It has been substantiated in the clinical literature that communication issues between pharmacists and clinicians impact levels of meds administration errors. For example, a March 2021 article in PSNet/Patient Safety Network, a publication sponsored by the federal Agency for Healthcare Research and Quality (AHRQ), entitled “The Impact of Communication on Medication Errors,” found that “Providers can decrease risk of adverse drug events by improving the effectiveness of transitioning patients between healthcare settings. Transferring a patient from one care setting (e.g. hospital, nursing facility, primary care, long-term care, home health care, or specialist care) to another is termed a “transition of care” by the Centers for Medicare & Medicaid Services.” Further, it found, “Hospital discharges are one example of a transition of care, and over 35 million hospital discharges occur annually in the United States. One randomized controlled trial found that more than half of the patients discharged from a hospital experienced a clinically important medication error within 30 days of discharge, and approximately 4% of these adverse drug events were related to anticoagulants. It has been estimated that the cost of unplanned readmissions is 15 to 20 billion dollars annually.”
Similarly, a February 2024 article in StatPearls made available through the National Library of Medicine, and entitled “Medication Dispensing Errors and Prevention,” found that “Medication errors rank as the most frequent and avoidable source of patient harm. They can manifest at various points in the healthcare process, ranging from prescribing to actual drug administration.” The article’s authors noted that “Several factors increase the risk of medication errors, including older age, an overburdened healthcare system, an elevated number of prescribed drugs, comorbidities, and multiple prescribers for one patient. Medication errors, in turn, contribute to various adverse outcomes, such as drug-drug interactions, a higher number of hospital admissions, increased outpatient visits, prolonged hospital stays, elevated patient management costs, and heightened patient mortality risk.”
Pharmacists working in the trenches are very aware of these issues. One of them, Anthony Bono, RPh, a staff pharmacist at Englewood Health in Englewood, New Jersey, who has been on the pharmacy staff of that hospital for 32 years, has had the full range of experiences around communication and other issues in medication dispensing. His team has been using the Micromedex solution from the Ann Arbor, Mich.-based Merative, for a decade now. Bono spoke recently with Healthcare Innovation Editor-in-Chief Mark Hagland regarding how he and his team have been benefited from the clinical decision support solution, and how its use has improved interactions with clinicians. Below are excerpts from that interview.
When was the solution implemented?
Micromedex was first installed about ten years ago. They wanted to develop a resource that allows questions to be asked. Micromedex is the Rolls Royce of resources It is very precise, and if you have questions, it’s a good place to go. I like using it. If I’m alone at night and I’m the only pharmacist in a 300-bed hospital, I don’t want to go to Google
What are the typical questions that come up?
Very often, patients, especially elderly, come in with a pill box that’s not identified. And the medication ID that Micromedex has is very good, with confirming photographs. The only limitation is that we can’t tell the patient how old the medication is, for example.
So if the original medication is not in the original bottle, that could be an issues, correct?
That’s right; you’d be amazed by how many elderly patients come in with pills in a pill bottle, but not the correct one. They’ll pour pills into a new bottle. And unfortunately, there are cases in which a medication is not on the formulary. And Micromedex does a good job identifying the pills as well as giving you the information. Also for compatibility between drugs. Many IV solutions are incompatible with each other
What are some of the broader issues around the management of time for pharmacists?
Most of the issues that come through the pharmacy, questions about meds or procedures, normally, we have a window of time; but there are instances where there is no window, they want an answer right away An example: a baby coming into the neonatal intensive care where there was an overdose; unfortunately, we had a case where the father fell asleep on the baby and suffocated the baby. And when there’s a code white, I find the baby’s weight right away Micromedex has a pediatric emergency medication chart: you type in the baby’s weight, and it gives you every cardiac or emergency med that could be used with that baby’s weight, because it’s all based on milligrams per kilo. They’ll be using various cardiac meds to revive the child. So when you type the baby’s weight into the calculator, every dosage will come out.
You’d be surprised how many times doctors, when pressed for time, will write milligrams per kilo instead of micrograms per kilo. But this tool helps me to ensure the correct dosage and correct use of the medication. It also gives the concentration of the meds to be used. Sometimes, you’ll see instructions on the substance, but not on how to make it, not how to compound it. And Micromedex will help with that. We standardized neonatal drips years ago, to make sure the concentration and drip rate were correct. But we created a chart with pretty much every drip that might be needed, and anything a neonate might need. We looked for a resource that might be able to help us, and we found Micromedex.
What are the issues around optimizing communications and meds delivery processes?
Communication is a must: repeat what you want, repeat it over and over again. You’d be amazed by how many lookalikes and soundalikes there are: dopamine and dobutamine, two cardiac meds that sound alike, and are very different.
What is the pharmacy-nursing communication dynamic or element in this?
One clear element is that no matter how rushed you might be, you have to step back and think carefully. A mistake, in my experience, will happen when it’s a regular day. And I can tell you from my experience that you’ll look at an order and say, this isn’t right. You might have twins, newborn baby male A and newborn baby male B. I like to call and confirm. There’s a moment in time when you can confirm. And sometimes, we do catch errors, and that is appreciated by the medica staff and the nursing staff. Nurses will call to confirm, particularly about concentrations—am I giving the right drug, the right dose, etc.? And I don’t take anything for granted; let’s make sure we’re talking about the right person, for example. And I’ve had to ask nurses to slow down when we’re communicating. And it’s satisfying when you can intervene.
How should health IT leaders think about these things?
Pharmacists are extremely lucky to have tools like Micromedex. We once used an actual physical book; and you had to look up individual drugs and had to try to compare side effects, for example. Now we have a resource like Micromedex where it can be utilized for patient safety and accuracy and for consistency
How should CIOs, CMIOs, think about this broadly?
If Micromedex or anything could be the source that the healthcare industry uses, the goal is a consistency of answers. For example, if there’s a neonatal crisis in the ED, once there’s that emergency, everyone stops what they’re doing and focuses on that child who’s in trouble. And we will all work in the moment to confirm. Human error will unfortunately always exist, but when you have a group of people looking at a resource and concentrating on it, and shouting out to each other, that helps. My institution will want a pharmacist to go to the ED when there’s a crisis. But we do need to be able to check into the computer. So the next step is putting the tool on our mobile phones.
