hospital staffing future

[nampa1]

Recently a hospital resident speaker, at undergrad school conventions, mentioned that he thought hospital staffing positions, eg., verify physician orders at the computer, would be eliminated by techs or automation--the only thing left being clinical positions. From my pharmacy friend's POV, clinical jobs are seen as icing on the cake, but not essential, where the staffing jobs in the hospital are the ones that are needed to run the place. I can see the number of staffers being reduced but not eliminated. The drug warning software is a joke and techs can not verify, if I am correct. If staffing goes, the whole edifice will fall. Can anyone elaborate on this?

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[Got Em]

Recently a hospital resident speaker, at undergrad school conventions, mentioned that he thought hospital staffing positions, eg., verify physician orders at the computer, would be eliminated by techs or automation--the only thing left being clinical positions. From my pharmacy friend's POV, clinical jobs are seen as icing on the cake, but not essential, where the staffing jobs in the hospital are the ones that are needed to run the place. I can see the number of staffers being reduced but not eliminated. The drug warning software is a joke and techs can not verify, if I am correct. If staffing goes, the whole edifice will fall. Can anyone elaborate on this?

No software can ever eliminate pharmacists. This hospital speaker obviously does not know what he is talking about. Computers are pretty useless if nobody can clear out exceptions. You can also never make an algorithm for every type of drug interaction, condition, etc.

 

[crazybob]

No software can ever eliminate pharmacists. This hospital speaker obviously does not know what he is talking about. Computers are pretty useless if nobody can clear out exceptions. You can also never make an algorithm for every type of drug interaction, condition, etc.

 

[janeno]

In my opinion, verifying orders is pretty clinical. It's actually essential - you are making sure that the patient receives the right medication, dose, route, etc.

 

[All4MyDaughter]

In my opinion, verifying orders is pretty clinical. It's actually essential - you are making sure that the patient receives the right medication, dose, route, etc.

Yeah. No way that can be left to a tech.

 

[spacecowgirl]

CPOE absolutely does not replace what we do. There is no way to automate clinical judgement. If you see the sheer # of alerts that pop-up with CPOE, you'll see what I mean. I absolutely do not worry about this at all.

 

[J ROD]

The mind is a terrible thing to waste.

Computers understand black and white and we as pharmacist get paid what we do because we work in areas of grey.

Think.....and reason!!

 

[Electrode]

The mind is a terrible thing to waste.

Computers understand black and white and we as pharmacist get paid what we do because we work in areas of grey.

Think.....and reason!!

ePIC

As a hosp tech, we're already stretched out enough! Adding the pharmacist duties to my current responsibilities = requesting for my resignation. It doesn't even sound realistic as a matter of fact. It's practically impossible.

 

[CYP3A4]

I agree with the guy who thinks the clinical positions are "the icing on the cake". Very few institutions can justify the cost of a strictly clinical pharmacist.

However I think both opinions presented are incorrect. My current title is "Clinical Pharmacist" but I split my time 50/50 between the units and the main pharmacy. Oder entry (or order verification for those who have CPOE) requires a clinical approach no matter how you look at it. I really get annoyed at people who make this distinction between "staff" and "clinical" pharmacist. A good pharmacist's brain shouldn't shut down just because he/she isn't only verify orders and overseeing technicians. I have made some important clinical interventions just by doing the cart fill (ie. noticing a HIV patient has an incomplete HAART regimen).

Pharmacists need to be thinking clinically at all times.

 

[janeno]

I agree with the guy who thinks the clinical positions are "the icing on the cake". Very few institutions can justify the cost of a strictly clinical pharmacist.

However I think both opinions presented are incorrect. My current title is "Clinical Pharmacist" but I split my time 50/50 between the units and the main pharmacy. Oder entry (or order verification for those who have CPOE) requires a clinical approach no matter how you look at it. I really get annoyed at people who make this distinction between "staff" and "clinical" pharmacist. A good pharmacist's brain shouldn't shut down just because he/she isn't only verify orders and overseeing technicians. I have made some important clinical interventions just by doing the cart fill (ie. noticing a HIV patient has an incomplete HAART regimen).

