Pharmacy Agents for Change

Hospitalized patients who suffer from multiple chronic diseases, such as diabetes, high blood pressure and congestive heart failure, are especially subject to complications of polypharmacy, an industry term for the use of multiple medications that may be contraindicated, redundant or, in combination, dangerous. Vulnerabilities arise when patients receive prescriptions from multiple physicians and don’t realize that new prescriptions are supposed to replace ones they already are taking, or that the prescriptions conflict with or duplicate medications already in use. Many of these problems occur because there’s insufficient communication among physicians, pharmacists, patients and discharge nurses—something that might be alleviated if pharmacists play a greater coordinating role.  In addition, pharmacists sometimes find that patients might be better served with different drug choices, doses or dosing schedules.

The Pharmacy Agents for Change Fellowship was launched to show how expanding the role of clinical pharmacists in medication management and administration can improve safety and quality of care for patients and potentially reduce costs.  Hospital and nursing home-based pharmacists conducted demonstrations to expand and transform their roles to serve as patient educators, therapeutic consultants and quality champions with a goal of reducing preventable complications that arise when patients must take multiple medications. All participants received training in PRHI’s Perfecting Patient CareSM method of process improvement and work redesign.

Inaugural projects selected addressed various problems arising from polypharmacy and ranged from demonstrations to reduce patient falls to ones improving the review of medications at discharge.



Karen Fielding, PharmD
Western Psychiatric Institute & Clinic of UPMC

Juliana Nowak, RPh, CGP
Magee-Womens Hospital of UPMC

Rhonda Horton, PharmD, BCPS
Allegheny General Hospital

Karen Steinmetz Pater, PharmD, BCPS, CDE
University of Pittsburgh School of Pharmacy UPMC Comprehensive Lung Center

Lori Mezeivtch, RPh
UPMC Pittsburgh AIDS Center for Treatment (PACT)

Cindy Powers, PharmD
Allegheny General Hospital

Jamie Montgomery, RPh
Western Psychiatric Institute & Clinic of UPMC- Forbes Pharmacy

Irina Sheyko, PharmD
Jefferson Regional Medical Center

Eric Yarnell, RPh
Western Pennsylvania Hospital

The Pharmacy Agents for Change Fellowship program was built on a 1999 Jewish Healthcare Foundation-funded study at the University of Pittsburgh Center for Research on Health Care that concluded patients often were able to take fewer medications when pharmacists reviewed their prescriptions and dosing regimens often could be changed or streamlined to achieve better outcomes.


ROOTS: Pharmacy Agents for Change – Wrong Medication, Bad Chemistry.

All PRHI Publications.