Implementation and evaluation of an IV room technology-assisted workflow system integrated within the electronic medical record at oncology infusion center pharmacies.

PURPOSE: To describe the implementation of an IV room technology-assisted workflow (TAWF) system integrated within a health system's electronic medical record (EMR) and compare the TAWF system's impact in improving workflow at multiple ambulatory infusion pharmacies. SUMMARY: IV room TAWFs help to standardize intravenous admixture operations while incorporating patient safety measures such as ingredient barcode scanning and image capture. The 4 oncology infusion center pharmacies of a large health system implemented a TAWF system integrated within the health system's EMR software, transitioning to the new TAWF system from an external TAWF system operating outside of the EMR. Considerable planning was required to determine the hardware and workflow processes needed for the new integrated TAWF system to function within pharmacy IV rooms. Several operational challenges were encountered during the initial implementation phase of the project. Frequent occurrence of system malfunctions during the product imaging step was the largest problem, which was overcome by special hardware and a software upgrade. The project also involved an evaluation of the integrated TAWF system after implementation to ensure the pharmacies maintained operational efficiency and patient safety. The evaluation showed that after an initial transition period, the new technology was able to maintain IV admixture efficiency and safety. CONCLUSION: This project and subsequent evaluation showed the operational feasibility, efficiency, and safety of a TAWF integrated within the health system's EMR software.

Development of health-system inpatient pharmacy clinical metrics.

PURPOSE: To describe a process to identify metrics that represent the impact of inpatient pharmacy services on patient outcomes across a health system. SUMMARY: The authors describe a systematic process of identifying inpatient clinical outcome measures that could represent pharmacists' impact on patient outcomes and eventually be displayed in a dashboard within the electronic medical record (EMR). A list was generated through literature review, assessment of practices at other sites, evaluation of current pharmacy services, and collaboration with the quality department and System Pharmacy Clinical User Group. The project team narrowed the list through assessment against standardized criteria. An assessment tool was designed and distributed to stakeholders to prioritize clinical outcome measures for inclusion on the dashboard. The clinical outcome measures were transformed into metrics by determining measurement criteria, inclusion and exclusion parameters, and review time frame. After validation, the metrics are planned to be displayed on an inpatient pharmacy EMR dashboard. Exemption from institutional review board review was granted for this project. CONCLUSION: A systematic process was developed and used to identify inpatient clinical outcome metrics.

Enactment of mandatory pharmacy technician certification in Kansas.

PURPOSE: The successful enactment of mandatory pharmacy technician certification in Kansas is described. METHODS: In 2004, Kansas began requiring registration of all pharmacy technicians with the state board of pharmacy. Registration identified individuals working as pharmacy technicians but did not require any specific education or certification. In September 2012, the Kansas Board of Pharmacy created a task force of key stakeholders including pharmacists from multiple areas of practice, the University of Kansas School of Pharmacy, organizational leaders from the Kansas Council of Health-System Pharmacists (KCHP) and Kansas Pharmacists Association, and professional lobbyists. The goals of this task force were to research practices of technician certification in other states and to make recommendations to the state board of pharmacy on how Kansas could accomplish mandatory technician certification. RESULTS: The task force outlined the steps needed to achieve legislation that could be supported by the members. These topics included the creation of a technician trainee category, grandfathering certain technicians who had been practicing for a designated period of time, state board-approved exemptions, training requirements, age and education requirements, continuing-education requirements, and pharmacist:technician ratio. The recommendations were finalized at the August 2013 Kansas Pharmacy Summit, and the proposed legislation was introduced and passed during the 2014 legislative session. KCHP members learned many valuable lessons about advocacy and the legislative process with this initiative, including building relationships, working with legislators, and working with other professional organizations. CONCLUSION: The formation of a task force led to the successful passage of a bill granting the Kansas Board of Pharmacy the authority to issue regulations regarding mandatory pharmacy technician certification.

A comparison of heart rate changes associated with levalbuterol and racemic albuterol in pediatric cardiology patients.

BACKGROUND: To our knowledge, no data exist regarding the effect of levalbuterol and racemic albuterol on heart rate in pediatric cardiology patients. OBJECTIVE: To compare heart rate change in pediatric cardiology patients receiving levalbuterol and/or racemic albuterol. The secondary objective was to identify characteristics associated with heart rate changes observed with these drugs. METHODS: A review of electronic medical records at a pediatric academic hospital was conducted to determine the equivalence of heart rate change in patients receiving levalbuterol or racemic albuterol. Patients receiving at least 3 doses of levalbuterol and/or racemic albuterol during the study period were included if they were younger than 18 years and had a diagnosis of congenital heart disease (CHD), cardiomyopathy, or supraventricular tachycardia. Patients were excluded if they received a ß-blocker or continuous racemic albuterol or did not have documented pre- and postdose heart rates. RESULTS: One hundred ninety-two patients were included. One hundred forty-two received racemic albuterol, 40 received levalbuterol, and 10 received both racemic albuterol and levalbuterol. The mean increase in heart rate for patients receiving racemic albuterol and levalbuterol was 6.8 beats/min and 6.2 beats/min, respectively (p = 0.01). In patients with CHD, the racemic albuterol group experienced a mean heart rate increase of 6.6 beats/min compared to 6.3 beats/min in the levalbuterol group (p = 0.01). Equivalence was also determined in patients without surgical intervention and patients receiving concomitant cardiac and respiratory medications. Equivalence was not established in other analyzed subgroups secondary to insufficient sample sizes. CONCLUSIONS: Racemic albuterol and levalbuterol were associated with increased heart rate in pediatric cardiology patients. This increase was found to be equivalent.