Working together: Technology plus pharmacist intervention improves patient care

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Health-system pearls on technology strategies

From tracking medication education to determining the optimal timing of medication doses, health systems are using technology in new ways to improve patient care. These strategies and others were highlighted at the 2012 American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting & Exposition. With pharmacists at the center of patient care, information technology (IT) experts shared their experiences with implementing advanced programs and initiatives.

Timing is everything

Gregory P. Burger, PharmD, a clinical pharmacist at the Lawrence Memorial Hospital in Lawrence, KS, underscored the importance of correctly timing therapeutic drug levels in a computerized physician order entry (CPOE) system. The hospital went live with CPOE in 2010 and determined that the pharmacy department would time all therapeutic drug levels for physicians.

The hospital conducted a study that compared 1 year of phenytoin level timing data prior to CPOE initiation with 1 year of data post–CPOE implementation. Burger said he and his colleagues reviewed lab records to see when the patient’s blood was drawn and reviewed the electronic medical record to see when the nurse gave the dose. They found that pre-CPOE, about 72.9% of doses were timed incorrectly, and post-CPOE, with pharmacist involvement, only 17.3% of doses were timed incorrectly. Burger and his group also compared the original CPOE ordering process with the hospital’s current enhanced CPOE process, which added to the improved timing of doses. However, pharmacist involvement was key to improved dose timing, Burger noted. “Pharmacists should be involved with pharmacokinetics, and that includes timing of medications,” he concluded.

Get your vendors talking

Andrew R. Trella, PharmD, Director of Pharmacy at Lehigh Valley Hospital–Muhlenberg in Bethlehem, PA, told meeting attendees that developing an interface between your online ordering system and your robot is a good idea. This brings LEAN principles into your operation, creates an automated system, and allows for less inventory on the shelf, which saves money, he noted.

Trella and his team began the process of developing an interface at Lehigh Valley Hospital–Muhlenberg by bringing all of the relevant people together—the robot vendor, wholesaler, pharmacy staff, and the hospital technology department. The group developed a process in which robot technicians generate an extract file from the robot server. That file is imported into the wholesaler order entry program, and the pharmacy buyer reviews the wholesaler order before submitting it.

Between June 2011 and May 2012, the interface program saved Lehigh Valley Hospital–Muhlenberg around $56,000, according to Trella. For the same time period, approximately $120,000 was saved at a sister hospital, Lehigh Valley Hospital–Cedar Crest.

Educate as you medicate

Loan Vu, PharmD, MBA, described the importance of combining pharmacist interventions with IT at a Philadelphia-area health system to increase communication about medications. With the goal of improving the health system’s HCAHPS (Hospital Consumer Assessment of Health Care Providers and Systems) scores on the communications about medicines domain, an interdisciplinary team developed numerous interventions for pharmacists and other clinical staff.

Vu and colleagues created the acronym STAR to help nurses with the medication communication process. The acronym stands for “stop when you give the medication, think, act, and review the medication with the patient,” Vu noted.

Pharmacists also attended a 2-day seminar on motivational interviewing skills. The expanded pharmacist role, in which medication reconciliation was provided at admission, discharge, and postdischarge, was implemented in one MedSurg unit.

During a 4-month period, the overall HCAHPS score for the hospital communication about medicines domain remained about the same; however, there was a 20% increase in scores for the unit where pharmacists were involved, Vu noted. “Having IT intervention alone is not as effective as … collaboration [and] partnership among pharmacy and other departments … to improve our scores,” said Vu.

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