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Communication

Taking Control of Your Internal Reference Library

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We’ve all seen this; a healthcare worker in a white coat, pockets stuffed with papers. In hand, they have a notebook, handheld calculator, and a variety of dog-eared papers.

Early in my career, I decided to take a clinical supervisory position after serving 15+ years as a traveling executive for a healthcare company. Though I had been a licensed pharmacist for 25+ years, I had not “practiced pharmacy” in a long time. One of my colleagues at the time jokingly referred to me as “clinically dead”.

Pharmacy practice had seen many changes in my 15-year “absence”. When I left, hospital pharmacists were consigned to one room together, typically in the basement somewhere. But now, I was observing a highly diversified and far more clinically evolved practice. Pharmacists were out on the floor with nurses and the dispensing function was being integrated more fully with direct patient care.

My biggest concern was that I had no idea what reference information was in the pockets of all those white coats for which I had the responsibility to supervise. I felt that I had no control over the information my staff was using in the clinical decision making process.

I asked each of my staff to give me a copy of what there where using as a reference and/or tool in their decision-making process. Once they were gathered, we complied those papers and put them on the web for ease of access. We added search terms to make it even easier to find the information and RxDOCUMENT™ was born. Actually, it was the birth of RxTOOLKIT® itself, as that was our very first app.

RxDOCUMENT™ provided an easy to access standardized internal reference library and eventually grew to hold slide presentations, in-service materials, policies, procedures, and best practice recommendations.

RxDOCUMENT™ was our first application and is still one of our most popular!

Of course, now days, your staff could be using a digital notepad full of links. But whatever method they use, what really matters is taking control, and getting everyone on the same page. RxDOCUMENT™ can help you to establish your standardized reference library and provide a strong foundation for your staff’s clinical decision-making process.

For more information about RxDOCUMENT™ please contact us or visit RxTOOLKIT.com.

It’s Time for Pharmacy to Find Ways to Collect and Share Information – by Jerry Fahrni

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A big thanks goes out to Jerry Fahrni for giving us permission to reprint his post. We couldn’t agree with him more. In fact, many of the points he brings up are actually issues we have already solved with RxTOOLKIT® applications:

RxCONNECT™ our secure HIPAA compliant internal communications tool also used to monitor and document pharmacy refrigerator status

RxDOCUMENT™ our searchable document management system used for online data collection and organization

RxPACK™ our easy online logbook for bulk labeling, repackaging, and inventory management

All of our applications include robust search and reporting features.

Here’s the full article, It’s Time for Pharmacy to Find Ways to Collect and Share Information, originally posted on :

 

Regardless of what everyone thinks, the healthcare industry is in the infancy of “big data”. The concept isn’t new, but we still have a long way to go, especially in pharmacy. I recall sitting at conferences years ago listening to sessions describing data collection and manipulation. The problem has been that data, especially that found in pharmacies is scattered across disparate systems without an effective method for connecting the dots. The adoption of electronic health records (EHRs) has made things better, but much of the data collected in an average acute care pharmacy is outside the EHR’s reach.  And to say that most pharmacies have their collective heads buried in the sand, would be putting it kindly.

Those on the outside often find it difficult to understand the sheer volume of data that’s produced in a pharmacy. Unfortunately, the data sources are mostly stored in disparate systems creating silos, which makes each system blind to the others. Is is possible to connect the systems and exchange data? Sure, but few if any are doing it.

Data sources in pharmacies come from places like clinical interventions, inventory management, cost containment strategies, regulatory compliance, internal communications, and so on.

Take for example the simple goal of managing all the drugs used in an acute care pharmacy. It’s not uncommon for pharmacies to have several sources of data from various systems within the pharmacy:

