ASHP InterSections ASHP InterSections

June 17, 2015

At NMMC, Pharmacists Introduce Medical Residents to Comprehensive Care

From left, James L. Taylor, Pharm.D., talks to a patient about his medication regimen.

From left, James L. Taylor, Pharm.D., talks to a patient about his medication regimen.

PATIENT-CENTERED CARE is intrinsic to good outcomes and requires a multidisciplinary, team-based approach. At North Mississippi Medical Center’s (NMMC) Family Medicine Residency Center in Tupelo, a special program ensures that family practice residents have access to the medication knowledge and experience of pharmacists. And the results have been extraordinary.

J. Edward Hill, M.D., faculty member in the family medicine residency program and a past president of the American Medical Association, is a big fan of the program. “Having a pharmacist in a clinic like this, working side-by-side with residents every day, is the most exciting thing for patient care and resident education I’ve ever seen,” he said.

As part of the program, each class of eight first-year residents inherits a panel of patients from the graduating class before them. They then follow the patients throughout the three years of their residencies as the patients transition through clinic visits, hospital admissions and discharges, and extended care facilities.

Positively Impacting Residents’ Learning Process

James L. Taylor, Pharm.D., the primary care pharmacy manager at the Center, guides residents on medication management every step of the way.

“I serve as a source of information to residents and do one-on-one consults, both in chronic care services and on transitional care services,” Taylor said. “For example, if the residents want to start someone on insulin, they ask me to do the initial education as well as the follow-up and titration. When the residents go on rotation, I’m their back-up in talking to patients when they’re not available.”

Having access to a pharmacist who can provide this kind of oversight has dramatically changed patient care at NMMC, according to Dr. Hill.

“On a daily basis, James catches things that could turn out to be errors or safety issues. He has had a major impact on the residents’ learning cycle and dramatically improved the care they provide,” he said.

Ensuring Comprehensive Care

Taylor, who works alongside a licensed social worker and five fellow faculty members and clinicians, draws upon his work as a pharmacist to provide residents with practical pointers that will enhance care. For example, Taylor understands the various insurance plans that the clinic’s patients have based on his work getting prior authorizations for various treatments. This knowledge has made him cost-sensitive, which he stresses to the residents.

J. Edward Hill, M.D.

J. Edward Hill, M.D.

“If a patient can’t afford the medications they’re prescribed, we’ve done them no good. So, I like to impress upon the family practice residents that they should be aware of the formulary coverage issues and costs of drugs available to the patients,” Taylor said. “If we could do this in every clinic, we would cut down on call-backs to the clinic that retail pharmacists need to make if a prescription is not covered, and our patients would be better served.”

Taylor has worked extensively with teams of physicians and administrators in the NMMC system to determine the safest and best ways to discharge patients and transition them through the care continuum. Taylor’s efforts help reduce readmissions and increase clinic follow-up, and he builds upon this success by passing proven care strategies along to the residents.

“We’ll make follow-up calls within two business days of hospital discharge to make sure patients have follow-up appointments, and we counsel them on their concerns,” Taylor said. “Residents learn how to question patients to get the right information about whether they are taking their medications correctly, and if not, why not.”

Kristi M. Gholson, Pharm.D., FASHP, director of pharmacy for the family medicine residency program, emphasized the program’s forward-thinking approach. “The residents may end up practicing somewhere that doesn’t have access to pharmacists the way they have now. We won’t be there to do this [kind of work] for them, so we teach them our way of thinking.”

A Welcome Addition

Feedback from both current and former residents has been overwhelmingly positive, said Gholson. “Some of them have said that they would never want to work in a clinic that didn’t have a pharmacist.”

Indeed, several former residents still reach out to Taylor for advice. “Hopefully, I’ve given them some things to think about when they are out there on their own, practicing evidence-based medicine and balancing cost considerations, so they can make the right choices for their patients.”

We need someone who has a broad knowledge of all medications, and that’s what pharmacists bring to us and to our patients. — J. Edward Hill, M.D.

That Taylor still hears from former residents is testimony to the value of pharmacists’ training and expertise, said Gholson.

“It shows that there’s a need for our knowledge. As a profession, we have to continue to market ourselves. We need to differentiate our skills and expertise from those of other members of the healthcare team.”

Dr. Hill said that physicians should welcome pharmacists as integral members of the care team.

“We often know enormous amounts about the medications in our particular specialties, but we need someone who has a broad knowledge of all medications, and that’s what pharmacists bring to us and to our patients.”

