Implementation and evaluation of an EHR-integrated mobile dispense tracking technology in a large academic tertiary hospital.

PURPOSE: The purpose of this study was to evaluate the impact of implementing an electronic health record (EHR)-integrated mobile dispense tracking solution. METHODS: This quasi-experimental study was conducted at Houston Methodist Hospital. The study timeframe consisted of 1-year pre- and postimplementation phases, with a 1-month washout period. The medication tracking function was implemented in a multiphase approach. The primary endpoint was the weekly redispense rate due to missing medication or delay in delivery. The secondary endpoints were total redispenses due to missing medication or delay in delivery per 1,000 medication messages and per 1,000 inpatient discharges and dispense tracking scanning compliance post implementation. RESULTS: Analyses demonstrated a sustained decrease in redispenses from 3.24% to 2.70% (95% CI, 0.10-0.60; P = 0.006). The study also demonstrated a statistically significant decrease in redispenses per 1,000 medication messages from 190 to 127 (95% CI, -27.21 to -4.23, P = 0.008). Analysis of redispenses per 1,000 patient discharges showed a nonsignificant reduction after implementation from 216 to 194 (95% CI, 54.63 to -77.71; P = 0.730). The department achieved 90.7% dispense tracking compliance. CONCLUSION: EHR-integrated mobile dispense tracking technology effectively reduced the redispense rate and total redispenses normalized to medication messages for missing medication and delay in delivery. Interprofessional collaboration and effective change management strategies are essential to the successful implementation of medication dispense tracking technology.

Systemization of a pharmacy technician career ladder in a multi-hospital system.

Purpose: Hospital consolidation into larger, systemized health systems has enabled system-wide standardization of promotion processes, including pharmacy technician career ladders. However, whether system standardization affects the job satisfaction or outcomes of pharmacy technicians is unknown. The purpose of this project was to assess pharmacy technician perceptions and outcomes after systemization of a pharmacy technician career ladder. Methods: Pharmacy technician satisfaction scores and outcomes (promotion and turnover rates) were assessed in an eight-hospital health system before and after systemization of a pharmacy technician career ladder. Results: Two hundred and forty-nine pharmacy technicians were employed during the pre-intervention (n = 104) and post-intervention (n = 145) time periods. One hundred and twenty-three of 145 (84.83%) pharmacy technicians completed a job satisfaction survey after implementation of the system-wide technician career ladder. Overall satisfaction for the career ladder averaged 3.8 ± 0.61 or between neutral to positive satisfaction. There was no difference in total satisfaction regardless of teaching (3.8 ± 0.59) or community hospital (3.8 ± 0.63) location (p = 0.53) or stratifying by Pharmacy Technician status. A total of 50 pharmacy technicians were hired during the study period, either during the pre-implementation (n = 36) or post-implementation (n = 14) time periods. Time to the first promotion averaged 1.73 ± 1.00 years in the pre-implementation period and 1.36 ± 0.55 years in the post-implementation period (p = 0.20). Technician voluntary turnover was similar between the time periods. Conclusion: In conclusion, the standardization of a systems-level pharmacy technician promotion ladder from a single hospital to a systems-level was associated with positive job satisfaction and similar promotions and turnover rates as the historic, single hospital-based promotion ladder.

Second victim syndrome and the pharmacy learner.

This commentary describes the concept of second victim syndrome and its application to pharmacy learners and preceptors. Although there is published literature regarding implementation of second victim syndrome programs at an institutional level, there is limited guidance regarding the second victim syndrome in the context of a pharmacy training environment; however, there are known risk factors such as medication safety events, failure to rescue events, or overall lack of experience of a clinician. With a growing awareness of the mental health concerns of health care providers, this is a potential area for growth and skill development for pharmacists of all levels. As pharmacy leaders and role models, we have a fundamental ethical responsibility to take care of our learners, particularly when it comes to emotionally challenging patient care scenarios. By giving a name to what our learners may be experiencing, the second victim syndrome, we can progress toward improving the well-being of these learners and increase their ability to be effective pharmacists. Involvement with medication safety events or patients with negative outcomes has been shown to have adverse professional outcomes, and this article describes steps that can be taken by preceptors and peers to help facilitate professional growth and recovery. Second victim is an underappreciated phenomenon that can have a profound impact on pharmacists' well-being. Strategies for proactive recognition and intervention are vital.

A systematic approach to optimize electronic health record medication alerts in a health system.

PURPOSE: The effectiveness of a systematic, streamlined approach to optimize drug-drug interaction alerts in an electronic health record for a health system was studied. METHODS: An 81-week quasi-experimental study was conducted to evaluate interventions made to medication-related clinical decision-support (CDS) alerts. Medication-related CDS alerts were systematically reduced using a multi disciplinary healthcare committee. The primary endpoint was weekly overall, modification, and acknowledgement rates of medication alerts after drug-drug interaction reclassification. Secondary endpoints included sub analysis of types of medication alerts (drug-drug interaction and duplicate therapy alerts) and alert use by providers (pharmacist and prescribers). Data was analyzed using interrupted time series regression analysis. RESULTS: After implementation of the new alert system, total number of weekly inpatient alerts decreased from 68,900 (66,300-70,900) and 50,300 (48,600-53,600) in the postintervention period (p < 0.001). The perentage of alerts acknowledged weekly increased from 11.8% (IQR, 11.4-12.1%) in the preintervention period to 13.7% (IQR, 13.3-14.0%) in the postintervention period (p < 0.001). The percentage of alerts that were modified also increased from 5.0% (IQR, 4.9-5.3%) in the preintervention period to 7.3% (IQR, 7.0-7.6%) in the postintervention period (p < 0.001). Both increases were primarily seen with pharmacists versus other healthcare professionals (p < 0.001). CONCLUSION: A committee-led systematic approach to optimizing drug-drug interactions facilitated a significant decrease in the overall number of alerts and an increase in both medication alert acknowledgement and modification rates.

Implementation and evaluation of a sterile compounding robot in a satellite oncology pharmacy.

PURPOSE: The purpose of this study was to quantify the impact of robotic technology on efficiency, accuracy, and cost in a satellite oncology pharmacy. METHODS: A 33-week quasi-experimental study was conducted at an academic, quaternary care institution with 1,119 licensed beds from June 2016 to February 2017 to evaluate the turnaround time (TAT) for preparations compounded by automated robotic compounding technology (ARCT) versus historical procedures. Secondary endpoints included mean preparation time and percentage of doses with a TAT of <30 minutes before and after the implementation of ARCT and were evaluated using time-segmented regression analysis. The cost savings in the satellite oncology pharmacy was determined by comparing usage of closed-system transfer devices (CSTDs) and labor costs between study phases. Accuracy of the intervention was expressed through a descriptive analysis of mean ARCT dose preparation deviations and preparation failures. RESULTS: Data for 1,453 preparations were included for analysis. The mean ± S.D. preimplementation TAT was 64.1 ± 27.9 minutes, which decreased to 53.2 ± 32.2 minutes after ARCT implementation (p < 0.01). Financial benefit was demonstrated through supply cost savings. Breakeven was estimated at 8.6 years after capital expenditure, with an annualized projected savings of $129,477. The mean ± S.D. deviation of the doses compounded using ARCT was -0.58% ± 0.01% from the ordered dosage. CONCLUSION: Adoption of ARCT for compounding of admixtures containing 4 oncology agents reduced TAT and preparation time and led to lower expenditures for CSTDs.