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Experts offer these tips on how to get the most out of electronic program
Optimize medication management
Hospital system pharmacies can improve how they use electronic medication management and tracking programs by following expert advice.
For example, some nonprofit hospitals might track information that will assist them in keeping their tax-exempt status.
"We track our hours of teaching, and every time we have an interaction with a surgical resident, we submit it to our administration," says Mark Mills, PharmD, BCPS, clinical coordinator of St. John Medical Center.
Or hospitals might use the data for research purposes.
"We're in the early stage of a collaboration with Clemson University researchers," says Lynn Ethridge, PharmD, manager of pharmacy informatics at the Greenville Hospital System of Greenville, SC.
"Anytime we need to call a physician to have a drug, dose, or interval adjusted, we call that a near-miss event," Ethridge says. "So we're starting to look at that information as a means to measure near-misses medical events."
Mills and Ethridge offer these suggestions for other ways to maximize data and value from an electronic medical management and tracking system:
• Give feedback to staff: "We present information to staff at staff meetings to let them know how we're doing as a department and to give them a sense of ownership," Ethridge says.
"We show that we're not just plugging in numbers to the database every day, but we're actually using them for a good purpose," she adds. "We want to show our administration that we're doing things above and beyond entering orders in a computer."
The pharmacists' extra work in capturing the interventions and other data will help justify their jobs and their salaries, Ethridge says. "Pharmacists are not cheap."
The medical management and tracking data illustrate how hard pharmacists are working, and it's important to let the pharmacy staff hear kudos.
"We show our staff what a great job they're doing because in the grind of everyday work they don't always get that feedback," Ethridge says. "We show them how this is great, and we give them a pat on the back."
When the Greenville Hospital System's pharmacists first learned how many interventions they were logging in each month, they were surprised, Ethridge recalls.
"We'd never measured that part of their jobs before," she says. "We were able to capture when they entered orders and new starts, but we couldn't show them how they made this number of interventions in a month."
Now managers can tell pharmacists how many times they positively impacted patient care and lowered length of stay, she adds.
• Use electronic program to target specific interventions: "We have pharmacists who target specific interventions, such as fall prevention, renal dosing," Mills says. "They enter those interventions into the electronic program and track them."
The pharmacists are assigned specific duties, such as targeting patients who are receiving a particular medication, he says.
"They evaluate those patients and document the outcomes in the program," Mills says. "Pharmacists also do renal dosing and evaluate patients who might be on medications that cause them to be at high risk for falls."
It's fairly simple to create new fields for intervention tracking and to eliminate fields that are no longer necessary, he adds.
"For a while we tracked the pneumococcal flu vaccine," Mills explains. "Then that number stabilized and the hospital was doing well on that measure, so we're just not documenting it any more."
The data still are being collected, so if it ever becomes a problem again, it can again become a field that's pulled out and reviewed, he adds.
• Lobby for more staff, showing medication management data: "We've added more staff to the clinical department based on the information," Ethridge says.
As the Greenville Hospital System adds services, such as an ambulatory care clinic and a vascular service to improve outcomes, then pharmacists are hired to support those patients and physicians, she explains.
"We've added an anticoagulation pharmacist position and are actively seeking to fill that position," Ethridge says. "We anticipate increasing our risk avoidance savings in that area."
• Pull reports that compare data: "There's a global report that we run every month, and it tallies everything," Mills says.
For instance, the global report provides these tallies:
- total number of interventions;
- adverse event reactions;
- number of interventions per day; and
- total cost savings per day.
Mills can click on a pharmacist's name and see how many interventions he or she has reported.
"That's a good way to get an idea of what's going on with each individual pharmacist," he says.
"You can also create your own report on how many IV to POs you have," Mills says.
Also, Mills knows from the database that there were around 2,500 interventions in a recent month, and pharmacists have a high acceptance rate of 96% from prescribers.
"It helps having pharmacists on those teams," Mills notes. "We build rapport with prescribers, and they feel comfortable with us, so when we make suggestions they accept them."
• Track unapproved abbreviations: The Joint Commission of Oakbrook Terrace, IL, has a strict stance against unapproved abbreviations, Ethridge says.
"We use the program to capture both unapproved abbreviations and prescribers who use them so we can send information back to the medical staff that grants privileges to prescribers," Ethridge says.
For example, prescribers often abbreviate morphine sulfate as MS4 or MS. But these abbreviations also could be confused with magnesium sulfate, so they're supposed to spell it out to avoid having someone dispense the wrong medication, she explains.
"Doctors being extremely busy individuals tend to abbreviate, and it's a habit we have to get them out of for patient safety," Ethridge says.
Also, physicians are supposed to spell out the terms "four times daily" and "once daily," instead of using the abbreviations QID and QD, she adds.
"We put a laminated copy of the Do Not Use Abbreviations in every patient chart, and we put educational posters in nursing stations and lounges," Ethridge says. "We sent out notices to physicians and put it on the main GHS web site, and we published it in our medical staff newsletter."
Anytime a physician wrote a prescription with an unapproved abbreviation, pharmacy staff called the physician to let him or her know that it was an unapproved abbreviation, Ethridge says.
"We asked them to rewrite the order to an approved method of order logging," she adds. "Then we printed monthly reports per prescriber, sending them information and supporting data from the Joint Commission, about how they did."
Since focusing on this intervention through the medication management program, the hospital system has greatly decreased its use of unapproved abbreviations, she says.