Prospective daily review of discharge medications by pharmacists: Effects on measures of safety and efficiency.

PURPOSE: Results of a pilot project to improve the safety and efficiency of the discharge process by adding daily pharmacist review and preparation of discharge medication orders to an existing discharge medication reconciliation workflow are reported. SUMMARY: Due to patient capacity issues, the pharmacy department of a large tertiary medical center implemented changes to the existing medication discharge workflow. A steering committee was established, with subgroups responsible for workflow development, electronic medical record enhancement, and data collection designated. Patients admitted to 5 hospitalist services, 1 otolaryngology service, and 1 gynecology service were included in pilot testing of a new discharge workflow over a 7-week period. The new workflow included pharmacist daily prospective preparation of discharge medication orders by "pending" (i.e., managing all aspects of) orders for providers to sign. After implementation, a 22% relative reduction (p = 0.046) in pharmacist-identified medication-related problems was documented. Additionally, the proportion of discharges occurring before noon was increased on all services involved in the pilot project, including a significant increase (from 19% to 23%, p = 0.001) on the hospitalist services. Challenges identified during the pilot project included suboptimal initial provider acceptance and added pharmacist workload. On average, an additional 16.2 minutes of pharmacist time per patient was required for ordering of discharge medications throughout a patient stay. CONCLUSION: Implementation of a discharge process that incorporated pharmacist pending of discharge medication orders throughout the patient stay improved measures of safety and efficiency of the discharge process.

Interprofessional development and implementation of a pharmacist professional advancement and recognition program.

PURPOSE: The interprofessional development, implementation, and outcomes of a pharmacist professional advancement and recognition program (PARP) at an academic medical center are described. SUMMARY: Limitations of the legacy advancement program, in combination with low rates of employee engagement in peer recognition and professional development, at the UW Health department of pharmacy led to the creation of a task force comprising pharmacists from all practice areas to develop a new pharmacist PARP. Senior leadership within the organization expanded the scope of the project to include an interprofessional work group tasked to develop guidelines and core principles that other professional staff could use to reduce variation across advancement and recognition programs. Key program design elements included a triennial review of performance against advancement standards and the use of peer review to supplement advancement decisions. The primary objective was to meaningfully improve pharmacists' engagement as measured through employee engagement surveys. Secondary outcomes of interest included the results of pharmacist and management satisfaction surveys and the program's impact on the volume and mix of pharmacist professional development activities. Of the 126 eligible pharmacists, 93 participated in the new program. The majority of pharmacists was satisfied with the program. For pharmacists who were advanced as part of the program, meaningful increases in employee engagement scores were observed, and a mean of 95 hours of professional development and quality-improvement activities was documented. CONCLUSION: Implementation of a PARP helped increase pharmacist engagement through participation in quality-improvement and professional development activities. The program also led to the creation of organizationwide interprofessional guidelines for advancement programs within various healthcare disciplines.

Effective use of workload and productivity monitoring tools in health-system pharmacy, part 2.

PURPOSE: The current status of external and internal workload and productivity measurement systems and strategies to improve their use to maximize overall pharmacy department operational performance and staffing effectiveness are described. SUMMARY: The use of operational benchmarking is increasing within health systems as a tool for continuously measuring and improving departmental performance and evaluating departmental success. Unfortunately, software used for benchmarking purposes is available through a limited number of commercial vendors and consultants, and these systems are unable to effectively measure department operations and overall performance. The theoretical value of benchmarking and productivity measurement systems, including a description of the various definitions, tools, and data sources for comparing pharmacy productivity data, is summarized. The limitations of commercially available vendor productivity monitoring systems and desired strategies for improving their use are also reviewed. Preferred productivity and cost metrics for measuring pharmacy department effectiveness are suggested, and strategies for obtaining value from external and internal productivity monitoring systems are explored. CONCLUSION: Challenges with external operational benchmarking and internal productivity monitoring systems are numerous. These systems rarely measure the quality of pharmacy services provided and their effect on patient care outcomes and the total cost of care. Benchmarking vendors must modernize their software and develop internal checks to confirm data integrity in order to make their products more useful and reliable. In addition, data supporting the patient care role of the pharmacist should be integrated into all productivity monitoring systems and be used to demonstrate the positive impact of pharmacy services on the total cost and quality of patient care.