Pharmacists need to be thinking clinically at all times.

totally agree

 

[Rebel78]

I agree with the guy who thinks the clinical positions are "the icing on the cake". Very few institutions can justify the cost of a strictly clinical pharmacist.

However I think both opinions presented are incorrect. My current title is "Clinical Pharmacist" but I split my time 50/50 between the units and the main pharmacy. Oder entry (or order verification for those who have CPOE) requires a clinical approach no matter how you look at it. I really get annoyed at people who make this distinction between "staff" and "clinical" pharmacist. A good pharmacist's brain shouldn't shut down just because he/she isn't only verify orders and overseeing technicians. I have made some important clinical interventions just by doing the cart fill (ie. noticing a HIV patient has an incomplete HAART regimen).

Pharmacists need to be thinking clinically at all times.

Agreed. I think the future is in the hybrid positions, not many places will be able to justify a purely "clinical" pharmacist financially.

 

[Its Z]

One size does not fit all.

There are many different types of hospitals. From 25 bed rural Critical Access hospitals to 1,500 bed Mega Univerisity Teaching systems.

Hybrid clinical/staff pharmacist has been my model for the past 15 years. However, there's still a need for a clinical manager to oversee the clinical program who may not participate in distribution. This depends on the size of the hospital. I believe the cut off point is 150 beds where you need a clinical manager.

At a 500 bed community hospital, I believe Clinical Manger, Infectious Disease, Critical Care, and ED pharmacists who do not dispense can have a significant role in managing clinical/staff hybrid pharmacist programs.

But in Academia, there's a need for pure clinicians in a teaching environment and as a secondary provider such as transplant and oncology. Teaching is an important role for an obvious reason...

Of course 25 years ago in CA where clinical pharmacy was in vogue.. countless clinical pharmacists roamed the hallways of hospitals... but the hospital administrators pulled the plug on that one pretty quick.

 

[aboveliquidice]

Of course 25 years ago in CA where clinical pharmacy was in vogue.. countless clinical pharmacists roamed the hallways of hospitals... but the hospital administrators pulled the plug on that one pretty quick.

This is why people think you're old... just 'sayin

 

[nampa1]

ePIC

As a hosp tech, we're already stretched out enough! Adding the pharmacist duties to my current responsibilities = requesting for my resignation. It doesn't even sound realistic as a matter of fact. It's practically impossible.

I think the clinical resident guy meant that staffers would be outsourced to a central location and verify through the internet visually, not that the concept of a staffer would be gone.

 

[Praziquantel86]

So to those of you who mention that a pharmacist is essential in the checking process, what are your opinions on the "tech check tech" ideal? While I realize it might not be the best for a hospital setting, I think it is something that is likely to occur in retail settings sooner rather than later.

This may be bad for the pharmacist job market, but I don't honestly think it will negatively affect the patient base as long as there is still a pharmacist available for counseling and the like. Thoughts?

 

[psychoandy]

So to those of you who mention that a pharmacist is essential in the checking process, what are your opinions on the "tech check tech" ideal? While I realize it might not be the best for a hospital setting, I think it is something that is likely to occur in retail settings sooner rather than later.

This may be bad for the pharmacist job market, but I don't honestly think it will negatively affect the patient base as long as there is still a pharmacist available for counseling and the like. Thoughts?

I thought this was regarding order verification, not actual physical drug checking.

I think tech-check-tech is a potentially good idea IF the techs are trained correctly, are willing to do it, get comensated a bit more, and have a very low threshold for discussion with RPh. There would have to be a lot of regulations i.e. no IVs, insurance, etc. This also requires the board of pharmacy to be on board, which they may not be as this is a typical hospital RPh role. In terms of retail vs hospital, I always thought of it as a hospital idea. At Midyear there were like 3-4 resident posters evaluating tech check tech.

 

[PharmD RPh]

I thought this was regarding order verification, not actual physical drug checking.

