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John Ascatigno, Assistant Pharmacy Director, and Fred Perino, Pharmacy Director.
There was a time when the main role of a hospital pharmacist was to make sure that nurses had adequate supplies of medications, which were kept in labeled bottles in locked cabinets on each hospital unit. When a medication was needed, the nurse would unlock the cabinet, take out the dose from the appropriate bottle and give it to the patient. There were few safety measures in place to ensure that the right medication in the right dose was given to the right patient.
This was obviously neither the safest nor the most efficient way to dispense medications.
With the use of integrated medical records and modern technology, however, the role of hospital pharmacists has changed dramatically, evolving from a supply function to one based on the attitude of “patient safety first.” Phelps is well ahead of the curve in the use of these advanced technologies, and in fact is among the top 1.6% of hospitals nationwide for their utilization, according to HIMSS Analytics, a subsidiary of the Healthcare Information and Management Systems Society.
“The technologies we use at Phelps are expected to become the standard for all hospitals in the future, but Phelps is leading the industry,” says Pharmacy Director Fred Perino. “Technology contributes immeasurably to ensuring the safety of our patients. For example, instead of working with handwritten doctor’s orders and paper charts, we receive clearly legible electronic orders and records. This is not only a safer method, it is more efficient. Greater efficiency gives our pharmacists more time to review each order thoroughly to ensure that the medication and dosage ordered is appropriate and safe for the patient.”
Computer Physician Order Entry (CPOE) and Medication Dispensing Stations
Nearly all Phelps physicians now enter orders for a patient’s medications into MEDITECH, a hospital-wide computer system that integrates all aspects of every patient’s medical care, including lab work, X-rays and medication administration. Because the number of handwritten physician orders has been significantly reduced, potential problems that can be caused by poor handwriting are prevented. Upon receipt in the pharmacy, the accuracy of all medication orders is verified by the pharmacist based on a review of the patient’s height and weight, age, proper dose, possible drug interactions, allergies, and the appropriateness of the drug for the patient’s condition or disease.
Assistant Pharmacy Director John Ascatigno explains: “With integrated medical records, we are much more involved with relating the medication ordered to the individual patient’s diagnosis. This allows us to intervene with physicians when needed, and to make recommendations regarding medication therapies for patients – one more way to ensure the safety of our patients. For example, pharmacists are able to monitor the renal function of every patient and adjust the doses of appropriate drugs based on how the kidney is functioning.”
Delivery of non-urgent medication orders takes place on the next scheduled delivery round, which occurs every hour. If the need for medication is more urgent, such as when pain medication is needed, nurses can obtain the drug from one of the PYXIS Medication Stations located at each nursing station. The nurse enters a code and the patient’s account number into the PYXIS machine and the medication is quickly and accurately dispensed. Details regarding drugs dispensed through PYXIS are integrated into MEDITECH and become part of the patient’s electronic record.
Bar Code Technology
Every dose of medication is electronically bar coded before leaving the pharmacy. At the patient’s bedside, a nurse or other professional uses a medication verification system scanner to scan the bar code on the patient’s wristband and the barcode on the medication. The two codes must match in order for the medication to be administered, thus ensuring that the right medication is given to the right patient. The scan also updates the patient’s electronic Medication Administration Record (eMAR), which allows all medical providers to view the entire medical record online, including if a drug was given, when it was given, who gave it, and any comments recorded by the nurse.
Unit Dose Dispensing System
The Phelps pharmacy has a robotic packaging device called the TALYST packager, which individually packages and barcodes each dose a patient is scheduled to receive over a 24-hour period, producing a long strip containing the full day’s doses. A pharmacy technician double-checks the robotic strip for accuracy, places it in a medicine bin designated for the patient, and adds any drugs that are not handled by the robot. A pharmacist then triple-checks all medication before the bins are sent up to the patient floors. No medication leaves the pharmacy unless it has been checked by a pharmacist.
Receiving medications in this easily identifiable and ready-to-use form means that nurses don’t have to spend time preparing and organizing medications and have more time to be with their patients. And pharmacists no longer have to spend time packaging items by hand.
Continuity of Care
Technology allows for a much better flow of information about a patient’s medications before, during and after a hospital stay, which contributes to patient safety. “Pharmacists, physicians and nurses all strive for continuity during every phase of a patient’s care,” says Perino. “With a computerized system, it’s easy to compare medications taken by patients before coming to the hospital with what they receive while they are here and help to ensure that the proper medications will be prescribed for them when they are discharged.”
“Our goal has been to develop the safest possible medication delivery system based on the technology available, combined with the expertise of our pharmacy staff. We are proud to have achieved that goal,” says Ascatigno.