—By Terri D’Arrigo

June 9, 2015

Building Bridges to Pharmacy’s Future: Optimizing Patient Outcomes

John A. Armitstead, M.S., R.Ph., FASHP

John A. Armitstead, M.S., R.Ph., FASHP

Editor’s Note: The following inaugural address was given by new ASHP President John A. Armitstead, M.S., R.Ph., FASHP, at ASHP’s Summer Meetings in Denver, June 9, 2015. Armitstead is System Director of Pharmacy, Lee Memorial Health System, Fort Myers and Cape Coral, Fla. The address will also be published in the August 15th edition of AJHP.

 

Good morning!

To say it is an honor to serve as your president is an understatement. I am so grateful for this opportunity to serve our patients, our profession, and our society.

Ever since my introduction to ASHP during my college years at Ohio Northern and my ongoing training at Ohio State, I have been intrigued and invigorated by this great professional society. Its influence on my career has been remarkable. ASHP has opened my heart and my mind to opportunity and action. The examples set by many of our profession’s finest leaders have created pathways and bridges to grow professionally and realize dreams.

I have many individuals to thank, starting with my wife, life partner and best friend—also a pharmacist—Ima Darling Armitstead. Thank you for your love, support, and guidance. You have given me infinite refills on our prescription for life.

I want to thank my children Jaclyn and Jonathan; my parents, Austin and Bianca; my sister Nancy, brother Alan, and my parents-in-love, Frank and Pat. My inner circle of love also includes Armitsteads, Haydens, and, of course, the Darling sisters. The support of my family, from birth and through marriage, from student to practitioner and leader, has been a bedrock of joy for me.

As I was considering what I wanted to speak about today, I discovered an insightful poem called “The Bridge Builder.” In it, an elderly man crosses a lazy stream and then turns around to construct a bridge to provide others with safe passage. When the man is asked why he built a bridge when he had already safely crossed the wide chasm, this is what he said:

 

The builder lifted his old gray head;
“Good friend, in the path I have come.”
He said, “There followeth after me today
A youth whose feet must pass this way.
That chasm that has been naught for me
To that fair-haired youth may a pitfall be.
He, too, must cross in the twilight dim;
Good friend, I am building the bridge for him.”

As I reflect on the profession of pharmacy, and specifically pharmacy in health systems, I am thankful for the past leaders—bridge builders for all of us—who have created a vision, sought consensus, and made the act of patient care delivered by pharmacists what it is today.

These leaders have advanced our profession and patient care by publishing, presenting, and developing practice guidelines and policies. They have advocated for pharmacy and for patients. They have precepted, networked, and mentored the next generation. They have built the bridges that we easily cross today.

In my career of 35 years, many bridge builders have paved the way for me. I especially want to thank Ivey, Latiolais, Sherrin, Parker, Hunt, Schneider, Silvester, Colgan, Manasse, Abramowitz, Zellmer, Eckel, Rough, Smith, Jolowsky, Hynniman, Theilke, Ashby, Lazarus, White, Godwin, Anderson, Zilz; and my Florida colleagues and dear friends, McAllister and Rapp.

Thanks also to my colleagues throughout the years at some of the nation’s finest healthcare institutions, including the U.S. Public Health Service, Riverside Methodist Hospitals, Ohio State University Hospitals, University of Cincinnati Hospital, University of Kentucky Healthcare, and my present team at Lee Memorial Health System.

These institutions and their staff have allowed me to apprentice and engineer improved patient care outcomes.

Bridges for Our Patients

Verrazano -1

The Verrazano-Narrows Bridge under construction, c. 1960. Image courtesy of Barton Silverman/The New York Times

When I was a child living in New York City, I watched the building of the Verrazano Narrows Bridge connecting Staten Island to Brooklyn. Before the bridge was built, you could only cross the choppy waters of the Hudson River by ferry. There was a gap called “The Narrows”; the gateway to New York Harbor, a chasm of two miles created 18,000 years ago at the end of the ice age. When the Verrazano was completed in 1964, it connected these lands to development, commerce, expansion and growth. The chasm was bridged.

Today, I want to talk to you about the importance of bridging the gaps in continuity of care… in our relationships with patients and peers… and in the work that ASHP is doing every day to further our professional aspirations and goals.

We have come so far on the road to improved patient outcomes and enhanced opportunities for pharmacists as key members of the healthcare team. We must continue to build bridges for patients in transitions of care and in ambulatory care. We must forge ahead and continue to redefine our profession, strengthen our workforce, and nurture and maintain our relationships and connections.