I think tech-check-tech is a potentially good idea IF the techs are trained correctly, are willing to do it, get comensated a bit more, and have a very low threshold for discussion with RPh. There would have to be a lot of regulations i.e. no IVs, insurance, etc. This also requires the board of pharmacy to be on board, which they may not be as this is a typical hospital RPh role. In terms of retail vs hospital, I always thought of it as a hospital idea. At Midyear there were like 3-4 resident posters evaluating tech check tech.

No way a BOP will ever let a tech do the final verification. That is the last line of defense against a med error. The more we are willing to say a tech can do this the more we degrade our value.

 

[All4MyDaughter]

Certified techs can already check each other on Pyxis refills. At my hospital they also check each other on a lot of the premade IV stuff.

When I say a pharmacist is essential to the verification process, I mean verification of the order (dose, duration, drug interactions, flow rate, concentration, whatever). That's not tech work.

 

[R2pharmD2]

No way a BOP will ever let a tech do the final verification. That is the last line of defense against a med error. The more we are willing to say a tech can do this the more we degrade our value.

The nurse who administers the med is going to be the last line of defense in a hospital setting, or at least this is the case where I work. The nurse has the advantage of working directly with a handful of patients, and that does make them uniquely suited to catch some mistakes in some instances. I personally think it's ridiculous to expect anyone other than a pharmacist to do a pharmacist's job, but maybe the expectation is that the nurse, and not the "verifying tech", is ultimately going to catch these mistakes?

 

[All4MyDaughter]

The nurse who administers the med is going to be the last line of defense in a hospital setting, or at least this is the case where I work. The nurse has the advantage of working directly with a handful of patients, and that does make them unique suited to catch some mistakes in some instances. I personally think it's ridiculous to expect anyone other than a pharmacist to do a pharmacist's job, but maybe the expectation is that the nurse, and not the "verifying tech", is ultimately going to catch these mistakes?

The presence of the nurse as the last line of defense is what allows hospitals to get away with "tech check tech" on certain things (see my examples above). At least that's how it was explained to me.

 

[owlegrad]

Certified techs can already check each other on Pyxis refills. At my hospital they also check each other on a lot of the premade IV stuff.

When I say a pharmacist is essential to the verification process, I mean verification of the order (dose, duration, drug interactions, flow rate, concentration, whatever). That's not tech work.

Not at my hospital.

 

[delano2000]

Not at my hospital.

Not mine either. About the only tech-check-tech that you will see in my hospital is with adult/pedi crash cart trays and the anesthesia trays for L&D. Sometimes we can get a tech to check stuff that we weighed out to complete a certain compound (eg. Dr. Garza Butt Paste). But all Pyxis, cartfill, IVs, Chemos and narcs have to be checked by the RPh.

 

[confettiflyer]

You can source a lot of things to your hospital techs, but ultimately it has to come back around to a pharmacist since every single order coming in is looked at "clinically." At some point, it's not cost-effective.

At some point, you've distilled it out as far as it can go and your workflow can't get any more efficient. Tech-check can work and make operations more efficient, but you open veritable pandora's box of liability issues, plus clinical decision making by "staff" pharmacists still needs to occur at some point.

 

[All4MyDaughter]

Not at my hospital.

Not mine either. About the only tech-check-tech that you will see in my hospital is with adult/pedi crash cart trays and the anesthesia trays for L&D. Sometimes we can get a tech to check stuff that we weighed out to complete a certain compound (eg. Dr. Garza Butt Paste). But all Pyxis, cartfill, IVs, Chemos and narcs have to be checked by the RPh.

Interesting. Now I'm wondering if it's a state thing, a VA thing or just a "my hospital" thing.

They also check each other on unit dosing and inpatient compounding (SMOG enemas, Magic Mouthwash, etc).

 

[spacecowgirl]

Certified techs can already check each other on Pyxis refills.

This is what we do. It's the only thing we don't do the final check on. Still plenty for us to do.

 

[PharmD RPh]

Interesting. Now I'm wondering if it's a state thing, a VA thing or just a "my hospital" thing.

