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by Celia Renteria and Bob Goodwillie
Healthcare leaders understand that improving interdisciplinary teamwork is critical to success within the new performance-driven care delivery landscape. Because medication management processes are central to patient safety and outcomes, collaboration between nursing and pharmacy in particular is becoming a focal point of process improvement--often requiring organizations to take a hard look at existing culture in order to make the appropriate changes.
Establishing a chemistry of trust and open communication between nursing and pharmacy departments can be challenging, but when a healthcare organization finds that "sweet spot" where a collaborative approach to problem-solving comes naturally, everybody wins--especially the patient. At Yuma Regional Medical Center (YRMC), we've been able to maintain a successful nursing-pharmacy partnership for decades because it is built around the patient's needs as opposed to those of an individual department.
Effective collaboration between pharmacy and nursing has enabled us to identify and design medication management processes that create the most efficient workflows for both departments while keeping patient safety at the forefront. The result has been more nursing time at the patient bedside and cost reductions through greater efficiencies. Additionally, we've been able to allow our pharmacy staff to work at the "top of their license," maximizing their capabilities and expertise for higher quality care.
While there is no one-size-fits-all formula for success in building a collaborative culture, we've identified some best practices that lay the foundation to support long-term sustainability. These include:
1. Provide top-down resource support
One of the greatest catalysts to collaboration at YRMC is the presence of pharmacists on the unit floors to work with nurses, physicians and patients. Clinical pharmacists are available at YRMC on the nursing units 12 hours a day, seven days per week and by phone during the other 12 hours. This model has proven priceless for fostering understanding and respect between the two disciplines. Not only does this approach support greater collaboration, but it also improves patient care and workflow efficiencies as nurses are not continually calling the central pharmacy with questions.
While effective for building a culture of trust and open communication, this type of top-of-license approach to pharmacy resources can be a tough sell to C-suite leaders who face difficult financial decisions each day. Our pharmacy director has taken the approach of growing our pharmacy department by asking for just one pharmacist for one year. If the director can demonstrate the value of the pharmacist to the C-suite leaders, then the pharmacist stays and the process is repeated. However, success hinges on top-down support for pharmacy presence on nursing units, so it is critical to document patient safety and productivity benefits.
2. Improve workflows and patient care by leveraging automation
While the way pharmacy automation is deployed and used may vary from one hospital to another, pharmacy and nursing teams should work together to determine how to make the most of technology to improve workflows and patient care.
One best practice that we've observed is the use of tools such as bedside barcode scanning, automated dispensing cabinets (ADCs), robot technology and inventory management software to improve patient safety and medication management workflows. At YRMC, robot technology alongside ADCs allows the pharmacy to maintain lower inventory and use fewer staff resources, supporting more top-of-license work throughout the hospital. Leveraging more automation to improve workflow has allowed us to free up more time for pharmacists and nurses to give direct patient care.
3. Identify the best medication management model
There is no one-size-fits-all model for medication management processes, and every hospital must determine what best supports its goals, whether they include a centralized, decentralized or a hybrid model. YRMC determined a hybrid model would best support our patient safety goals while also reducing costs.
With our current process, all first doses are initiated from the central pharmacy via robot technology with the exception of stat, "pro re nata" (PRNs) and controlled medications. This model enables better inventory management as each ADC only has an average of 150 line items versus the 700-800 line items that is often required for stocking ADCs in other facilities. Most other medications are delivered to medication boxes outside of each patient room. This has also improved nursing workflows, allowing more time at the patient bedside.
4. Open interdisciplinary communication
Trust and transparency are the keys to successful collaboration. One way YRMC fosters these characteristics is through interdisciplinary representation on committees, including the Quality Council and Practice Council, as well as Clinical Nurse Educator meetings. We openly discuss issues and opportunities to identify process improvement strategies, and all parties avoid the "blame game"--with each taking responsibility for errors and working together to improve patient care. Both nurses and pharmacists gain a greater understanding of each other's workflow, and decisions on medication delivery processes are made together. The result is an increased resolve to collaborate.
The goal for all healthcare organizations is to provide safe, quality care to all patients. By focusing on the patient when developing medication management strategies and interdisciplinary initiatives, everyone benefitsâ€”nursing staff, pharmacy staff, hospital and patient.
Bob Goodwillie is the assistant pharmacy director and Celia Renteria is a clinical nurse expert at Yuma Regional Medical Center, a 406-bed hospital in Yuma, Arizona.
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