Computerized patient records are not unique. Hundreds of hospitals are beginning to benefit from them.
Computerized dispensaries of medication orders are popping up in many hospitals, too.
But when Jacobi Medical Center integrated the two, it created a unique way to get pharmacy orders from clinician to patient with maximum accuracy and minimal manpower.
Besides decreasing the turnaround time between ordering and administering drugs, the marriage of the two systems has freed pharmacists to walk away from an assembly-line job and add their know-how to care throughout the hospital.
Since 1993 Jacobi has been the pilot implementation site for a computerized patient record system at New York City Health and Hospitals Corp.
Among the features of the Ulticare system, marketed by Atlanta-based Medaphis, is an electronic link allowing clinicians to send orders directly to the pharmacy department. That eliminates transcription errors and cuts through any number of delays inherent in handing off scraps of paper, says Joseph Alongi, Jacobi's pharmacy director.
The on-line system also ends the waiting and searching around for paper charts. Pharmacists now can look up on-line charts for lab results, tests, dietary information and medical histories. All enter into checking doses, catching possible drug interactions and deciding such things as whether to order an antibiotic as a capsule or suspension, says Joseph D'Agostino, an assistant pharmacy director.
The Ulticare system can take all the information and alert pharmacists to such problems as allergies, drug interactions and duplicated therapies. Ultimately the system tells pharmacists exactly what medication orders are needed in the next 24 hours, D'Agostino says.
But lining up the orders is only half the job. Filling them is the detail-conscious finale. That manual task typically ate up six hours of every day for several pharmacists and technicians.
That's when the RxOBOT pharmacy robotics system from McKesson Automated Healthcare steps in. Purchased for $594,000, the system selects and retrieves unit doses of bar-coded patient medications from a "pick" station of medication packets on wire racks, depositing the orders in a bar-coded tray for each patient.
That signaled an end to the pill-filling chores, but it still meant rekeying all the information from the Ulticare system to the RxOBOT.
An interface between the systems completes the automation, allowing the robotic station to take its orders directly from the list compiled by the Ulticare system, says Jim Stockdale, Jacobi's associate executive director. "The key to this institution is the marriage of the two," he says. "Individually they would be fine; married, they are unique."
For pharmacists, the innovation has engineered a virtual career change. Before automation moved in, pharmacists were spending 70% to 80% of their time filling orders, transcribing and checking them, calling labs or hoofing it to the labs themselves to find orders, says Howard Nadel, an assistant pharmacy director. Now that process happens largely without lifting a finger.
But instead of cutting back sharply on pharmacists, Nadel says the hospital has sent most of them on rounds -- checking drug levels of patients, suggesting medication adjustments to physicians, managing side effects, educating patients on what their medications do and how to take them after leaving the hospital.
"Pharmacists are allowed to be pharmacists instead of clerks and secretaries," Nadel says.
Some of the benefits:
Consulting with patient-care teams. Optimum care often depends on altering drug regimens after more is known about a patient's condition or progress, Nadel says. Since they started attending meetings with psychiatry staff, for example, pharmacists have had to intervene or modify orders placed by physicians an average of 18 times a day instead of the usual 39 times. That more than 50% drop represents improved prescribing practice as well as savings in pharmacist time.
Counseling patients at discharge. Hospitals can head off future medication-related problems by going over details with patients before they leave, Alongi says. For example, different types of insulin are prescribed for both short-term and long-term effect, and a patient who doesn't get a proper explanation may end up back in the hospital, he says. An industry study estimates each discharge interview done by a pharmacist saves $200 to $300 in readmission and emergency costs. Jacobi pharmacists have doubled the number of interviews, saving an extra $4,500 a week.
Interviewing admitted patients. At the trauma center, physicians are concerned mainly with the pressing problem that brought in a patient. But before the trauma, a person may have been on medications that could cause other problems if caregivers aren't aware of them, Alongi says. A pharmacist can make sure to start them on medications that were interrupted as well as improve the selection of new medications, he says.