They also check each other on unit dosing and inpatient compounding (SMOG enemas, Magic Mouthwash, etc).

There's no way I would feel comfortable or take responsibility for "tech checks" under my license. I have already seen internal med error event numbers that take place in my workplace by our district and you would be surprised how many mistakes pharmacists make in a given month on a large scale just within a district. I could only imagine what that number would be if we expanded the technician role. Would you want a surgical tech performing a surgery on you instead of a surgeon? I personally would not. The surgical techs qualifications would just be to assist the surgeon not perform the surgeons job duties. I believe we have maxed out the role of a certified tech and don't see how we can safely expand their role anymore than what it already is without increasing med errors.

 

[rph3664]

I never worked at a "tech check tech" place, and when my last employer proposed it, we pharmacists quickly shot it down. One reason, albeit one we didn't tell TPTB, is that we all knew that the techs they would choose to be the ones in charge would be the ones who make the most mistakes but get away with anything because they're brown-nosers, or in one case, a member of a protected class (disabled).

 

[All4MyDaughter]

There's no way I would feel comfortable or take responsibility for "tech checks" under my license. I have already seen internal med error event numbers that take place in my workplace by our district and you would be surprised how many mistakes pharmacists make in a given month on a large scale just within a district. I could only imagine what that number would be if we expanded the technician role. Would you want a surgical tech performing a surgery on you instead of a surgeon? I personally would not. The surgical techs qualifications would just be to assist the surgeon not perform the surgeons job duties. I believe we have maxed out the role of a certified tech and don't see how we can safely expand their role anymore than what it already is without increasing med errors.

I'm pretty sure that the tech-check-tech is legal under state law, at least for cart fill. I seem to remember it being discussed at a recent law review.

 

[PharmD RPh]

Also try explaining a med error to a patient in which the technician made the mistake during the "tech check". I'm sure sure that wouldn't be an easy conversation to have or lawsuit to defend.

 

[All4MyDaughter]

Also try explaining a med error to a patient in which the technician made the mistake during the "tech check". I'm sure sure that wouldn't be an easy conversation to have or lawsuit to defend.

Conversations about errors are never easy to have, regardless of who made the error. And since we're talking about hospitals, it would be three individuals who are complicit in the error (tech, tech, nurse). If it's legal and consistent with hospital policy, it would be handled just like any other medical error in court.

If techs are checking each other in contraindication of state law and/or hospital policy, then that's a different matter.

 

[spacecowgirl]

I know it's legal in our state. For Pyxis fills I have no problem with it. Only the techs that want to do it went through the training and go through audits. I would not feel comfortable with anything beyond that.

Hell, when I worked as an intern, not only did pharmacists not check Pyxis refills, the weren't double checked by anyone! Hopefully the tech that pulled the refill didn't also fill it but there were no guarantees about that.

We all make mistakes, tech or not. It takes no special skills to check a Pyxis refill other than attention to detail. You don't need an advanced degree for that

 

[PharmD RPh]

So to those of you who mention that a pharmacist is essential in the checking process, what are your opinions on the "tech check tech" ideal? While I realize it might not be the best for a hospital setting, I think it is something that is likely to occur in retail settings sooner rather than later.

This may be bad for the pharmacist job market, but I don't honestly think it will negatively affect the patient base as long as there is still a pharmacist available for counseling and the like. Thoughts?

I personally don't like the idea and while I could see chains pushing for this, who would legally be held responsible for a med error here? In my state I can tell you it's the RPh on duty at the time the error occurs. We once had an error where a tech opened a bag to combine multiple bagged rxs into one bag and the tech combined 2 different patients. We know it happened this way because of the time in which the rxs were verified was very far apart. The board acknowledged it was the techs mistake but still fined the RPh on duty $500 and it went on the RPhs record. The board held that it was the pharmacists duty to ensure that the correct medication went to the correct patient.

In this case the tech check tech would not have a nurse to catch anything before it was administered to the patient. Too risky still for some techs whose formal education just includes on the job training.