Effective use of workload and productivity monitoring tools in health-system pharmacy, part 1.

PURPOSE: The current status of external and internal workload and productivity measurement systems and strategies to improve their use to maximize overall pharmacy department operational performance and staffing effectiveness are described. SUMMARY: The use of operational benchmarking is increasing within health systems as a tool for continuously measuring and improving departmental performance and evaluating departmental success. Unfortunately, software used for benchmarking purposes is available through a limited number of commercial vendors and consultants, and these systems are unable to effectively measure department operations and overall performance. The theoretical value of benchmarking and productivity measurement systems, including a description of the various definitions, tools, and data sources for comparing pharmacy productivity data, is summarized. The limitations of commercially available vendor productivity monitoring systems and desired strategies for improving their use are also reviewed. Preferred productivity and cost metrics for measuring pharmacy department effectiveness are suggested, and strategies for obtaining value from external and internal productivity monitoring systems are explored. CONCLUSION: Challenges with external operational benchmarking and internal productivity monitoring systems are numerous. These systems rarely measure the quality of pharmacy services provided and their effect on patient care outcomes and the total cost of care. Benchmarking vendors must modernize their software and develop internal checks to confirm data integrity in order to make their products more useful and reliable. In addition, data supporting the patient care role of the pharmacist should be integrated into all productivity monitoring systems and be used to demonstrate the positive impact of pharmacy services on the total cost and quality of patient care.

Determining the feasibility of robotic courier medication delivery in a hospital setting.

PURPOSE: The feasibility of a robotic courier medication delivery system in a hospital setting was evaluated. SUMMARY: Robotic couriers are self-guiding, self-propelling robots that navigate hallways and elevators to pull an attached or integrated cart to a desired destination. A robotic courier medication delivery system was pilot tested in two patient care units at a 471-bed tertiary care academic medical center. Average transit for the existing manual medication delivery system hourly hospitalwide deliveries was 32.6 minutes. Of this, 32.3% was spent at the patient care unit and 67.7% was spent pushing the cart or waiting at an elevator. The robotic courier medication delivery system traveled as fast as 1.65 ft/sec (52% speed of the manual system) in the absence of barriers but moved at an average rate of 0.84 ft/sec (26% speed of the manual system) during the study, primarily due to hallway obstacles. The robotic courier was utilized for 50% of the possible 1750 runs during the 125-day pilot due to technical or situational difficulties. Of the runs that were sent, a total of 79 runs failed, yielding an overall 91% success rate. During the final month of the pilot, the success rate reached 95.6%. Customer satisfaction with the traditional manual delivery system was high. Customer satisfaction with deliveries declined after implementation of the robotic courier medication distribution system. CONCLUSION: A robotic courier medication delivery system was implemented but was not expanded beyond the two pilot units. Challenges of implementation included ongoing education on how to properly move the robotic courier and keeping the hallway clear of obstacles.

Strategic approach for improving the medication-use process in health systems: the high-performance pharmacy practice framework.

PURPOSE: A strategic approach to improving the medication-use process in health systems by using a framework for setting priorities on the basis of feasibility, the potential for financial return, and the effect on quality and safety is described. SUMMARY: A panel consisting of leaders in health-system pharmacy identified seven dimensions of high-performance pharmacy (HPP) framework: medication preparation and delivery, patient care services, medication safety, medication-use policy, financial performance, human resources, and education. Performance elements, which are specific policies, procedures, activities, and practices that indicate high performance and result in a financial or clinical return on investment of resources, within each dimension were identified. References, practice standards, and policies related to each performance element were also identified. By consensus, the panel assigned qualitative metric scores for each of the 69 performance elements that represent the panel's assessment of the resources necessary to achieve full implementation of the element and the potential financial and quality and safety returns if the element has not yet been implemented. It is noted that a pharmacy department's actual outlay of resources and expected financial return will differ depending on the size of the health system, the size of pharmacy staff, and the extent of previous implementation efforts. The framework can also be used to rejustify existing services and programs and identify opportunities for improvement. CONCLUSION: The HPP framework characterizes pharmacy performance elements on the basis of feasibility, financial return, and effect on quality and safety. The framework provides pharmacists with a means to establish priorities in improving the medication-use system.