Great examples abound of how pharmacists are moving into direct patient care in ambulatory settings. At Avera Behavioral Health Center in Sioux Falls, S.D., pharmacists have transitioned to clinical services and patient-specific care by focusing on medication reconciliation, patient education, targeted medication therapy protocols and managing drug-induced adverse effects in their mental health patients.

At Palomar Health in Escondido, Ca., pharmacists are working throughout the continuum of care by developing an effective transitions-of-care program that emphasizes medication safety and individual patient outcomes. They accomplish this through a community-based transitions program.

Effective transitions from hospital to home or from a community setting into the hospital are key areas in which pharmacists can make a difference. Pharmacists can bring value in both guarding against newly emerging medication-related problems and the potential for an escalation of adverse conditions as patients transition to home settings.

Care transitions with a focus on medication management are essential to improve health outcomes. The distinct medication expert on the multidisciplinary team is the pharmacist. In concert with physicians, nurses, and others who contribute to the overall care of patients, pharmacists can develop care plans that translate into reduced readmissions and improved outcomes.

Results of ASHP’s recent National Survey show that practice is evolving and that pharmacists are becoming more and more involved in transitions of care.

Although this progress has been good, pharmacists must do better, and we must do it much quicker. Incremental change will no longer suffice.

Over 60 percent of responding health systems task pharmacists or pharmacy technicians with taking medication histories at admission. And over 60 percent have pharmacists conduct discharge medication counseling, and discharge planning.

Although this progress has been good, pharmacists must do better and we must do it much quicker. Incremental change will no longer suffice.

We need to take responsibility for our patient’s medication education and their ongoing care. We must begin to care about the whole life of the patient rather than just the episodic care we provide at different points in the care process. It is time to accelerate our incremental efforts into monumental success for our patients.

We must ensure continuity of care during patient transitions between care settings, and we must manage care effectively.

We must be the key provider following up on drug-related problems, and we must effectively conduct medication education to promote patient self-care.

Let me give you a personal example of what I’m talking about. Recently, I had a patient who had gone home after surgery and was prescribed an analgesic. Because my contact information is included on the discharge patient education information, the patient called me.

His question? Not something related to pain control or medication interactions. He wanted to know why he was hadn’t had a bowel movement in over three days. Now, that may seem like a low-level concern for a pharmacist with years of clinical experience and training. But, for this patient, constipation was the driving concern. His issue was resolved after daily consultation with his pharmacist… three, four, and five days post discharge.

If you’re sitting there wondering if something this mundane is important to the whole life of your patient, I’m here to say emphatically, “yes.” We have to be ready to manage everything related to our patients’ medication regimens beyond their hospitalization.

Bridges to Ambulatory Care and Primary Care

As you can see, bridges are not simply a metaphor to me. They are connections that link one place to another. They stand as a testament to our ingenuity. This pharmacist-to-be was born and raised in New York City, and there certainly is no more iconic bridge than the Brooklyn Bridge. Completed in 1883, it was truly a magnificent feat of engineering, a wonder of the world. It stands strong today.

Brooklyn bridge-1

The Brooklyn Bridge under construction, circa 1880. Picture courtesy of Wikipedia.

Pharmacy practice is synonymous with bridge building. Today, we have new opportunities to step into ambulatory and primary care settings, working on healthcare teams in accountable care organizations, physician’s offices, hospital outpatient clinics & pharmacies, patient-centered medical homes, and community healthcare centers.

Indeed, one of the most exciting recent developments has been the increasing number of pharmacists who are becoming part of patients’ medical homes. Patients are welcoming us into that space because of our critical role in medication therapy management to optimize outcomes.

As electronic medical records continue to advance, they will eventually become patient-owned and held. Once that happens, I believe patients will see clearly what an essential role we play, and patients will have their own pharmacists.

It is truly an exciting time! We can find examples everywhere of how far pharmacist care has come.

Pharmacists at Kimbrough Ambulatory Care System in Fort Meade, Md., are providing primary care services to military veterans. Pharmacists manage patients’ lipids and anticoagulation, and assist with post-deployment care of soldiers. Kimbrough pharmacists are building bridges of care for our military heroes and their families.

At the Diabetes Medical Management Clinic in the VA San Diego, the clinic is run by pharmacists and provides integrated care that covers not only diabetes, but hypertension, lipids, food choices, activity, adherence, and motivation as well.