But going back to OP stating techs would do order review is crazy too. I know most hospitals physician order entry systems will prompt the physician regarding a drug interaction and or anything that is a high dose etc. So what if a hospital just went to the physician doing order entry and then there is no check by the RPh and the hospital Pharmacy just has a tech check tech policy? In this case the hospital would eliminate staff positions. What would be the consequence of such a system in regards to safe medication use in the hospital setting?

 

[powertoold]

CPOE absolutely does not replace what we do. There is no way to automate clinical judgement. If you see the sheer # of alerts that pop-up with CPOE, you'll see what I mean. I absolutely do not worry about this at all.

Well, CPOE won't replace us, but once a non-academic hospital implements it, pharmacy staff will be reduced. I think community hospital DoPs will need to push clinical / decentralized pharmacy in order to maintain pharmacy staff after CPOE is implemented.

In hospitals that still don't have CPOE, much of a pharmacist's time is spent clarifying handwriting issues, like dosing, drug name, unclear orders, etc. True, there are significant issues that come up, but with CPOE, you don't need as many pharmacists.

What community hospital pharmacies need to do is follow Kaiser in implementing more clinical pharmacy protocols. This way, pharmacists are monitoring certain aspects of pharmacotherapy and making recommendations as needed.

I think many of the new "meaningful use" measures coming from Health Reform will allow pharmacists to do other things than just order entry / processing. This isn't to say that order entry isn't important / clinical, but once CPOE comes into play, you honestly only need 1-2 experienced pharmacists to verify all of them.

 

[All4MyDaughter]

Well, CPOE won't replace us, but once a non-academic hospital implements it, pharmacy staff will be reduced. I think community hospital DoPs will need to push clinical / decentralized pharmacy in order to maintain pharmacy staff after CPOE is implemented.

In hospitals that still don't have CPOE, much of a pharmacist's time is spent clarifying handwriting issues, like dosing, drug name, unclear orders, etc. True, there are significant issues that come up, but with CPOE, you don't need as many pharmacists.

What community hospital pharmacies need to do is follow Kaiser in implementing more clinical pharmacy protocols. This way, pharmacists are monitoring certain aspects of pharmacotherapy and making recommendations as needed.

I think many of the new "meaningful use" measures coming from Health Reform will allow pharmacists to do other things than just order entry / processing. This isn't to say that order entry isn't important / clinical, but once CPOE comes into play, you honestly only need 1-2 experienced pharmacists to verify all of them.

Source? I've seen a number of posts on SDN that contradict the idea that CPOE reduces the need for pharmacists.

In my personal experience, the only FULLY CPOE hospital I've worked in has more pharmacists on staff than I've seen anywhere else.

 

[rxlea]

No tech check tech here... Everything, including trays, get checked by the pharmacists.

And seriously...this rumor that CPOE reduces staff needs to stop. All the hospitals that I know people at/heard of that implemented CPOE hired more staff. Speaking of which, we are going to be hiring a new BMT pharmacist in the next 20 days. We lost ours to the new MD Anderson clinic in our state...she got the job there to be closer to home. You don't have to be residency trained...just have some experience and not be a douche.

 

[spacecowgirl]

Well, CPOE won't replace us, but once a non-academic hospital implements it, pharmacy staff will be reduced. I think community hospital DoPs will need to push clinical / decentralized pharmacy in order to maintain pharmacy staff after CPOE is implemented.

In hospitals that still don't have CPOE, much of a pharmacist's time is spent clarifying handwriting issues, like dosing, drug name, unclear orders, etc. True, there are significant issues that come up, but with CPOE, you don't need as many pharmacists.

What community hospital pharmacies need to do is follow Kaiser in implementing more clinical pharmacy protocols. This way, pharmacists are monitoring certain aspects of pharmacotherapy and making recommendations as needed.

I think many of the new "meaningful use" measures coming from Health Reform will allow pharmacists to do other things than just order entry / processing. This isn't to say that order entry isn't important / clinical, but once CPOE comes into play, you honestly only need 1-2 experienced pharmacists to verify all of them.

