Implementation of an integrated computerized prescriber order-entry system for chemotherapy in a multisite safety-net health system.

PURPOSE: The development of a computerized prescriber order-entry (CPOE) system for chemotherapy in a multisite safety-net health system and the challenges to its successful implementation are described. SUMMARY: Before CPOE for chemotherapy was first implemented and embedded in the electronic medical record system of Harris Health System (HHS), pharmacy personnel relied on regimen-specific preprinted order sets. However, due to differences in practice styles and workflow logistics, the paper orders across the 3 facilities were mostly site specific, with varying clinical content. Many of these order sets had not been approved by the oncology subcommittee. In addition, disparities in clinical knowledge and lack of communication contributed to inconsistencies in order set development. Led by medical directors from medical oncology departments at the 3 facilities, pharmacy administrators, and information technology representatives, HHS committed resources to supporting the adoption and use of a CPOE system for chemotherapy. Five practical lessons of broad applicability have been learned: engagement of interprofessional stakeholders, optimization of workflow before CPOE implementation, requirement of verification tool for CPOE, consolidation of protocols, and commitment to ongoing training and support. Evaluation of the CPOE system demonstrated a systemwide reduction in medication errors by 75% (p < 0.05). Satisfaction with the CPOE system varied among sites and was unchanged institutionwide 6 months after the CPOE implementation. CONCLUSION: The development and implementation of CPOE for chemotherapy at a multisite safety-net health system created opportunities to optimize patient care and reduce variations through interprofessional collaborations. Initial evaluation suggested that CPOE reduced the medication-order error rate and improved user satisfaction in 1 of 3 facilities.

Evaluating pharmacy leader development through the seven action logics.

PURPOSE: Pharmacy leader development over time was analyzed using the seven action logics. METHODS: As part of an ongoing leadership seminar series, students were required to select a visionary pharmacy leader and conduct a structured interview to evaluate pharmacy leaders' action logics. A standardized questionnaire comprising 13 questions was created by the class. Questions addressed leadership qualities during the leaders' early years, education years, and work years. Transcripts were then coded by two separate trained investigators based on the leader's stage of life to provide a score for each action logic individually over time. Kappa coefficient was used to evaluate interrater agreement. RESULTS: A total of 14 leaders were interviewed. All leaders were currently employed and had won national awards for their contributions to pharmacy practice. Overall, there was 82% agreement between the two evaluators' scores for the various characteristics. Action logics changed based on the leaders' life stage. Using aggregate data from all leader interviews, a progression from lower-order action logics (opportunist, diplomat, expert) to higher-order action logics (strategist, alchemist) was found. Ten leaders (71%) were diplomats during their early years. Six leaders (43%) were experts during their education years, and 4 (29%) were strategists or alchemists. During the third life stage analyzed (the work years), 6 leaders (43%) were strategists, and 2 were alchemists. During their work years, all leaders had a percentage of their answers coded as alchemist (range, 5-22%). CONCLUSION: Throughout their professional careers, pharmacy leaders continually develop skills through formal education and mentorship that follow action logics.