A Spoonful of Teamwork Makes the Medicine Go ‘Round
The small “vending machine” in every inpatient unit is a visible reminder that drug ordering and dispensing at BWH is a sophisticated enterprise. With just a few keyboard strokes on the SureMed machine, nurses can open a drawer and retrieve many of the medications needed for their patients. Behind the scene is a team that continuously assesses the process and works to answer these improvement questions:
What do we do?
“The emphasis is on ‘we’ — the interface between nurses and pharmacists to shape a fluid system,” said Judy Hayes, RN, MSN, director of Professional Practice, Quality and Staff Development. She and William Churchill, RPh, director of the Pharmacy, co-chair the Nursing Pharmacy Committee, composed of nurses, pharmacists and staff from Quality Management and Information Systems. “We work together to identify everything that needs to happen to efficiently get patients their medications.”
How do we do it?
Currently, about 85 percent of the drugs used on the units are dispensed by the automated machine. What goes into the drawers depends on patient conditions commonly treated on the floor. When a drug is dispensed, it is recorded by the computer. Once a day (twice in the ICUs), Pharmacy generates a report of the count and restocks the drawers.
Drugs not stored on the unit are delivered by Pharmacy on an hourly basis. But first, pharmacists must compare the order with the patient’s profile (allergies, drug reactions, etc.) to ensure appropriateness and safety. Urgent needs are handled by paging a pharmacist.
How can we do it better?
Nurses can voice their suggestions through the Pharmacy Liaison Program. Assigned to each unit is a nurse liaison (often the manager) and a pharmacy manager or supervisor. In addition to meeting monthly with the nurse to discuss needs and improvement ideas, the pharmacist is available to assess immediate or emerging issues identified by the clinical staff.
“The liaisons focus on system issues such as better aligning the drugs in the automated dispenser with patient profiles, missing medications, stock counts and response time,” said Colleen Zidik, RN, BSN, (pictured, right) assistant nurse manager on Tower 10 and 9D. For example, their pharmacy liaison, Michelle McCrea, RPh, (pictured, left) developed a way to log in the temperature of the SureMed’s refrigerated compartment to comply with a drug’s storage regulations.
“The liaison program breaks down department barriers, allows us to determine medication trends, be more accurate and deliver more efficient and cost-effective care,” said McCrea.
Do you have an improvement idea? Please contact your nurse or pharmacy liaison.