by Maggie Lockwood

Ten to 15 years ago, it wasn’t uncommon to find a hospital’s pharmacy staff sequestered in the pharmacy, conferring with their provider colleagues by phone and focused entirely on dispensing and verifying the medication needs for their hospital. Today, thanks to a web of technology that connects the pharmacy to the hospital, you’re more likely to find pharmacists on the floor supporting providers in their medication decisions, not in the basement.

With the support of technology for ensuring safety and accuracy in the dispensing process, health-system pharmacists are able to spend the bulk of their time out of the pharmacy itself and with the other care providers interacting with patients and providing critical medication-related advice.

In the most progressive health-system care models, getting the best outcomes means that pharmacists are most valuable helping the prescribers select the most appropriate therapy, rather than just reviewing the orders once they’ve hit the pharmacy systems
Medication safety remains paramount, of course, and health-system pharmacies need to have the technology and processes in place with the dispensing workflows to ensure that the medications pharmacists and doctors decide on are in fact the ones getting dispensed to a patient, and without any undue delays. This means that pharmacies are coming to rely more on automation to make the process both safer and more efficient, with the holy grail being to fill 100% of prescriptions with automation.

That may sound like too high a standard to meet, but consider this: There is technology out there that can enable the hospital pharmacy to scan into high-density storage automation every medication it receives, whether oral solids or unit-of-use items. This scan can then also integrate into the electronic medical record (EMR) and the inventory tracking system embedded in the EMR. Staff can see what’s in inventory from any location. Because health systems are providing care as 24-seven operations, and at a scale that often encompasses large staffs spread across the various sites and care specialties coordinating information, making it available as needed system-wide, and tracking inventory is critical.

Seamless Integration is Key

This can be done by prescribers and the pharmacy sharing a common informatics system.
With a common platform, the pharmacy is alerted when new orders come in, and can track meds as they are dispensed from automation that’s not confined within the pharmacy itself, but located out on the inpatient units. With all this technology networked, no longer does the pharmacy need to print a report to review their inventory, but can see orders real-time.

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Another area where integration of the hospital systems creates efficiencies is the pharmacy’s IV workflow. Here software guides technicians through the steps of compounding and then weighs the dose pre- and post-production and uses gravimetrics to verify that the dose is prepared accurately. There is automation here as well, with robotic systems that handle those steps together, scanning against the order to verify and sending to the technician to label it and send it to the floor.

Shifting Roles through Technology Investment

With technology allowing the care model to evolve so that many pharmacists are now out working in the hospital units, there are new roles for them. The generalist pharmacists, typically with a year of postgraduate residency training, are responsible for the day-to-day patient monitoring and prescriber-order verification. All prescriptions are electronically entered and the generalist pharmacists are reviewing them for appropriateness, not just right drug, right dose, but also from an operational standpoint as far as the best way to deliver the drug to a patient. These pharmacists may be based in a small space on the nursing unit so they can interact with the care team and answer nurses’ questions.
Specialty practice pharmacists, typically with two years of postgraduate training with a focus on a specific disease area, whether it’s oncology, critical care, emergency medicine, are part of the rounding team. These pharmacists can focus on recommending the best pharmacotherapy based on the prescriber’s diagnosis.

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And with all the systems integrated the specialty pharmacists, who are rounding with the care team, make a recommendation to the prescriber as to the best therapy, the prescriber enters that into the system, and the generalist pharmacist can view it instantaneously. This is a model that brings tremendous efficiency to care delivery.

Adding technology to such a diverse setting requires identifying how an investment will benefit patient safety, the pharmacy workflow, pharmacists role in clinical care, and of course, return on investment (ROI).

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ROI Is Not Just About Reducing Costs

Don’t get caught thinking that ROI simply means saving money. It’s not always that simple. What you are really looking for is technology that is going to solve the problems you are identifying within your care processes and prescribing and dispensing workflows. You are also going to want to consider, as we’ve seen, what new roles staff can take on once you invest in a new technology.

One example is infusion pumps, which can be integrated with the EMR. When the nurse is at the bedside, they scan the patient, they scan the medication, and they scan the pump. The pump will automatically program with the parameters that the pharmacist has verified in the EMR. This takes a task off the nurse’s plate. Another is software that detects the diversion of controlled substances. Anytime a nurse removes a drug or controlled substance from the dispensing automation on the floor, the software compares that nurse to peer nurses, looking for outliers. Pharmacy technicians in advanced roles can review the charts to verify the software indeed found a problem.

With COVID-19, a lot of health systems have taken a huge hit because they lost so much volume this spring. Elective surgeries were canceled and there was a costly scramble to free up inpatient beds for a surge of COVID-19 patients. But a moment of crisis can be an excellent time to reassess your model and start strategizing to be among the most progressive health-systems by investing in technology that supports the right kind of collaboration between the pharmacy, and all the patient-care oriented staff. Be sure you are taking time to consider what your health-system may need to do next to ensure the best outcomes. CT

Maggie Lockwood is VP, director of production at ComputerTalk. You can reach her at maggie@computertalk.com.

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