In the post-health reform era, solidifying medication management workflows to produce optimal outcomes and eliminate the potential for adverse drug events (ADEs) is critical for all healthcare organizations. Medication errors, whether minor or critical in nature, have become a focal point of public scrutiny, but also for hospitals as they compete within the framework of regulatory initiatives such as Value-Based Purchasing and the Hospital Readmissions Reduction Program.
It’s no wonder that this issue has taken center stage. Industry statistics reveal that the United States currently spends $200 billion annually to address improper use of medicines and adverse events.1 Medication errors also account for the most hospital-acquired conditions and readmissions.
|Debra Jarratt, RPh, Executive Pharmacist Consultant, Aesynt|
Many factors contribute to medication errors, but one specific challenge that is quickly moving to the forefront is the impact of interruptions and distractions in the pharmacy. Recent studies have examined the impact of increased interruptions, finding some pharmacists experience as many as one interruption or distraction every two minutes.2 Both scientific and anecdotal evidence suggest a direct link between increased error rates and interruptions. For example, when pharmacists have to abandon their work to answer incoming phone calls, they may incorrectly fill prescriptions when they return, having lost a singular focus on their initial task.
Healthcare leaders understand that pulling a medical professional away from a task at hand results in increased potential for a missed step or compromised process. In addition to patient-safety concerns, productivity is affected as pharmacists are constantly faced with unexpected tasks that prevent them from filling prescriptions in an efficient and timely manner. Decreased productivity in the pharmacy can slow down operations across the entire hospital or health system, resulting in reduced patient safety, inefficient workflows, decreased patient satisfaction and lower reimbursement.
For hospitals to reduce the risk of ADEs, they must take a holistic approach to their broader medication management strategy. By deploying strategies designed to minimize distractions in the pharmacy, hospitals can help improve productivity and patient safety issues. This includes automating medication management processes in order to eliminate much of the opportunity for error, helping pharmacists work at top-of-license for improved patient safety and operational efficiencies.
Primary causes of interruptions
Whether they have to clarify medications, transfer calls or confirm orders, pharmacists are inundated with outside requests that require leaving one unfinished task to manage another.
Even the workspace design within a pharmacy can contribute to a highly social environment that increases the likelihood of interruptions. Open rooms often make it easy for pharmacy staff to consult with each other. And most hospital pharmacies have a window allowing staff and patients to approach at will to ask questions or pick up medications, creating unplanned interruptions for staff. However, staff may not realize when a simple question is breaking the concentration of a colleague who is focused on a complex dosage calculation. While multi-tasking is an expected job skill for pharmacists, patient safety and productivity are affected if pharmacists cannot focus on the task at hand.
Open operational environments also tend to lead to personal conversation. Many health professionals attribute telephone calls and patients as the primary sources of distraction in healthcare settings, but some studies actually rank professionals as the primary culprits because they frequently initiate personal conversations with co-workers.3
Other common distractors include lack of knowledge about a particular medication that requires pharmacists to consult reference sources, or personal issues that are at the forefront of a professional’s thoughts.
A relatively new form of distraction across all healthcare settings is the ever-present electronic device, which can have both positive and negative impacts on medication management workflows. While electronic devices allow for more immediate access to key reference data and other patient information, they also open opportunities for technological interruptions in the care setting – personal tasks, social media and personal text communication to name a few.
Understanding the challenge
When it comes to medication management, timing and delivery are key components. Not only do interruptions affect pharmacy workflows, but the delays in timing and delivery have a trickle-down effect throughout the hospital, impacting not only productivity but also patient safety, outcomes and satisfaction.
Consider the typical scenario in which an admitted patient is waiting to receive antibiotics for bronchitis. While the patient waits in discomfort, the pharmacist dispensing the ordered medications is pulled away by a clinician who needs to discuss another patient’s order. Naturally, this delays delivery of the antibiotics. Not only is productivity affected, but the patient’s condition may worsen significantly when he or she does not receive medications in a timely manner. In other situations, delayed medications can have more direct results on patient safety.
Accuracy is another critical challenge during many pharmacy dosing and dispensing functions. In the case of pediatric, neo-natal and chemotherapy dosing, for instance, miscalculating by a decimal point can be lethal. If a pharmacist pulls up 1 ml instead of 0.1 ml, for example, the results can be devastating.
Methods to prevent interruptions
Other functions that should be completed in an area free from distraction are dosing of investigational study drugs, compounding activity and order entry. Establishing “quiet zones” that enable pharmacists to focus on these functions without risk of interruption is one essential step toward safer medication management workflows. The key is training staff to understand that these zones, whether a designated area in an open pharmacy or in a private room, are off limits when a pharmacist is working.
Visual markers can be effective tools for designating quiet zones. Because a separate room is not always available, some hospital pharmacies define these areas via red tape on the floors, cones, signage or special lighting. Others may be more creative, distributing noise-cancelling headphones or providing pharmacists in the quiet zone with a cape or special attire that signals they are not to be disturbed. Designating one person for high-risk tasks can also help narrow the potential for error and interruption.
In addition to establishing quiet zones and designating staff to high-risk tasks, automating some medication management practices can also add value. Within an overall effort to minimize the potential for error as a result of distractions, centralized dispensing solutions that utilize barcode administration can virtually eliminate the impact of human error associated with dispensing and dosing. A growing body of evidence points to the effectiveness of barcode technology for improving workflows and delivering improved patient safety outcomes. It’s just as important to remove repetitive, time-consuming dispensing tasks from the pharmacy staff’s workload through automation and barcode technology to free up their time and increase their focus on higher-level patient care; this also helps eliminate the need to multi-task while filling orders. Automation and barcode technology have been proven in many markets throughout the world to be accurate, safe and capable of eliminating mistakes caused by human error. This technology in healthcare has helped enhance patient safety by eliminating human error and improving efficiency and throughput.
It’s not only pharmacy staff who benefit, though; automating medication management also benefits nursing workflows. Nurses can receive everything needed for a particular patient in one envelope from the pharmacy instead of making multiple trips to dispensing units to obtain medications. Nurses encounter interruptions from other nurses, staff, family and physicians as they walk through the hallways. By having an envelope containing all of the necessary medications, nurses won’t need to walk back and forth to retrieve items, thereby minimizing interruptions and streamlining the medication administration process. Ultimately, nurses are able to spend more time at the patient bedside, which results in higher-quality care.
Fewer distractions, better medication management
Distractions and interruptions are a reality for any clinical hospital environment, but pharmacy departments are particularly vulnerable. Minimizing the impact of distractions can have a positive effect on patient safety, outcomes and overall satisfaction and should be an integral part of any medication management strategy. Many best practices can be implemented to diminish disruptions to pharmacy workflows, including the use of automation to minimize the potential for error and maximize the delivery of optimal patient care.
- IMS Institute for Healthcare Informatics, “Avoidable Costs in U.S. Healthcare.” http://www.imshealth.com/deployedfiles/imshealth/Global/Content/Corporate/IMS%20Institute/RUOM-2013/IHII_Responsible_Use_Medicines_2013.pdf
- Silver, Julie. “Interruptions in the Pharmacy: Classification, Root-Cause and Frequency. http://www.ismp.org/docs/silverj_shs2010.pdf
- American Pharmacists Association. “Deflect distractions and intercept interruptions.” http://www.pharmacist.com/deflect-distractions-and-intercept-interruptions