The University of Toledo Medical Center is introducing a program that puts the skills, knowledge and abilities of clinical pharmacists directly on patient-care units.
Five pharmacists — Sherry Scotton, Paul Samenuk, Jeanette Woodruff, Lorne Roby and Bob Wright — have been assigned to inpatient floors, placing them in the middle of patient-care activities, according to Russell Smith, pharmacy operations manager.
The pharmacists are providing services on the hospital’s third, fourth, fifth and sixth floors. Plans call for the program eventually to be extended to the surgical intensive care unit, Emergency Department and surgical suites, and to operate on weekends if funds become available to hire additional pharmacists.
Smith used the term “decentralized pharmacy services” to describe the new initiative that has pharmacists stationed on the units Monday through Friday from 7 a.m. to 7 p.m. They review and verify physicians’ medication orders; answer questions from physicians, nurses, therapists, nutritionists and other members of the health-care team; provide therapeutic drug monitoring; note allergies and potential adverse medical interactions; and perform medication reconciliation.
In the past, Smith explained, hospitalized patients were served from the hospital’s central pharmacy, located on the ground floor and isolated physically from patient-care areas. Physicians’ written prescription orders were submitted via fax.
Now physicians fill out prescription orders that are picked up by pharmacists throughout the hour. They first screen and approve the orders on the floor — looking for sound-alike and look-alike medications or omissions that others may miss or dosages that don’t seem right — and then electronically enter it into the patient’s profile in a computer. Within seconds of approval, nurses have immediate access to computerized medication tracking and dispensing cabinets located on each nursing unit and used to distribute hundreds of medications.
The process cuts the time getting prescribed medications to patients, which is critical because patients’ medication needs often rapidly change.
Smith said that a major advantage of having pharmacists on the floors is the opportunity for physicians, residents and nurses to quickly consult one-on-one with them. Because they are experts in medication safety and effectiveness, pharmacists can quickly address potential drug interactions and suggest effective medication alternatives.
“Patient safety is improved through that kind of communication and the involvement of pharmacists,” said Joel Tavormina, pharmacy director. “The new program reflects the hospital’s commitment to provide health care that is extremely patient-centered and safe.”
Tavormina hopes the new program will encourage departments throughout the hospital to tap into pharmacy as a resource. UT pharmacists are well-trained in clinical issues and can assist nurses and physicians in day-to-day patient care, he added.
Having pharmacists working on patient floors not only improves care, it also improves pharmacists’ job satisfaction, Smith noted.
A seven-month pilot study led by Monica Nayar, a pharmacy practice resident, was conducted on a third-floor nursing unit last year to work out some kinks and to obtain feedback from nurses. As a result of the enthusiasm and support expressed by third-floor nurses, it was decided to expand it to other units.
Deana Sievert, nursing director for four hospital care units, applauded the new program.
“The decentralized pharmacist program has been wonderful for the staff, physicians and especially the patients,” she said. “It has definitely created a team atmosphere that was hard to achieve before when our pharmacist was in the basement. The program has saved nursing time for sure.”
Nurses are making fewer phone calls to the pharmacy because they can communicate with pharmacists directly, saving time, she noted.
“Also, I believe it creates a safer environment because now we have an easily accessible pharmacist who can help answer questions and who has access to all the information we have access to,” Sievert added. “So the nurse is no longer communicating information over the phone. We can pull the chart and order and look at it together to design a plan that is optimal for the individual patient. The impact has been huge. In fact, we have seen a significant decrease in occurrence reports related to medications and medication administration since we began our pilot. I’m convinced that this will also happen with the other units.”
The central pharmacy continues to serve as the hub for preparing more sophisticated, complex therapies such as sterile products, gene therapies and chemotherapy.
The program also has an educational component as College of Pharmacy students will participate so they can learn the role of “decentralized pharmacists.”