Pharmacists at the VA San Diego are helping patients improve their personal goals. These pharmacists are bridging the care gaps and changing lives as a result.

In both the ambulatory and primary care space, we are accomplishing great things. But we need to continue to push for progress in this area…

In both the ambulatory and primary care space, we are accomplishing great things. But we need to continue to push for progress in this area, particularly on the issue of provider status for pharmacists. We all must get behind ASHP’s assertive advocacy in Congress and reach out to our own senators and representatives to make sure they know that pharmacists can improve patient care.

We must achieve provider status recognition for pharmacists’ critical role in ambulatory care, primary care, immunizations, and medication therapy management.

And we must create the kinds of sustainable business models that ensure pharmacists are compensated for their expertise and training.

Bridges to Interdisciplinary Care

We are now carving out our essential roles in patients’ lives as well as our place in patient-centered medical homes. But we need to build more bridges to interdisciplinary care. Team-based care will require patients to actively participate in their own health and wellness through disease prevention, treatment, and monitoring to ensure the best outcomes.

Ladies and gentlemen, you can’t build a bridge without architects, engineers, builders, and inspectors. Likewise, patient care cannot be effectively rendered without physicians, nurses, pharmacists, care management, the entire allied health team.

Consider the work of the healthcare team at the Mountain Area Health Education Center in Asheville, N.C. Pharmacists there manage specialty clinics in anticoagulation, osteoporosis, and care transitions. Multidisciplinary teams collaborate, and pharmacists expertly manage drug selection, titration, and monitoring. Interdisciplinary care and optimal patient outcomes are the drivers for everything this team does.

Bridges Within Our Profession

This example raises the obvious question. How can we inspire our future leaders to provide this kind of care? How can we energize accomplished clinicians with new insights? And what must we do to equip our successors so that they can become leaders, coaches, teachers, motivators, and strategists?

We must clear out any barriers that block both their individual growth and our progress as a profession. Every pharmacist must be prepared to lead.

It is clear to me that simply relying on a pharmacy education that is years behind us and only investing in modest continuing education efforts will not be enough to help us become optimal patient care providers.

Pharmacists must begin to care for the whole life of the patient.

Pharmacists must begin to care for the whole life of the patient.

As a strong supporter of Continuous Professional Development—or CPD—for all members of our workforce, pharmacists and pharmacy technicians, I believe each individual must play an engineer’s role in the construction of new bridges to our future.

CPD is the means by which people maintain, develop, and advance their professional skills and knowledge. It is a structured approach to learning that helps ensure advancement of competencies to practice, taking in new knowledge, skills, and practical experience. CPD is a way to practice at the top of your license.

At my institution, I ask that every pharmacist and pharmacy technician develop his or her own Continuous Professional Development Plan. Individuals are encouraged to stretch beyond their reach to develop skills for future practice.

This includes innovations related to practice advancements, lean transformation activities, practice-related competencies, specialty certifications, preceptor development, and teaching certificates. These activities are designed to enhance the training, competency, and performance of every pharmacist and technician.

As a guide for your individual CPD plan, I am reminded of a quote by Arthur Ashe: “Start where you are. Use what you have. Do what you can.”

Lee Memorial’s support and encouragement of CPD plans is helping to enhance pharmacists’ and pharmacy technicians’ contributions to patient care, and it is propelling our profession forward.

Bridges We Must Build

The message I want to leave you with today is that it is time for all of us to build bridges to the future… connections that will allow us to take on new roles that will benefit our patients.

It is time for full utilization of pharmacist skills as THE medication therapy expert.

It is time to create seamless delivery of care to our patients.

Pharmacists and pharmacy technicians are poised to optimize patient outcomes through inter-disciplinary medication management. As you attend the rest of the Summer Meetings then head back to your practice sites, I hope you’ll keep the following in mind as we all work to advance the care of patients:

1) We must improve continuity of care for every patient through advancing pharmacists’ role in ambulatory and primary care.

2) We must become team based, collaborative care leaders.

3) We must achieve provider status for pharmacists.

4) We must individually dedicate ourselves to robust continuing professional development.

If you were to ask me to pick the most important of these four, it would be CPD. That’s because continuing professional development will help us to maintain practice excellence, will enhance the chances for achieving provider status, and will elevate pharmacists’ role as patient care providers.

