Implementing an ER MedRec service...but how?

[Music Man]

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I'm trying to find a niche at my new gig here and my options are not many so I thought I might as well go to the ER. Hey, it gets me out of the claustrophobic and boring environment of the pharmacy (and there are some really pretty girls down there, too). I've already spoken with the ER docs, they are definitely on board.

Now my DOP wants me to put together a business plan for this service so we can pitch it to her "bosses". This is not something I have any experience with and any good ideas for how to approach this would be helpful. I'll do some googling, but I know that some of you on here will have experience with this you can pass along to me. Thanks.

 

[WVUPharm2007]

Your going to try to get into med rec stuff?

You poor, poor soul.

What type of stuff do you need help with/opinions on?

 

[njac]

I just threw up in my mouth.

 

[rxlea]

I just threw up in my mouth.

Funny. My Quality Improvement project involves med rec sheets. We are going to do an audit and compare intake/discharge. Last audit of a small sample of patients for 3 months = 75% error rate .

Saw Imdur, no dose, no interval, NOTHING, except "hold for BP <100"

Then I saw "Wellbutrin XL BID" AND "Wellbutrin SR BID" --> patient went home with that.

Saw worse ones...

 

[xiphoid2010]

Funny. My Quality Improvement project involves med rec sheets. We are going to do an audit and compare intake/discharge. Last audit of a small sample of patients for 3 months = 75% error rate .

Saw Imdur, no dose, no interval, NOTHING, except "hold for BP <100"

Then I saw "Wellbutrin XL BID" AND "Wellbutrin SR BID" --> patient went home with that.

Saw worse ones...

The problem here is one of cost/benefit. Not to mention the horror of having to do it.

Nurse already does it. Yeah, they don't always get it right, but that's why pharmacist verifies orders before putting it into the computer, and should catch most of the really fishy stuff (like the welbutrin xl bid). How much added benefit is there to mandate pharmacist involvement on top of that? Is it more than hiring a pharmacist to do it?

Err, I would shoot myself if I had to do med rec on every single patient that comes through the ER door. You better be able to justify that the benefit is > the cost before you put some poor pharmacist through that hell hole.

 

[R2pharmD2]

Find an experienced tech to do it. A tech with both retail and hospital experience would be a heck of a lot better at it than a nurse. Cheaper too.

 

[rxlea]

The problem here is one of cost/benefit. Not to mention the horror of having to do it.

Nurse already does it. Yeah, they don't always get it right, but that's why pharmacist verifies orders before putting it into the computer, and should catch most of the really fishy stuff (like the welbutrin xl bid). How much added benefit is there to mandate pharmacist involvement on top of that? Is it more than hiring a pharmacist to do it?

Err, I would shoot myself if I had to do med rec on every single patient that comes through the ER door. You better be able to justify that the benefit is > the cost before you put some poor pharmacist through that hell hole.

Well this is for an institution that has some specific problems and they asked us to do this QI project. They had to do the 25% technology use required by "Obamacare", so from what I can tell, they put in some half-ass programming that will need to be changed. Cerner but no CPOE, also. Anyway, I won't get into any more of the specifics but hopefully this will result in some changes that will prevent the ridiculous errors they are currently seeing.

 

[Praziquantel86]

Make sure that you incorporate expansion of your role into your business plan, if you even go through with making one. Medication reconciliation, regardless of what the VA might tell you, is not an efficient use of pharmacist time or education.

While it is an essential function, a specifically trained technician or RN (competency must be documented to satisfy current JC regulations), can do it. The pharmacist on the floor can scrutinize the outpatient medications to look for errors that occurred during admission and have a much larger impact there.

 

[VCU07]

I completely disagree. I'm an EM pharmacist for a 650 hospital and mediation reconciliation is one of our main objectives. Never do I let RNs or techs do my med recs. It has to be done and done correctly from the get go. We don't need to play "catch up" later on my having a pharmacist on the floor review it. Further, this would take away time from what they provide on the floor. Have you had to deal with F'd up med recs? I promise you, leave it to a RN to do it and you will be spending a lot of your time with clarification.

Make sure that you incorporate expansion of your role into your business plan, if you even go through with making one. Medication reconciliation, regardless of what the VA might tell you, is not an efficient use of pharmacist time or education.

While it is an essential function, a specifically trained technician or RN (competency must be documented to satisfy current JC regulations), can do it. The pharmacist on the floor can scrutinize the outpatient medications to look for errors that occurred during admission and have a much larger impact there.

 

[owlegrad]

My DOP agrees with you. We do all the work upfront so that we do not have to it on the back end.

I completely disagree. I'm an EM pharmacist for a 650 hospital and mediation reconciliation is one of our main objectives. Never do I let RNs or techs do my med recs. It has to be done and done correctly from the get go. We don't need to play "catch up" later on my having a pharmacist on the floor review it. Further, this would take away time from what they provide on the floor. Have you had to deal with F'd up med recs? I promise you, leave it to a RN to do it and you will be spending a lot of your time with clarification.