I am a pharmacist in a rural, non-academic hospital, with full CPOE. We added staff, not reduced staff. I'm glad I don't spend my time clarifying written orders from crappy quality faxes. Not why I spent 10 years on my education.

We do a decent amount of pharmacy driven dosing and I do a lot of quality improvement and "clinical" programming. There is a surprising amount of work to do even with CPOE, it's just a lot less busy work.

 

[njac]

No tech check tech here... Everything, including trays, get checked by the pharmacists.

And seriously...this rumor that CPOE reduces staff needs to stop. All the hospitals that I know people at/heard of that implemented CPOE hired more staff. Speaking of which, we are going to be hiring a new BMT pharmacist in the next 20 days. We lost ours to the new MD Anderson clinic in our state...she got the job there to be closer to home. You don't have to be residency trained...just have some experience and not be a douche.

is it posted? I know someone looking for aBMT job.

 

[rxlea]

is it posted? I know someone looking for aBMT job.

It will be. send me a PM and I will give you my email address. If you can send the resume to me today or tomorrow I can leave it on my director's desk with a note. Then your friend will have to apply online but will get a second look.

EDIT: and if anyone else cares, we have an ICU and ID position available as well. Those are already posted online! I am not checking my SDN mail regularly right now so if you want dibs, it has to happen this weekend.

 

[Praziquantel86]

I personally don't like the idea and while I could see chains pushing for this, who would legally be held responsible for a med error here? In my state I can tell you it's the RPh on duty at the time the error occurs. We once had an error where a tech opened a bag to combine multiple bagged rxs into one bag and the tech combined 2 different patients. We know it happened this way because of the time in which the rxs were verified was very far apart. The board acknowledged it was the techs mistake but still fined the RPh on duty $500 and it went on the RPhs record. The board held that it was the pharmacists duty to ensure that the correct medication went to the correct patient.

In this case the tech check tech would not have a nurse to catch anything before it was administered to the patient. Too risky still for some techs whose formal education just includes on the job training.

But going back to OP stating techs would do order review is crazy too. I know most hospitals physician order entry systems will prompt the physician regarding a drug interaction and or anything that is a high dose etc. So what if a hospital just went to the physician doing order entry and then there is no check by the RPh and the hospital Pharmacy just has a tech check tech policy? In this case the hospital would eliminate staff positions. What would be the consequence of such a system in regards to safe medication use in the hospital setting?

I was always under the impression that tech-check-tech was just to make sure the right pill is in the bottle, name of the drug matches what's on the Rx, etc. I think in those cases it is the second set of eyes that's helpful, not the Pharm.D.

Clinical checks should never be replaced by a pharmacist, and DUR still needs to be done. For retail at least, those can easily be centralized and significantly cut down on staffing levels. Not sure how this would work in hospitals as of right now.

And CPOE definitely does not cut cause a cut in pharmacist staffing levels. The problems inherent with written orders are simply replaced by a new set of problems unique to CPOE. If anything, staffing levels increase as the pharmacy is able to become decentralized and more "clinical". When pharmacists have more free time to make interventions and live on the floor, true cost saving can be seen with each pharmacist position added.

 

[PharmD RPh]

I was always under the impression that tech-check-tech was just to make sure the right pill is in the bottle, name of the drug matches what's on the Rx, etc. I think in those cases it is the second set of eyes that's helpful, not the Pharm.D.

Clinical checks should never be replaced by a pharmacist, and DUR still needs to be done. For retail at least, those can easily be centralized and significantly cut down on staffing levels. Not sure how this would work in hospitals as of right now.

And CPOE definitely does not cut cause a cut in pharmacist staffing levels. The problems inherent with written orders are simply replaced by a new set of problems unique to CPOE. If anything, staffing levels increase as the pharmacy is able to become decentralized and more "clinical". When pharmacists have more free time to make interventions and live on the floor, true cost saving can be seen with each pharmacist position added.