In closing, I will paraphrase a portion of the poem “The Bridge Builder” that I mentioned at the start of today’s remarks:

“To our patients may a pitfall be.
They, too, must cross in the twilight dim;
Good friend, pharmacists are building the bridge for them.”

Let’s build those bridges!

Thank you!

 

June 3, 2015

White House Forum on Antibiotic Stewardship

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

Paul W. Abramowitz, Pharm.D., Sc.D. (Hon.), FASHP

I HAD THE PLEASURE YESTERDAY of participating in an invitation-only event at the White House on antibiotic stewardship.  In March, President Obama released a National Action Plan to Combat Antibiotic-Resistant Bacteria, which outlined key actions to be taken or overseen by the Departments of Health and Human Services (HHS), Defense, State, Agriculture, and Veterans Affairs; Centers for Disease Control and Prevention (CDC); and other federal agencies.  The event was part of that initiative.  The morning session started with comments from Secretary of Health and Human Services Sylvia Burwell, Secretary of Agriculture Tom Vilsack, Director of the CDC Tom Frieden, and the Assistant to the President for Science and Technology Policy John Holdren.

The Forum included almost 150 leaders from many sectors of society, including CEOs and other officials of various healthcare organizations; agriculture, food, and pharmaceutical industries; consumer groups; and other stakeholders, all working together toward the development of solutions to minimize the spread of bacterial resistance and to improve antibiotic use.  It was truly an honor to be there representing our members and the patients they serve.

As you know, ASHP and its members have played major roles in antimicrobial stewardship and infection control efforts for many years.  Pharmacists have integral roles on hospital antimicrobial stewardship teams, and from a public health perspective are major forces in protecting our increasingly fragile antibiotic armamentarium.  It was clear to me as I listened to the speakers and participated in the breakout sessions that the White House, CDC, and the other stakeholders all viewed pharmacists as an essential part of the solution to the problem of bacterial resistance and believed that pharmacists can greatly contribute to improving antibiotic use and thus patient care.

During the White House Forum, I spoke to the work ASHP and its members have done for decades to improve antimicrobial use in hospitals, clinics, and other settings, adding  that ASHP and its members are prepared to help advance this important effort in any way we can. I noted that ASHP National Survey data shows that only about 50 percent of hospitals have antimicrobial stewardship programs in place, and that we would like to work through the President’s initiative to help to significantly increase that number.  I also noted that electronic health records need to be further enhanced to better support stewardship efforts, and that new or expanded methods to provide smaller facilities with access to stewardship programs through telehealth and others means need to be considered and supported.

I believe there was enthusiasm among the various stakeholders and senior members of the Obama administration and CDC about these ideas, and we look forward to working with them soon to help prioritize and take action on these and other ideas brought forth by the leaders present at the Forum.

In a letter sent by ASHP to the CDC prior to the Forum, we made a number of commitments, including conceptualizing the development of pharmacy-specific metrics for antibiotic stewardship programs that could potentially become part of a larger national effort and database.  We also discussed the roles ASHP could play in fostering interdisciplinary education, standards development, research, and collaboration.

I believe that something very important for our patients and overall public health started yesterday at the White House Forum on Antibiotic Stewardship.  Further, we know that pharmacists are a necessary part of the solution to this significant public health and patient safety problem.  I look forward to engaging the expertise and passion of ASHP’s exceptional members in taking advantage of this important opportunity to preserve and foster the growth and development of lifesaving antibiotics.

Paul

June 2, 2015

UI Hospitals and Clinics Smart Pumps Project Reduces Errors

Filed under: Clinical,Current Issue,Feature Stories,Innovation,Managers,Quality — Kathy Biesecker @ 12:47 pm
University of Iowa Hospitals and Clinics' new pump-EMR integration has resulted in a significant decrease in manual pump programming and increase in compliance.

University of Iowa Hospitals and Clinics’ new pump-EMR integration has resulted in a significant decrease in manual pump programming and increase in compliance.

IN FEBRUARY 2014, University of Iowa Hospitals and Clinics (UI Hospitals and Clinics) in Iowa City began electronically integrating its intravenous (IV) infusion pumps and electronic medical record (EMR).

The primary goal? Increase patient safety by preempting inaccurate manual keypad entries when programming infusions at the pump. Studies have shown that IV medication errors are associated with a high likelihood of patient harm compared with other routes of administration.[i]

A Huge Patient Safety Win

“Anytime you can automate a process, you remove the potential for human error,” said Jeff Killeen, Pharm.D., manager of pharmacy informatics with UI Hospitals and Clinics.

