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by Steve Kessinger
"Optimizing patient outcomes through interdisciplinary medication management" is our pharmacy department's purpose. Let me elaborate on our recent transition to fulfill that objective.
The implementation of an electronic medical record (EMR) system has profoundly affected efforts to improve medication safety and advance pharmacy practice. Perhaps the most noteworthy endeavor has been the implementation of computerized physician order management (CPOM) functionality. Prior to this project, copies of hand-written medication orders were scanned to the pharmacy department for manual transcription into a patient's medication profile.
Pharmacists spend most of their time reviewing and transcribing handwritten information into electronic data. Once a day, a paper copy of the medication administration record (MAR) was printed on the nursing unit. Nurses manually recorded doses administered and made hand-written changes to this medical record document as the medical staff made drug therapy changes during the day.
These manual processes were problem-prone, subject to frequent illegibility issues, and relied on the unique skill and experience of the pharmacist to decipher the handwritten art form.
With CPOM implementation, prescribers electronically transcribe their own medication orders into the patient record. New or modified orders are transmitted to an electronic-verification queue, where a pharmacist reviews them for appropriateness, drug interactions and contraindications. The verification process significantly reduces the amount of time pharmacists spend managing medication orders.
When medication related problems are identified, the pharmacist consults with the prescriber to modify the order or change the therapy. CPOM also has facilitated the medication reconciliation process on admission, transfer and discharge. A cumbersome paper process with multiple handoffs has transitioned to a fully functional electronic process. Pharmacists and pharmacy technicians assist in the emergency department with obtaining medication histories on admission and updating existing information when applicable.
The MAR, which is a history of medications administered to patients during their stay, has been transformed from a 24-hour paper copy to a real-time electronic version (eMAR). As prescribes added, modified or discontinued medication orders, the eMAR instantaneously updates. Prior to this, a delay of several hours would often occur before the order was manually processed through multiple handoffs from prescriber to unit secretary/nurse to pharmacist.
EMR functionality also integrated bedside barcode medication administration (BBMA) into nursing practice. The barcode on the patient armband and each medication dose is scanned prior to administration. If the drug, dose or patient does not match the current medication order, a warning alerts the nurse. With very few exceptions, this is essentially a fail-safe system. More than 1.5 million doses were recorded as administered at Florida's Cape Coral Hospital in 2013.
Although our pharmacists always have been involved in clinical drug monitoring activities, the time gained from CPOM has been instrumental in decentralization of clinical pharmacy services. In simple terms, pharmacists are out of the main pharmacy and deployed directly on the nursing units where they can freely consult with patients, nursing staff, medical staff, social workers and other healthcare providers to effectively, efficiently and proactively manage medication related issues. Pharmacists are deployed in the emergency department, the intensive care unite, and almost all of the medical/surgical units at least one full-shift a day.
In closing, here are some key goals the pipeline:
Steve Kessinger has been the pharmacy director at Cape Coral Hospital, in southwest Florida, since September 1996. He is a graduate of St John's University in New York, with a BS and MS degree in Pharmacy and an MBA from Florida Gulf Coast University.
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