Nurses and pharmacists partner for patient safety

Collaboration, teamwork emphasized

Seeking a shared vision for safe medication use in hospitals in the face of continuing work force shortages, leaders of five nursing and pharmaceutical organizations recently gathered in Washington, DC, to discuss how they could work together to achieve this common goal.

The meeting was convened by the American Association of Colleges of Nursing, the American Association of Colleges of Pharmacy, the American Nurses Association, the American Organization of Nurse Executives, and the American Society of Health-System Pharmacists (ASHP).

"The ideal construct in improving patient safety in the hospital setting should be a multi-stakeholder one," notes Kasey K. Thompson, PharmD, the ASHP’s director of patient safety.

The objectives of the session were to:

  • develop a shared vision of ideal medication distribution and administration in hospitals, including better utilization of nursing and pharmacy work forces;
  • recommend approaches to improve medication use in hospitals so as to ensure patient safety and therapy effectiveness.

Shortages shape vision

The overarching issue was patient safety and how nurses and pharmacists could collectively improve it, but the nagging issue of work force shortages was a strong presence. "We recognized that these are two professions with work force challenges," notes Thompson. "We also recognized that while, yes, we have a short supply, we also may not be using staff optimally."

For example, he offers, pharmacists may be performing too many technical functions and not enough patient care functions. "It may be the same with nurses," Thompson says. "Among the things we discussed was a model for redeployment."

Another charge the organizations placed on themselves at the beginning of the session, says Thompson, was to talk about revolutionary changes — as opposed to quick fixes — to better improve patient care.

"The thinking went in very diverse directions, such as a broader framework around better deployment and advocating for more effective use of information technology; not just better use, but more logical design that takes into
consideration how we do our work and how patients require care," Thompson observes. "For example, my organization is a strong supporter of bar-coding. Logically designed systems are effective almost 100% of the time; they increase nurse satisfaction and they decrease patient harm. But in some cases, nurses have not been involved in the decision-making processes of bar-coding, and you can end up with devices with fonts that are too small or a battery life that is too short."

Systems approach recommended

Based on his impressions of the executive session, Thompson came away with this possible model for a vision statement: "Hospitals will function as high-reliability organizations in which nurses, pharmacists, and other health professionals collaborate on teams to provide systems-oriented, evidence-based patient care to ensure the safe and effective use of medications."

While the statement has yet to be edited and finalized, Thompson identified these common themes from the executive session as steps that need to be taken to achieve that vision:

  • All hospitals should adopt a systems approach to medication use.
  • Health care professionals must be given the opportunity to practice in a safe, collaborative, and information-rich culture.
  • Hospitals should maintain an ongoing feedback system for quality improvement.
  • Hospitals must be appropriately staffed.
  • Decision-making must be evidence-based and standards-driven.
  • Caregiving must be supported by verified technology.
  • Health care professionals must have access to the resources necessary to deliver highly reliable, safe, and effective care.

While conceding that many of these points are obvious, Thompson is quick to emphasize that doesn’t mean they are universally practiced. "In many cases, we do not now have safe, collaborative, team-based systems," he says. "These are system issues that impact the whole industry. In order to help us get to specific problems, we have to achieve these goals."

Nor, he adds, does evidence-based, standards-driven decision-making occur consistently. "Not every stakeholder in health care would agree this is the best way to go," he says, "but this group did. From a clinician’s standpoint, and from the standpoint of hospitals and accrediting bodies, this is big news."

Thompson emphasizes that the Washington, DC, meeting was just a first step. The next steps, he says, will be to continue to meet and to broaden the list of stakeholders. "Broadly, we are looking to involve physicians and major accrediting bodies," Thompson says. "We are already involved, for example, with JCAHO [the Joint Commission on Accreditation of Healthcare Organizations] in the development of patient safety goals."

Need More Information?

For more information, contact:

• Kasey K. Thompson, PharmD, Director, Practice Standards and Quality Division, and Director, Patient Safety, American Society of Health-System Pharmacists, 7272 Wisconsin Ave., Bethesda, MD 20814. Telephone: (301) 657-3000, ext. 1270. Fax: (301) 664-8862. Web: www.ashp.org. E-mail: kthompson@ashp.org.