  • Room temperature items stored on shelves, carousels, or robots.
  • Refrigerated and frozen items stored in refrigerators or freezers that may be tied to the room-temperature inventory management system, or maybe not. Refrigerated and frozen medications may use a completely different method such as an RFID-enabled cabinets tied to a secondary source of control.
  • IV room inventory may be tracked, or more likely not tracked, once it leaves the “main pharmacy” area. It’s not uncommon for me to see IV room inventory treated as a location in which inventory is sent, i.e. no longer in inventory when it hits the IV room.
  • Controlled substances, the bane of pharmacy productivity, is stored and managed separately from all other medications. Does it have to be? No necessarily, but the currently accepted practice is driven mainly by regulatory compliance and fear. Don’t you think it’s entirely possible to design a system that would more easily manage controlled substances? Of course! But that’s not the way we roll. We prefer the most difficult, least efficient system possible. Mission accomplished, because that’s exactly what we have.
  • Management of medication kits, trays and transport boxes (trays). The amount of inventory stored in these trays is significant, and are often lost from pharmacy oversight upon reaching clinical areas. It’s amazing that medication trays are exactly the same as when I jumped into pharmacy practice nearly 20 years ago. It’s shocking just how poorly this area of pharmacy is managed. Some of my thoughts on the process can be found here.

Consider the amount of effort that goes into data collection for the soul purpose of regulatory compliance. Things like refrigerator and freezer temperatures, air flow and pressure differential in the cleanroom, documentation of blackbox warning drugs, and so on forever, create a mountain of information that is often collected on paper and stored in binders in some forgotten area of the pharmacy. It’s amazing in this is often considered best practice. I’m certain that much of this can be automated. Do other industries use such an antiquated system for data collection? I don’t know, but it shouldn’t be too difficult to find out.

I’ve mentioned only operational data to this point. What about clinical intervention data or financial information? The list goes on. Do pharmacy interventions really impact patient care in a positive way? I don’t mean in soft dollars, I mean in genuine, life altering ways? Possibly, at least in small studies. How about on a large scale? Don’t know. Can pharmacists actively improve pharmacy operations or the bottom dollar when engaged as part of the healthcare team? Don’t know.

What’s worse is that the data collected from all areas of pharmacy is rarely, if ever, pulled out of silos and incorporated into other data sets. What’s the value of that, you ask? Trends. It’s obvious to me that there are things within pharmacy data that we fail to see because the information is never compiled, stripped, joined, and analyzed. How big is the ripple effect of making a formulary change? Hard to say without looking at large groups of targeted data.

It’s staggering to think of what we’re missing by not taking full advantage of the data being generated in a pharmacy each and every day. Not to mention what could be found by compiling data from several, or several thousand pharmacies at once. The value of collecting and digesting massive amounts of data from national, regional, and local pharmacy practices is infinite.

Imagine being able to build true data-driven practices in both the clinical and operational pharmacy activities. Is there value in documenting that a patient is taking a drug with a black box warning? Maybe, but we don’t know. All we know is that some regulatory agency said we have to do it, so we do. But does it prevent anything? Who knows. Does drawing vancomycin troughs before the fourth dose improve outcomes, prevent toxicity, and decrease morbidity? Based on what I know, I think so. Has any of that ever been proven? Perhaps on a small scale, but nothing that I’m aware of that involves millions of data points. Then why do we do it? Because that’s the way it’s always been done. That’s the true definition of a non-data driven practice.

Is there a “best” way to handle sterile compounding? Is there a “best practice” for monitoring patients on heparin? I’m not talking about guidelines based on expert opinion, here. What I want is for someone to compile data from thousands of pharmacies across the country and really take a hard look at what’s is being done in pharmacies.

We’re seeing some of this in practice areas like UCSF’s precision medicine and many pharmacogenomics programs across the country. We should take their lead and apply those methods across the board. Data is power, and that power can be used to improve pharmacy practice. It seems to me that we have the ability, but thus far have failed to execute.

Someone call Google. They have a kind of data collection thingy, right?

 

 

Minimize Distraction. Maximize Communication.

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Anyone who has worked in any healthcare setting can attest what the ISMP and others have documented:

Distractions are a major contributor to medication errors.

Distractions can come from countless directions and have significant consequences. A recent article documented an average of about one interruption every two minutes in the pharmacy. According to the ISMP, the risk of any medication error increases 12.7% with each interruption, and the risk of a harmful medication error is doubled when nurses are interrupted 4 times during a single drug administration, tripled when interrupted 6 times.

Often times, basic methods of communication can actually lead to distraction. The telephone stands as the most prevalent method of communication in healthcare. Voice activated communication systems such as Vocera are also becoming more and more popular.

While these tools serve a fundamental purpose, they have the potential to become significant distractions to any healthcare worker. Phone conversations, with the exception of conference calls, require a 2‑way conversation. No one can predict when the phone will ring or when the Vocera will call your name. The caller has no way of knowing if the person they are trying to reach is in a situation where the distraction could prove to be problematic.

