Make your hospital a high reliability organization: 8 pharmacy strategies to improve the patient experience


Imagine your son or daughter is critically ill and comes down with a high fever. When you call the physician, they tell you to go to the emergency room straight away. There, the attending physician prescribes an antibiotic, but you and your child end up waiting 10 hours to get the medicine.

Imagine your grandpa has diabetes and he is experiencing out-of-control symptoms. He is stabilized in the ER, given a new drug and discharged. He later complains of heart palpitations and swollen legs — symptoms of heart failure. Finally, after three weeks and another trip to the hospital, it is determined the symptoms were not heart failure at all, just side effects of the new drug he received in the ER.

Imagine your friend was just diagnosed with an aggressive form of cancer. When he or she goes to arrange appointments for chemotherapy treatment, she is told the drug is on back order and that she should try back in a few days.

"Imagine how you feel sharing these stories at your team meetings," Rick Burnett, PharmD, COO of pharmacy management services firm Complete Rx, said in a webinar hosted by Becker's Hospital Review. "These all come from personal experience."

According to Dr. Burnett, many hospitals have too narrow a view of pharmacy in the hospital setting — it goes far beyond supply chain or a room in the basement that processes prescriptions. As the healthcare delivery system begins to put an increased focus on wellness, quality and integrated, team-based care, pharmacy will play an increasingly critical role in coordinating patient care.

"The medication use cycle touches about every patient that walks into the hospital. Not every patient will get an X-ray, physical therapy or a surgical procedure, but almost every patient will get a medication," Dr. Burnett said.

Pharmacy touches patient monitoring, nurse education, quality programs and reimbursement, among many other areas of the hospital.

"The patient doesn't see all this," Dr. Burnett said. "It's invisible until they see the medication, but the process is extremely important when you think about the impact the medication use cycle has on your patient's care."

Considering medication management is critical for almost every patient, the system still has much it could improve upon, according to Kenneth Maxik, director of patient safety and pharmacy compliance at Complete Rx, who joined Dr. Burnett for the presentation.

"There are approximately 7,000 deaths annually associated with medication errors," Mr. Maxik said, citing information from the U.S. Institute of Medicine's 1999 report "To Err is Human."

Healthcare is like the airline and nuclear power industries in that it is a high-reliability industry, Mr. Maxik said.

"Within a high-reliability organization, everyone who works both individually and together is acutely aware that even small failures in process can result in catastrophic outcomes," he said. When an environment or key safety process is changed in even the slightest way, that may lead to failure.

In their presentation, Mr. Maxik and Dr. Burnett offered the following eight strategies hospitals can use in regards to pharmacy that can help them operate as high-reliability organizations.

1. Manage reputation through medication management. Poor medication management can keep patients from coming to your facility at all. Mix-ups between high-alert medications or look-alike, sound-alike medications usually hit local and/or national news media, Mr. Maxik said, and unfortunately, these mistakes continue to occur. For example, a hospital in Bend, Oregon made headlines last December when a patient died after receiving the wrong medication. The patient was administered a paralyzing agent instead of an anti-seizure drug and the error was fatal.

2. Make pharmacy technicians record the patient and medication history. The patient history must be recorded as accurately as possible so medication reconciliation goes smoothly. If not managed correctly, medications can actually prolong hospital stays, according to Mr. Maxik and Dr. Burnett. One tip, they said, is to place pharmacy technicians at the bedside to assist nurses with medication management. Since pharmacy technicians are more familiar with the drugs and dosages, they can complete the work more quickly than nurses, which frees up their workloads for more top-of-license tasks. Additionally, pharmacy techs are less expensive to employ.

3. Place pharmacists in ICUs and inpatient units to help pain management teams. "Placing clinical pharmacists in an ICU improves outcomes and saves money, but many hospitals still don't do it," said Dr. Burnett. Pharmacists as part of pain management teams means patients can more effectively be treated for their pain and have a better understanding of their medications at discharge.

4. Educate patients to improve quality, outcomes and reimbursement. If patients' medications are properly managed and they are educated at discharge, their engagement can improve HCAHPS scores and post-discharge outcomes, which means better reimbursement for the hospital. "Many patients don't even realize there are pharmacists working in hospitals," Dr. Burnett said. "Having direct contact and educating [patients] on medications often leads to additional questions they may have and the interaction is more memorable for them, which helps with HCAHPS scores."

5. Leverage pharmacists beyond the hospital stay to prevent readmissions. After a patient leaves the hospital, follow up is required, especially for those with complicated conditions or therapies. Making sure patients have access to affordable generics is also important to ensure medication compliance and help avoid readmissions within the first 30 days.

6. Implement risk mitigation processes to reduce medication errors and improve patient safety. Ask each staff member to spend a small amount of time, even just 2 hours each year, to observe the workplace and identify potential risks. "We know [an at-risk behavior] is bad, but the issue is that we have done it before and it has been fine," Mr. Maxik said, comparing it to texting and driving. By asking staff to observe the workplace, they can better identify at-risk behaviors related to medication management and address them at team huddles.

7. Invest in pharmacy informatics. As pharmacy becomes more and more complex, a good way to invest in the future of medication management is through improving pharmacy informatics, which encompasses medication-related data across the acquisition, storage, analysis and distribution of pharmaceuticals. "It's hard to measure and improve performance if you don't have good information to start with," Dr. Burnett said.

8. Invest in pharmacy leadership. "We hope you will make the paradigm shift away from pharmacy as dispensing drugs and see it instead as a way to impact the patient experience," Dr. Burnett said. "More complex leadership and skill sets are key to having a ROI on pharmacy."


For more information, download the webinar presentation in PDF form here or view the webinar on YouTube here.

For more archived webinars, click here.

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