Utilization of a Pharmacy Clinical Surveillance System for Pharmacist Alerting and Communication at a Tertiary Academic Medical Center.

The objective of this analysis is to describe the utilization metrics of a pharmacy clinical surveillance system (PCSS) at a tertiary, academic medical center.We performed a retrospective database analysis assessing rule-based alerts (RBA), interventions and pharmacist communication notes documented in the PCSS from January 1, 2014 to December 31, 2014. Reports were generated on 92 unique RBAs sent to clinicians for evaluation. Metrics assessed included the number of RBAs that were triggered, clinically evaluated, intervened on by pharmacists, and therapeutic category of interventions. Pharmacy communication notes were also evaluated.A total of 399,979 RBAs were triggered through the PCSS. During that time, pharmacists documented a total of 17,733 interventions. The most common RBAs were related to lab abnormalities (132,487; 33 %) and anticoagulation/antiplatelet therapy (126,425; 32.1 %). Interventions were most frequently related to RBAs regarding anticoagulation/antiplatelet therapy (6412; 36 %) and antimicrobial therapy (3320; 19 %). Pharmacist communication was most commonly related to clarification of medication and lab orders, and therapeutic drug monitoring.Based on utilization metrics presented, the implementation of a PCSS has successfully generated RBAs to aid pharmacists in clinical practice and improved departmental documentation and communication. Further analysis is warranted to assess the impact of the RBAs, interventions, and communication notes on outcomes such as hospital cost and adverse drug events.

Assessment of the Impact of Nursing Interruptions on Pharmacist Workflow and Efficiency.

Background: Interruptions in the pharmacy setting by nurses are common. While the source of nurse-generated interruptions may be variable, the appropriateness of these interruptions remains unknown. Objective: To evaluate the impact and appropriateness of nursing interruptions on pharmacist workflow resulting from telephone calls, alphanumeric pagers, and in-person interactions. Methods: An electronic data collection tool was created to record nursing-based interruptions of pharmacists through telephone calls, pages, and in-person interactions. The data were collected during all pharmacist shifts (day, evening, and night) over 14 days in 2 separate, 7-day data collection periods in December 2011 and January 2012. The data collection form comprised 7 questions that addressed the purpose of this study, including the shift; unit location; type, nature, and appropriateness of the interruption; estimated time spent; and whether the interruption was duplicated. Results: A total of 3,531 interruptions were documented during the 14 days of data collection; an average of 252 data points per day were recorded by the pharmacists. About 55% of the interruptions were initiated through alphanumeric pagers, 33% from phone calls, and 12% from face-to-face interactions. Sixty-three percent of the total interruptions were annotated as appropriate interruptions, while 37% of were annotated as inappropriate interruptions. The total time spent addressing the interruptions deemed inappropriate was 75 hours during the study period. Conclusion: Distinct opportunities exist for process improvement changes, as well as educational and behavioral changes, that would greatly benefit nursing and pharmacy staff.

Improvements in a program to convert i.v. to oral medications at an academic medical center.

PURPOSE: Results of a study to implement targeted interventions to increase the number of documented i.v.-to-oral conversions and to increase cost savings from these documented conversions are reported. METHODS: A before-and-after analysis of i.v.-to-oral conversions at an academic medical center following the addition of targeted interventions to an existing pharmacist-initiated conversion program was conducted. Targeted interventions included staff training on i.v.-to-oral conversions, implementation of a new documentation system, and feedback to the staff. Major outcomes studied included the total number of i.v.-to-oral conversions documented per month and the cost savings generated by these conversions. RESULTS: The mean ± S.D. number of i.v.-to-oral conversions documented per month significantly increased after the implementation of targeted interventions (25 ± 9 before and 57 ± 6 after implementation, p < 0.0001). There was a nonsignificant increase in cost savings generated per month after implementation of the interventions. The most commonly converted medication was pantoprazole. Conversions of levetiracetam generated the highest cost savings. CONCLUSION: Addition of several targeted interventions to an existing pharmacist-initiated i.v.-to-oral conversion program led to a significant increase in the total number of documented conversions.