Phone calls or Vocera conversations can be considered a “conversational silo”. In most cases only two people are privy to what is discussed. These types of conversations tend to be repeated over and over again, especially when more than two people or multiple disciplines are involved in a patient’s care. If we don’t want to repeat them, all of the people involved in a patient’s care must have access to prior conversations. For example, if a nurse calls the pharmacy clean room to check on the status of an IV, they cannot know that a different nurse m­ay have just called with the same question. To the IV pharmacist, both phone calls prove to be significant distractions.

Email has proven to be another “conversational silo”. No one, outside the distribution list, has access to previous email conversations. Additionally, most email servers are not secure and fail to meet HIPAA compliance. An email could potentially be forwarded to anyone risking a breach in confidentiality.

RxTOOLKIT developed RxCONNECT for use as a secure internal information sharing tool to minimize distractions and document important communications. It connects users to information and to one another in an easily accessible and HIPAA compliant environment. RxCONNECT offers the accessibility of email but with added convenience and security.

RxCONNECT was designed following the model of social networking websites but within the secure environment necessary in any healthcare setting. Since we introduced RxCONNECT, our observation is that organizations have used the tool in two primary paths:

1. Operational
2. Patient disclosure/flow

Operational

Let’s look at an example. The Joint Commission now requires the monitoring of medication refrigerators and also requires the documentation of actions when a refrigerator has an out of range temperature. When an out of range temperature is reported, what was done and by whom? RxCONNECT provides an easy and efficient way of documenting information regarding each and every refrigerator. Each individual refrigerator becomes the title of the post. Any and all information regarding that “post” is then documented. Each entry is time stamped and because users must be logged in to use RxTOOLKIT, the name of the user who enters any post or comment is also documented. There is even a handy email link should you choose to send an “off line” communication to a single user or group.

RxCONNECT incorporates the use of smart text phrases, each designated for a specific function. Entering information such as “Out of Range Temperature – High” or “Checked refrigerator and door was open – Door was closed” can easily be added with just a click. Because RxTOOLKIT is internet based, conversations can be accessed from any PC, laptop, tablet, or smartphone.

Patient Discourse/Flow

Often times, conversations need to include general or logistical information, not clinical information required as part of the patient medical record. Let’s look at an example:

A patient (Mr. Jones) has an appointment at the out-patient infusion center for 10 AM. The patient is scheduled to receive a Daptomycin infusion that will need to be compounded by pharmacy. The patient has not been compliant on treatment and both pharmacy and nursing do not want to compound the drug unless his arrival has been confirmed. The orders are sent to pharmacy with the instructions “Wait for patient arrival”. Traditionally the primary method of communicating the arrival of the patient is to call to the pharmacy, specifically the clean room where the drug is going to be compounded. This call can easily create a distraction to the clean room staff (who is focused on compounding drugs for other patients). 

With RxCONNECT, the patient becomes the subject of the post. Information about the patient can be passed between clinic nurse and clean room pharmacist without the need for distractions. Nurse or pharmacist can document using smart text phrases designed for this specific type of interaction.

“Patient arrival is confirmed – OK to mix drug”

“Drug is mixed and being delivered”

RxCONNECT retains all of the information in a HIPAA compliant and secure environment. Each specific board can be restricted to users or groups within an organization on an “as needed” basis. RxCONNECT is only available to the users you select. Any logged in user, who has been granted access, can review all of the past conversations about a topic. RxCONNECT has a powerful search feature so all of the information is searchable and easy to find. A patient flow board can be customized to require MRN and specific therapy notes for each new patient post. This allows users to search by patient demographic information, specific therapy, or item within the context of any post.

RxCONNECT has proven to be an invaluable and distraction-free resource for communication. We are excited to see how our clients find new and innovative ways of using this application. Our goal at RxTOOLKIT is to put critical information quickly and efficiently into the hands of team members who need it most. RxCONNECT manages your most important information and optimizes communication between essential staff members. Let us know if you would like more information about RxCONNECT or contact RxTOOLKIT to schedule a live demo.

If you are a RxCONNECT user, leave us a comment below and let us know your favorite way to use RxCONNECT.