Optimizing the Medication Distribution Process for Inpatient Units

Pharmacy robots and automated dispensing cabinets are commonly used to distribute medications to inpatient units efficiently and safely. Decisions regarding the use of these technologies are often made without full knowledge regarding system effects. This paper determines a cost effective and safe way to distribute medications to patients across a hospital system by minimizing the distribution cost and missing dose rate. A mathematical model is formulated which captures key aspects of the pharmacy distribution process to determine a primary pathway to distribute each medication and dose type to each unit. The model focuses on three primary distribution pathways: cart fill via pharmacy robot, cart fill via pharmacy technician, and automated dispensing cabinets. The problem is solved using a complete year of data from the Geisinger Medical Center. The model results demonstrate the trade-off between pharmacy technician and nurse workload and missing dose rates that occur as hospitals move from a centralized pharmacy to automated dispensing cabinets. These results demonstrate the importance of evaluating the labor effort and missing dose rates when determining the best method to distribute medication.

Realizing the vision for pediatric pharmacy practice advancement through strategic planning and implementation

Purpose

In a rapidly changing healthcare landscape, pharmacy leaders must be agile and innovative to ensure that patients receive the highest-quality care. Here we describe the benefits of using a structured approach to pediatric pharmacy practice advancement guided by strategic planning and quality improvement principles.

Summary

Although there are many profound differences between pediatric and adult pharmacy management practices, many similarities also exist. Small- and large-scale change is most commonly guided by quality improvement methodology at Nationwide Children’s Hospital. Using this framework, the pharmacy practice model at Nationwide Children’s Hospital was reenvisioned to facilitate best patient outcomes and advance the role of pharmacists in the care of pediatric patients. Through these efforts, the percentage of inpatient hospital services with a pharmacist embedded into the care team increased from 67% to 90%, the number of pharmacists providing direct inpatient care increased from 27 to 50, and the number of ambulatory clinical pharmacists more than tripled, from 3 to 10. Enhanced clinical pharmacy services were developed to provide consistent care on weekends and holidays while striving to reach zero patient harm. Involvement of pharmacists and pharmacy technicians, alignment with the health system’s mission, and internal development of pharmacists through focused training programs were vital to successful practice advancement.

Conclusion

Significant practice model advancement in a pediatric healthcare system is achieved by using the organization’s common language for change, involving frontline staff in creating the vision, and leadership steadfastly committing to realize the vision.

Impact of the Pharmacy Practice Model Initiative on Clinical Pharmacy Specialist Practice

This paper describes the goals of the American Society of Health-System Pharmacists' Pharmacy Practice Model Initiative (PPMI) and its recommendations for health-system pharmacy practice transformation to meet future patient care needs and elevate the role of pharmacists as patient care providers. PPMI envisions a future in which pharmacists have greater responsibility for medication-related outcomes and technicians assume greater responsibility for product-related activities. Although the PPMI recommendations have elevated the level of practice in many settings, they also potentially affect existing clinical pharmacists, in general, and clinical pharmacy specialists, in particular. Moreover, although more consistent patient care can be achieved with an expanded team of pharmacist providers, the role of clinical pharmacy specialists must not be diminished, especially in the care of complex patients and populations. Specialist practitioners with advanced training and credentials must be available to model and train pharmacists in generalist positions, residents, and students. Indeed, specialist practitioners are often the innovators and practice leaders. Negotiation between hospitals and pharmacy schools is needed to ensure a continuing role for academic clinical pharmacists and their contributions as educators and researchers. Lessons can be applied from disciplines such as nursing and medicine, which have developed new models of care involving effective collaboration between generalists and specialists. Several different pharmacy practice models have been described to meet the PPMI goals, based on available personnel and local goals. Studies measuring the impact of these new practice models are needed.

Enhancing Practice Models by Recruiting Pharmacists with Specialty Training

The Director's Forum series is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. Evaluation of pharmacy practice models across the country promotes the expansion of clinical pharmacy services; some organizations may recruit pharmacists with specialty training. Specialty practice pharmacists are pharmacists who have extensive knowledge and experience in a particular area of pharmacy. Networking is a critical strategy in recruiting the best candidates for specialty roles. This article presents several strategies to assist pharmacy directors in hiring specialty trained pharmacists to enhance their practice model. These strategies apply to building practice models from small hospitals to large academic medical centers. Ultimately, recruitment of the best pharmacists to join the patient care team helps to build the best patient-centered pharmacy service.