Implementation of an electronic pharmacy scoring tool to prioritize clinical pharmacists' daily workflow at a pediatric institution

PURPOSE

To describe the development and implementation of an electronic pharmacy scoring tool (PST) to prioritize patients requiring clinical pharmacy intervention and assist in workload management in a freestanding pediatric hospital using quality improvement methodology.

SUMMARY

The department of pharmacy at Nationwide Children's Hospital developed a pediatric-specific PST within the electronic medical record to aid in patient prioritization and ensuring proficient daily workflow and qualifying workload for clinical pharmacists. The PST identifies patients for monitoring of high-risk medications, complex medication regimens, or abnormal laboratory values related to medication management. Application of the scoring tool ensures each patient is reviewed by clinical pharmacy staff each day, with initial efforts focused on patients with significant clinical pharmacy needs. This tool reduces the need for time-intensive manual chart review for identification of patients whose medication use and/or laboratory values afford greater opportunity for pharmacist intervention. Additionally, clinical pharmacist productivity metrics and workloads are considered, with the qualifying of patient care activities and quantification of time spent on patient review.

CONCLUSION

A PST enhances pediatric patient prioritization for clinical pharmacists by identifying patients most likely to require intervention in real time. The scoring tool enables future assessment of clinical pharmacists' workload assignments and better quantifies time spent on patient care activities.

Implementation of a prioritized scoring tool to improve time to pharmacist intervention

PURPOSE

The implementation of a prioritized scoring tool to improve time to pharmacist intervention is described.

SUMMARY

At the Ohio State University Wexner Medical Center, pharmacists are accepted providers of therapeutic drug monitoring of vancomycin and aminoglycosides. At the onset of this initiative and despite the implementation of an integrated electronic medical record (EMR), management of pharmacokinetically monitored medications was conducted using a paper monitoring form. The potential for transcription errors during this process provided an opportunity for improvement. For these reasons, the department of pharmacy focused its initial efforts for a patient scoring system on the pharmacokinetics scoring module. Adjustment of associated medications based on pharmacokinetic values was a core function of pharmacists of the institution and was expected to be conducted without fail. Vancomycin was used as the index surrogate pharmacokinetically monitored medication within the module for testing and validation because of the clear expectations and standardized resources available to pharmacists to complete the task. The pharmacokinetics scoring module was designed specifically for the function of dosing management, searching throughout the EMR and concisely displaying the information a pharmacist needs to make a clinical decision. Importantly, integration of the scoring module reduced the time to intervention from hours to minutes. The median time to intervention was reduced to within a clinical working shift (8 hours) with the scoring module versus 24 hours or longer with the paper monitoring system.

CONCLUSION

The implementation of an internally developed pharmacokinetics scoring module built into the EMR substantially reduced the time to clinical intervention for pharmacokinetic monitoring of vancomycin drug levels.