We used to have remote data review in my state but the board made us turn it off because they didn't like the idea. But instead of it occurring in a central location it happened all across the retail chains in that vicinity based on how busy your store was at the time. For example if my store was completely caught up but another store was getting killed with too many rxs then my store would start to get rxs for the store that was super busy. In this case remote verification did not have to be paid for at a separate location and didn't cost the company any more payroll as it just balanced the workload amongst pharmacists already working at the time.

While I believe a monkey can make sure the right pill matches the right image on the screen, as long as the board is still going to hold me accountable for med errors should they occur, I'd rather the RPh doing product review than a tech check tech.

 

[powertoold]

I am a pharmacist in a rural, non-academic hospital, with full CPOE. We added staff, not reduced staff. I'm glad I don't spend my time clarifying written orders from crappy quality faxes. Not why I spent 10 years on my education.

We do a decent amount of pharmacy driven dosing and I do a lot of quality improvement and "clinical" programming. There is a surprising amount of work to do even with CPOE, it's just a lot less busy work.

Well, nothing you've said in this post contradicts mine.

If pharmacists were simply going to do order entry / processing, then CPOE would reduce staffing. That's why community hospitals need to grab onto more "pharmacy driven dosing" and "quality improvement" duties.

With CPOE and decentralized pharmacy, hopefully we can get into valuable duties like discharge counseling and whatnot. Of course, many of the old-school pharmacists won't like this.

There's a ton of stuff we can do. The pharmacy administration just needs to be good at defending our cost-effectiveness.

 

[Praziquantel86]

Well, nothing you've said in this post contradicts mine.

If pharmacists were simply going to do order entry / processing, then CPOE would reduce staffing. That's why community hospitals need to grab onto more "pharmacy driven dosing" and "quality improvement" duties.

With CPOE and decentralized pharmacy, hopefully we can get into valuable duties like discharge counseling and whatnot. Of course, many of the old-school pharmacists won't like this.

There's a ton of stuff we can do. The pharmacy administration just needs to be good at defending our cost-effectiveness.

Not necessarily. CPOE does not mean that a pharmacist doesn't have to verify the order. When CPOE goes smoothly, it definitely cuts down on processing time. However, CPOE has it's own list of inherent problems (often related to drop-down menus, such as picking hydroxyzine instead of hydralazine) that require more effort from a pharmacist. It's just a different set of problems.

 

[All4MyDaughter]

Not necessarily. CPOE does not mean that a pharmacist doesn't have to verify the order. When CPOE goes smoothly, it definitely cuts down on processing time. However, CPOE has it's own list of inherent problems (often related to drop-down menus, such picking instead of hydralazine) that require more effort from a pharmacist. It's just a different set of problems.

Agree with this. The only thing it really changes is the handwriting issue. Everything else still has to be checked like it did before. And the potential for errors with drop down menus is pretty high, as you suggested. One of my practice sites had a patient almost die because the ER doctor picked hydralazine instead of hydroxyzine from a pulldown. The order looked fine to the pharmacist who verified it. Indeed there was nothing "wrong" with the order, except it was the wrong drug. So pharmacists still need to be vigilant and it still takes time and due diligence.

 

[owlegrad]

Agree with this. The only thing it really changes is the handwriting issue. Everything else still has to be checked like it did before. And the potential for errors with drop down menus is pretty high, as you suggested. One of my practice sites had a patient almost die because the ER doctor picked hydralazine instead of hydroxyzine from a pulldown. The order looked fine to the pharmacist who verified it. Indeed there was nothing "wrong" with the order, except it was the wrong drug. So pharmacists still need to be vigilant and it still takes time and due diligence.

What do you think should be done to prevent that from happening in the future? I think that would be an all to common problem. It is hard enough trying to guess what a doctor wrote down, I can't imagine having to wonder if the doc picked the right thing from a menu. At least with handwriting issues, they can be solved quickly most times in the inpatient setting. Not sure how to resolve a possible wrong drug selected problem or how you could even catch it.

