Creating a Better Safety Net
AMONG THE SIGNIFICANT TRANSFORMATIONS in hospital pharmacy practice that have pushed the profession toward more direct, safe, and effective patient care, the emergence of informatics ranks near the top. When they are well-designed and properly implemented, the complex technologies that constitute pharmacy informatics can reduce medication errors, streamline medication-related processes, monitor patient status, and provide pharmacists, physicians, and nurses with instant access to critical information at the point of care.
“The precision and safety we can provide to the medication system has been astounding,” said Leslie Mackowiak, R.Ph., M.S., director of clinical information systems at Vanderbilt University Medical Center in Nashville. Vanderbilt’s integrated medication system supports electronic transfer of medication information from physician ordering, through pharmacy verification, to nursing bar-coded medication administration and documentation.
The system verifies the dispensing authority of the caregiver and the patient’s identity; matches the identity with the medication profile from the pharmacy information system, which has checked against alerts or reminders; and then records the action in the electronic medication administration record.
Hospitals considering this type of new technology must weigh the equation of patient safety and quality of care, according to Karl Gumpper, R.Ph., BCNSP, BCPS, FASHP, director of ASHP’s Section of Pharmacy Informatics and Technology.
“Is this technology going to prevent a bad outcome and add a level of patient safety? Will caregivers be able to take better care of patients?” he queried. “In most cases, the answer is yes.”
ASHP Leading the Way
ASHP continues to be at the forefront of this special field, offering members a special section, continuing education and information resources, and practice documents like the Statement on the Role of Pharmacists in Informatics.
The Society also ensures that key elements of informatics and technology are rolled into every major Society initiative. For example, at ASHP’s Pharmacy Practice Model Initiative Summit in Dallas in November 2010, participants noted that key elements of pharmacy informatics are “important enablers” in developing optimal pharmacy practice models.
These elements include:
• Computerized physician order entry (CPOE)
• Automated dispensing/robotics
• Electronic medical records (EMR) systems
• Bar code technology during medication administration
• Clinical decision support systems (CDSS) integrated with CPOE
• Systems that capture and report pharmacy metrics and outcomes data, among other kinds.
According to ASHP practice surveys, 18.9 percent of hospitals used combined CPOE and CDSS, up from 10.4 percent in 2007, and 17.8 percent of hospitals reported the adoption of information technology (IT) to some degree by 2007.
Informatics creates a better safety net by removing stumbling blocks scattered throughout paper-based systems, such as prescription transcription errors and overreliance on memory, which too often result in medication errors, according to Gumpper.
“The ability to document a pharmacist’s intervention at the bedside into the medical record by laptop or tablet gives pharmacists the tools to actually do what they were trained to do in school and their residencies,” he added.
Informaticists as Liaisons
Enhanced patient safety is just one potential benefit of pharmacy informatics, according to Gumpper. He noted that technology that processes and verifies patient medication orders on the ward or in the clinic creates better work-flow efficiency and greater satisfaction among nurses and patients.
But technology cannot stand alone. Pharmacists who implement and manage pharmacy informatics systems consistently identify one factor as crucial to successful outcomes: translating clinical necessity into information technology (IT) systems and processes.
Without question, pharmacists, not IT professionals, are best suited to play that role, said Chris Urbanski, R.Ph., director of pharmacy informatics and medication integration at Indiana University Health in Indianapolis.
These pharmacy informaticists “bridge the gap and act as liaisons and interpreters between the purely IT and the clinical realm,” said Urbanski. “We have the clinical training, and I can much more easily teach information technology to a clinician than I can teach an IT person the clinical side.”
Pharmacists are obviously not computer scientists, added Mackowiak, who cultivated her expertise by working closely with IT experts. “You’ve got to know how to manage a database and envision how information will look on a computer screen. Those aren’t skills taught in pharmacy school.”
Demand for pharmacists with IT credentials will only keep rising, according to William Churchill, M.S., chief of service in the department of pharmacy at Brigham and Women’s Hospital in Boston. “As the profession grows, we’ll need more individuals with strong pharmacy backgrounds who also understand information systems,” he said. “These are pharmacists who can sit at the table and talk the language of informatics with software developers, systems analysts, and informatics managers.”
Finding those unusual skill sets isn’t easy, and pharmacy schools lag well behind the curve in filling this yawning knowledge gap. “There is not an abundance of people trained appropriately in health care informatics coming out of pharmacy schools ready to fill our needs,” Churchill said, adding that the profession must find new ways to prepare pharmacists for a future in which familiarity with informatics will be mandatory.
The Future of IT and Pharmacy
That future will see more connectivity among the assorted components of medical informatics. Ideally, the right information will flow more freely to clinicians precisely when and where they most need it, but without interrupting their work flow (persistent alerts for inconsequential drug interactions, for instance, only annoy and distract users). Caregivers, said Mackowiak, should not have to look from chart to chart or wait until they visit a patient’s room to obtain the most up-do-date case information, such as lab values or pain scores.
“In the past, you would have to query a few charts, search around, or go to the floors to find the patient record,” said Christine Beuning, Pharm.D., BCPS, pharmacy informatics application analyst with MultiCare Health System, which is based in Tacoma, Wash. “Now we can generate a report within our electronic health record in 30 to 45 seconds that includes specific clinical information from a patient’s chart. Pharmacists have always been in a contest with other providers for the paper chart, and now we’re more able to share the information.”
The reach of informatics will inevitably extend beyond individual hospitals and hospital networks. For instance, a specialist in Seattle outside of the MultiCare network will, with the patient’s permission, be able to call up relevant information from the patient’s EMR, seamlessly preserving continuity of care. E-prescribing will enable pharmacy informatics systems to capture prescriptions filled at retail pharmacies, bringing clinicians a step closer to complete medication reconciliation for patients who are moving between outpatient and inpatient care.
“Right now, we’re focused on what’s going on inside the four walls of the hospital,” said Gumpper. “Informatics gives us the opportunity to move beyond that and think about the care of the overall population of patients we serve. We’re going to take a much bigger view.”