March 5, 2004
Forget your image of the hospital pharmacist laboring behind a desk, counting pills out of large bottles. The hospital pharmacy has leaped out of that 19th century stereotype and into the 21st century using technology that is redefining the pharmacist?s role in patient care.
?The pharmacist has emerged as a key partner in the patient care team,? according to Pam Swarny, Director of Clinical Pharmacy at Union Hospital. ?The key has been getting the pharmacist out of the pharmacy and into the hospital?s patient care areas working alongside the physicians, nurses, dietitians, and other professional caregivers.?
Union Hospital has adopted a Decentralized Pharmacy System that frees the pharmacist from the traditional flow of paper that had the doctor and patients at one end and the pharmacist and paperwork at the other.
Now, when a patient?s doctor orders a medication, the pharmacist is able to implement the order from any nursing unit in the hospital. The pharmacist may have already consulted with the physician in person, discussing medication alternatives, treatments, dosages, and possible side effects. Swarny says that involvement in treatment decisions would not be as likely if the pharmacist was ?tied to the paper? in the basement location of the Pharmacy.
Paula Worth, a pharmacist at Union Hospital, consults with registered nurse Janet Ferrell about a patient's medications. The Decentralized Pharmacy System enables the pharmacist to be more closely involved with the patient care team.
Dispensing medications in the hospital has been revolutionized by the Pyxis technology systems. Twenty Pyxis units are located around the hospital, each securely holding hundreds of medications.
Swarny says the hospital?s Pyxis system dispenses approximately 82,000 patient medication doses per month. The process begins when the physician enters a medication order into the system. The reviewing pharmacist on the nursing unit reviews the order and confirms the medication?s availability in the Pyxis unit. The nurses use a touch screen on the Pyxis units to call up the patient?s medication orders. After proving the nurse?s identity with a fingerprint scan, one of a dozen drawers on the Pyxis unit slides out and a small section opens to reveal only the proper medication and dosage required.
Pam Swarny, director of clinical pharmacy at Union Hospital, is checking the hundreds of medications contained in one of the Pyxis units located throughout the hospital. The machine verifies identity by scanning a fingerprint to allow access to authorized medications and provides a complete record of each transaction for security and inventory control.
Swarny says the Decentralized Pharmacy System has clearly transformed the pharmacist?s role at Union Hospital. ?Since pharmacists have come out of the basement and up to the patient floors we?re averaging 1,200 physician consultations or therapeutic interventions every month.?
Swarny says the Decentralized Pharmacy System has the potential to reduce medication errors in every step of the process. There are fewer delays in getting the prescribed medications to patients, and the pharmacists have much more time for clinical care of patients. When certain drugs are prescribed Swarny says a ?therapy review? is triggered, further ensuring that the medication is appropriate and its use is monitored for safety.
The Decentralized Pharmacy System has been made possible thanks to a $278,000 federal grant for the purpose reducing medical errors. Union Hospital was one of four hospitals, members of the Independent Hospital Network, to receive such a grant. The others include Alliance Community Hospital, Pomerene Hospital in Millersburg, and Dunlap Hospital in Orrville.
In addition to providing the computerized pharmacy order entry system equipment, the grant money was used to purchase 25 new crash carts, each identically equipped. Swarny says that standardizing the crash carts enables hospital staff to know exactly what they?ll find on the crash cart regardless of where the ?code blue? takes place in the hospital.
The hospital's "Temp Track" system monitors the temperatures of refrigerated drugs kept in nursing stations around the hospital. Pharmacist Glenn Wisse is viewing the temperature record of one refrigerator in the hospital. The system will alert the staff anytime the temperature varies beyond the allowable range.
The federal grant money has also paid for a ?Temp Track? system to closely monitor the temperatures of refrigerated drugs. The system checks temperatures 96 times a day and sends an alert if the temperature varies outside an allowable range ensuring that refrigerated medications are constantly stored at the correct temperature.
Pharmacy services at Union Hospital are using new technology to free the pharmacist from the paper trail and pill bottles. Swarny says the pharmacist has become much more involved in the patient care team and is using technology to make that care safer by reducing the chance of errors.
Swarny says Union Hospital often hosts site visits from other hospitals and who wish to emulate the use of technology and the Decentralized Pharmacy model.