Purpose: Prior to 2008, the pharmacy practice model utilized by the University of North Carolina (UNC) Medical Center was a traditional central pharmacist and clinical specialist model. The department of pharmacy implemented a unique and innovative pharmacy practice model in 2008 organized around medical services. Through this medical service-based model, all patients are now covered by a pharmacist. The objectives of this study were to evaluate the sustainability of the improvements associated with the medical service-based pharmacy practice model at UNC Medical Center, which included pharmacist turnover, employee satisfaction and workforce engagement, resident and student involvement in patient care, and inpatient drug costs. Methods: This retrospective analysis focused on data spanning fiscal year (FY) 2004 to 2016. Internal data reporting sources were analyzed to evaluate the outcomes of this practice model. Results: In FY 2016, 67% of work groups were tier 1 (highest satisfaction tier) and 4% were tier 3 (lowest satisfaction tier) and inpatient pharmacist turnover rate was only 7% compared with a 17% hospital turnover rate. Prior to 2008, the average difference between actual and expected drug expenditures was $2.8 million per year, and post-implementation, the average difference improved to $3.3 million per year. In FY 2017, the department had 35 residents, representing a 169% increase in number of residency positions available compared with FY 2008. In FY 2016, 134 months of early immersion experiences were offered, 29 months of Introductory Pharmacy Practice Experiences (IPPEs), and 417 months of Advanced Pharmacy Practice Experiences (APPEs), which represents a 263% increase in IPPE months and a 369% increase in APPE months from FY 2008.Conclusion: This practice model, along with other factors, has had a continued sustained positive impact on employee engagement, inpatient drug costs, and patient care in our health system. In addition, this practice model is organized around pharmacist responsibilities that support continued growth of pharmacy learners. K E Y W O R D Sdrug costs, employee satisfaction, pharmacy administration, pharmacy service, practice models, turnover, workforce engagement

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Purpose Nurse practitioners, physician assistants, and pharmacists are advanced practice providers who are highly trained and qualified healthcare professionals that can help support traditional demands on oncologists' increased time in direct patient care. The purpose of this study was to detail and assess the creation of a privileging process for this group of medical professionals within an academic medical center. Obtaining the designation of limited oncology practice provider (LOPP) gives the right to modify chemotherapy orders and to order supportive care medications. Methods An interdisciplinary team developed a comprehensive training process inclusive of required educational domains, knowledge goals, and educational activities to become an LOPP. In 2018, five years after the implementation of the privileging process, a survey was distributed to assess perceptions of the training process and integration of LOPPs within oncology practice. Results Most oncologists noted that working with LOPPs is beneficial to oncology practice (94%) and that they make modifying chemotherapy orders more efficient (87%). Greater than 82% of LOPPs also reported that their privileges streamline the chemotherapy process and make them feel valuable. Conclusion The creation of the LOPP designation is an effective way to integrate nurse practitioners, physician assistants, and pharmacists within oncology practice. The inclusion of a focused privileging process ensures the safety of cancer care provided and has created a streamlined process for chemotherapy modifications and supportive care.