As for this whole thing about cutting down pharmacist's workload...How long does it take to type an order? That is the only part being cut out right? Everything else, reviewing, verifying, etc., still has to be done right? How much work can it really be cutting out? I ask because I have never worked with CPOE. It sounds like e-prescribing to me...I don't know too many people who find e-prescribing to be the bee's knees. It cuts out the handwriting issue and opens up a slue of other issues.

 

[All4MyDaughter]

What do you think should be done to prevent that from happening in the future? I think that would be an all to common problem. It is hard enough trying to guess what a doctor wrote down, I can't imagine having to wonder if the doc picked the right thing from a menu. At least with handwriting issues, they can be solved quickly most times in the inpatient setting. Not sure how to resolve a possible wrong drug selected problem or how you could even catch it.

As for this whole thing about cutting down pharmacist's workload...How long does it take to type an order? That is the only part being cut out right? Everything else, reviewing, verifying, etc., still has to be done right? How much work can it really be cutting out? I ask because I have never worked with CPOE. It sounds like e-prescribing to me...I don't know too many people who find e-prescribing to be the bee's knees. It cuts out the handwriting issue and opens up a slue of other issues.

I guess you could add a diagnosis field in the CPOE system. So if a pharmacist saw an order for "hydralazine for itching" you'd take a second look. The system already lists the patient's diagnoses in a separate area, so you could cross check. But in this case, the patient already had a diagnosis of hypertension, so the hydralazine wasn't totally out of the question.

I don't think it cuts down that much on the pharmacist's workload. Yes it eliminates handwriting and order entry. But you still have to do everything else.

 

[owlegrad]

I guess you could add a diagnosis field in the CPOE system. So if a pharmacist saw an order for "hydralazine for itching" you'd take a second look. The system already lists the patient's diagnoses in a separate area, so you could cross check. But in this case, the patient already had a diagnosis of hypertension, so the hydralazine wasn't totally out of the question.

I don't think it cuts down that much on the pharmacist's workload. Yes it eliminates handwriting and order entry. But you still have to do everything else.

I was wondering about that. Everyone's favorite entity JHACO requires indications for all PRN orders anyway, so I am sure CPOE systems already have a place for indications. The only issue I see with requiring indications is that doctors will invariably pick the wrong indications, and then you will have to verify which needs to be corrected, indication or drug. Still better than nothing, maybe?

 

[Its Z]

Hospital pharmacy staffing future is very bright for properly trained pharmacists. They'll verify and approve physician orders coming through CPOE while making clinical interventions and monitoring patients for core measure compliance. Those who just want to sit in front of a computer terminal processing orders could get weeded out.

Take my word for it on this one. Bookmark this thread. Pull it back up in 5 years, 10 years, and 15 years from now.

 

[All4MyDaughter]

I was wondering about that. Everyone's favorite entity JHACO requires indications for all PRN orders anyway, so I am sure CPOE systems already have a place for indications. The only issue I see with requiring indications is that doctors will invariably pick the wrong indications, and then you will have to verify which needs to be corrected, indication or drug. Still better than nothing, maybe?

I don't know if its practical to require a diagnosis for every RX but it would sure help prevent stuff like this.

 

[owlegrad]

I don't know if its practical to require a diagnosis for every RX but it would sure help prevent stuff like this.

I am sure there would be physicians (and pharmacists) who think it is unnecessary, but frankly I think it should be required for all prescriptions. Why shouldn't the pharmacist know why something is being given? It allows for more proper dosing checking.

 

[Praziquantel86]

I don't know if its practical to require a diagnosis for every RX but it would sure help prevent stuff like this.

We have an indication mandate for every order, unless it's on a pre-printed order set (pneumonia, ACS, post-op, etc.). We had pretty good buy-in after a couple of months. Every once in a while we'll get ridiculous things like intrathecal AmBisome for "Infection", but those are the exception.

Outpatient is a different story all together...NYS started printing organ systems checklists on the back of the official blanks, but hardly and docs use them and they're not very helpful even when they do.