Process for Veterans in Outpatient Settings by Clinical Pharmacist Practitioners.

Background: Pharmacogenomic Testing for Veterans (PHASER) is a US Department of Veterans Affairs (VA) program that offers a 16-gene laboratory test panel to patients. Pharmacogenomic testing results may improve patient care by providing patient-specific information on how effective a medication may be or identifying increased risks for adverse drug effects. A VA Central Ohio Healthcare System Pharmacy department initiative sought to increase outpatient PHASER ordering by clinical pharmacist practitioners (CPPs). Observations: CPPs were surveyed to address the current process and perceived barriers. Barriers identified by CPPs included a lack of clinician education materials, standardized screening process, comfort with PHASER ordering and education, support for the initiative, time constraints preventing patient education and ordering, higher priority clinical needs, forgetting to order, and increased workload and burnout. A gap analysis was used to create a new workflow with the goal of increasing PHASER orders by 50% after 3 months. The new workflow included prefilled templates, education, and visual reminders. PHASER orders increased from 87 preimplementation to 196 postimplementation, a 125% increase. Conclusions: This quality improvement initiative resulted in an increase in PHASER orders and a clearly defined process. Perceived barriers were identified, and process changes attempted to address them in a sustainable way.