Small hospital's best practices in safety are highlighted in new national collaborative
Small hospital's best practices in safety are highlighted in new national collaborative
Pharmacists help improve patient outcomes
Paynesville (MN) Area Health Care System is proof that it doesn't take a large hospital system to become a model for high performance.
This 25-bed, critical access hospital is dedicated to including pharmacists in its clinical care, devoting three full-time pharmacists to its hospitals and clinics.
"We see patients in the clinic with physicians; we help manage diabetes, do diabetes education, anticoagulation management, and general medical therapy management (MTM), as well," says Todd Lemke, PharmD, CDE, director of pharmacy service.
The hospital has been recognized by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health & Human Services (HHS) of Rockville, MD, as one of 34 high-performing sites in the Patient Safety and Clinical Pharmacy Services Collaborative (PSPC). The PSPC is a new venture that currently has 68 participating teams nationwide.
Clinical pharmacy participation in diabetes care has resulted in positive outcomes, Lemke says.
"We found that when we had a pharmacist involved with patient care, we had a 1.6% decrease in A1C values vs. what we found with standard care," Lemke says.
"Also, we found that anticoagulation patients generally are more in range when pharmacists are working with them," Lemke adds. "Eighty-nine percent of our anticoagulation patients were in range, vs. 50% of patients not seen by us."
Patient satisfaction surveys also indicated positive outcomes for pharmacist involvement.
"When we do patient satisfaction surveys, we find that 98%-99% of patients are satisfied with what pharmacists provide for them," he says.
In other outcomes, the hospital found that 92% of patients were testing their blood sugar levels after receiving pharmacist care and interventions. This is compared to the 10% who were testing their blood sugar levels among the patients receiving standard care, he says.
Paynesville Area Health Care System has an outpatient clinic and satellite clinics in small towns, and the system's goals are to expand pharmacy clinical services, Lemke says.
"Right now, we have pharmacists making telephone visits with patients in those clinics, but we plan to start sending pharmacists out there," he says.
Plans are to send the health system's pharmacy residents to the satellite clinics to meet with patients, Lemke adds.
"The other thing that we've been doing on the clinic side is we're trying to fix medication reconciliation in the clinic where most of the medications are originating," Lemke says. "So, we've involved clinic staff in how to enter orders in the emergency medical record so it's done consistently across the board."
Some of the changes might include the following:
- Work flow: "We're looking at clinic visits and how that flow works and how mistakes happen," Lemke says. "We're looking at ways we can make the process more automated for nurses and physicians, so they don't have to go back to update their medication list."
- Electronic template: The idea is to use an electronic template in the electronic medical record that will automatically update when someone inserts new medications in the file, Lemke explains.
"It's working, but we're still in the initial stages of getting everyone to do it," he says. "We're trying to move forward from there, and think we're more likely to get cooperation from other providers when they see the benefits."
- Medication lists: This idea came from a team in the PSPC, Lemke notes.
"We're printing out medication lists to give to patients in the waiting room so they have their list when they come in and can make sure it's correct while they're waiting to be seen," he says.
"Previously, patients were asked if they had any medication changes," Lemke says.
But patients might not recall all of their medications or what has changed. So the list, which provides a personal itemization of their medication prescriptions, can assist their recall. Also, by giving patients the medication list before they meet with a nurse, the process now gives patients time to carefully look it over and circle anything they know they are no longer taking, he explains.
- Update EMR at discharge: "Our electronic medical record draws from all of our satellite clinics," Lemke says. "So the medication list includes information from wherever we saw patients in the health system."
The hospital pharmacist updates the clinical medication record list when the patient is discharged from the hospital, Lemke says.
This process ensures a more accurate list when the patient returns to the hospital or a clinic for a follow-up visit, he notes.
"That's our hospital discharge reconciliation plan," Lemke says. "It's not difficult to do because the hospital pharmacist easily can log into the medical record and update the information in the patient's chart."
One of the advantages to being a small health system is that it's easier for a hospital pharmacist to obtain permission to view medical record information in clinics, Lemke says.
"At a big health system, it's not as easy to make that happen," he adds.
Paynesville (MN) Area Health Care System is proof that it doesn't take a large hospital system to become a model for high performance.Subscribe Now for Access
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