“Integrating our pumps with the EMR closes the gap between what happens after the prescriber orders a medication and what happens at the infusion pump,” he noted, adding that an additional goal was to prevent transcription errors that can occur when pumps are programmed manually. “Eliminating that source of mistakes is a huge patient safety win for any organization.”

Jeff Killeen, Pharm.D.

Jeff Killeen, Pharm.D.

Pharmacists still verify the IV medication orders after they are entered into the EMR but now, the order is confirmed by a nurse and sent wirelessly to the pump. The nurse then verifies the medication details on the pump and starts the infusion, which documents the entire process and updates the EMR. This completes the data loop.

“The process is safer for the patient. The fact that there is less manual programming of the pump means there are far fewer chances for errors,” said Pamela Kunert, MSN, RN-BC, nurse practice leader in nursing informatics at UI Hospitals and Clinics. She added that in cases of downtime, manual programming is still used.

Increasing Compliance, Reducing Workarounds

The 700+ bed academic medical center (which includes a 190-bed children’s hospital) has steadily rolled out the pump-EMR integration across the entire health system. By early June, the initiative will be complete, according to Chief Pharmacy Officer Mike Brownlee, Pharm.D., M.S., FASHP.

Dr. Brownlee has already documented a significant decrease in manual pump programming as well as a jump in compliance from 86 percent to 92 percent for staying within upper and lower pump “guardrail” limits.

“That doesn’t sound like a big increase, but when you’re making hospital-wide changes like this, even a one percent increase in compliance is difficult to achieve,” said Dr. Brownlee.

Because infusion pumps are usually operated in isolation and manual keypad entry remains an enduring source of miscues, uncertainty about which drug and what dose a patient actually receives has been a nagging concern, added Alison Woods, Pharm.D., director of ASHP’s Section of Pharmacy Informatics and Technology.

Often, in fact, the pharmacist doesn’t find out for quite some time that a nurse has keyed in order information incorrectly or overridden safety stop “guardrails” on a pump.

“Pump integration creates much-needed transparency for all healthcare providers in the loop because now everyone knows with confidence what’s being administered, at what dose, and at what rate of delivery,” she said.

“That transparency creates an environment that no longer relies on reacting to mistakes and fixing problems retroactively after a patient has been harmed. This use of smart technology creates an efficient and safer patient care environment.”

Improved Efficiency Leads to Fewer Errors

The new system’s impact on pharmacist workflow has been very positive, according to Dr. Killeen.

“Before we had pump integration, the pharmacist had to manually check on factors such as infusion rates, current dose, and duration of infusion. Often this meant they had to physically check the pump itself,” he said. “If anything, the change has made our pharmacy team’s work easier because all of that information is tracked and displayed automatically in nearly real time within our EMR.”

…Nurses don’t have to worry about keypad entry errors. So, when an alert on the pump does occur, they know it’s something they need to pay attention to.

Dr. Killeen also noted that pump integration has meant a substantial reduction in the number of safety alerts, which has led to a corresponding drop in manual workarounds on the nursing administration side.

“When the order parameters are properly set up through the EMR with corresponding configuration in your smart pump library and pump integration is used, nurses don’t have to worry about keypad entry errors,” he said. “So, when an alert on the pump does occur, they know it’s something they need to pay attention to.”

Gaining Buy-In from Stakeholders

The sizeable benefits created by the pump-EMR integration didn’t come easily, according to Dr. Killeen, who emphasized the enormous amount of resources and resolve required to plan and execute the project.

“This type of system-wide project isn’t something to approach lightly,” he said. “It’s not something you can lump in and implement with other day-to-day changes.

“For such a large project to succeed, you must determine well ahead of time the resources you’ll need to carry it out and make sure they will be available.”

It took several pharmacists and pharmacy technicians six to nine months of very time-intensive work throughout planning and roll out along with countless hours spent by nursing staff, he said.

Dr. Killeen also underscored the importance of support from institutional leadership and from every area affected by the project.

“I wouldn’t even think about doing this if we didn’t have backing from at the very least the chief nursing officer, the chief pharmacy officer, and the chief medical officer,” he said. “Take your time and do it right; once you do, it’s definitely worth it.”

–By Steve Frandzel

 

[i] Proceedings of a Summit on Preventing Patient Harm and Death from IV Medication Errors. American Journal of Health System Pharmacy, Dec 15, 2008;65:2367-2379.

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