 

[WVUPharm2007]

I completely disagree. I'm an EM pharmacist for a 650 hospital and mediation reconciliation is one of our main objectives. Never do I let RNs or techs do my med recs. It has to be done and done correctly from the get go. We don't need to play "catch up" later on my having a pharmacist on the floor review it. Further, this would take away time from what they provide on the floor. Have you had to deal with F'd up med recs? I promise you, leave it to a RN to do it and you will be spending a lot of your time with clarification.

What's even worse is when that med rec gets in the hand of whoever the attending is...and they actually order something off of it.

Then you have to track them down...tell them to change things...they get pissy because you interupted their dinner at Ruth's Chris...

...non-RPH entered med recs are a headache...

...of course, in the magical world of big budget hospitals, they have enough cash and manhours to do it themselves. My old job, there was no way in hell a pharmacist could have been dispatched for that.

 

[njac]

wow.

I did not do 2 years of residency for med rec to be the focus of my specialty.

 

[WVUPharm2007]

wow.

I did not do 2 years of residency for med rec to be the focus of my specialty.

I know a girl that did a residency at WVU and somehow created a unique position for herself at WVUH because she MADE this stuff her specialty.

 

[xiphoid2010]

I know a girl that did a residency at WVU and somehow created a unique position for herself at WVUH because she MADE this stuff her specialty.

What a colossal waste of a residency IMHO. it's medrec, not exactly a cerebral challenge. Get some lowly intern to this type of gopher work. Hey, I had to pay my dues when I was one.

 

[VCU07]

wow.

I did not do 2 years of residency for med rec to be the focus of my specialty.

They are a pain, but there are obviously many other things we do in the ED besides med recs lol. If I'm not mistaken, you did an EM residency?

 

[VCU07]

wow.

I did not do 2 years of residency for med rec to be the focus of my specialty.

What a colossal waste of a residency IMHO. it's medrec, not exactly a cerebral challenge. Get some lowly intern to this type of gopher work. Hey, I had to pay my dues when I was one.

Sad thing is it's not as straight forward as it seems. I have precepted students who have made errors on them. One led to a rapid response.

 

[rxlea]

RNs and techs are doing the med recs. The RNs don't know the difference between Wellbutrin XL and Wellbutrin SR, apparently They also scribble changes the doc/pharmacist never sees and the doc makes changes the pharmacist never sees. *sigh*

and, yeah, I don't see why a pharmacist should be doing the med recs. That would be a terrible waste of time/money (not to mention an insult to a residency trained pharmacist) 😛

 

[museabuse]

I'm getting more and more calls from nurses from different hospitals asking me to "verify" meds. I work at a 24 hour store and get several calls a night. Some calls can take 15 minutes if they are on tons of meds. I don't want to be an ass but I don't have time for this... Especially when they want me to spell evey drug. Plus i am by myself and when someone in drive through sees me on the phone and not helping them they will complain. I think I'll just give them the number to corporate privacy office, what do you think?

 

[rxlea]

I'm getting more and more calls from nurses from different hospitals asking me to "verify" meds. I work at a 24 hour store and get several calls a night. Some calls can take 15 minutes if they are on tons of meds. I don't want to be an ass but I don't have time for this... Especially when they want me to spell evey drug. Plus i am by myself and when someone in drive through sees me on the phone and not helping them they will complain.

This too

 

[xiphoid2010]

Sad thing is it's not as straight forward as it seems. I have precepted students who have made errors on them. One led to a rapid response.

Did you flunk that student? 🙄

 

[xiphoid2010]

I'm getting more and more calls from nurses from different hospitals asking me to "verify" meds. I work at a 24 hour store and get several calls a night. Some calls can take 15 minutes if they are on tons of meds. I don't want to be an ass but I don't have time for this... Especially when they want me to spell evey drug. Plus i am by myself and when someone in drive through sees me on the phone and not helping them they will complain. I think I'll just give them the number to corporate privacy office, what do you think?

No, it's called fax the Rx profile to them. This is what we hospitals do when we transfer/discharge patients. 😉

 

[owlegrad]

No, it's called fax the Rx profile to them. This is what we hospitals do when we transfer/discharge patients. 😉

That's actually quite clever. I might keep that in mind...

 

[joetrisman]

No, it's called fax the Rx profile to them. This is what we hospitals do when we transfer/discharge patients. 😉

I prefer this method as it eliminates communication error and saves me time.

 

[spacecowgirl]

I think this is hugely important, and very few places have found a way to do it efficiently and well. I for one, will be eager to hear what you find that works!

 

[Glycerin]

Our ED pharmacy techs do it. They're mostly accurate, too. But, they never have the final entry of the list into our CPOE; they hand us their paper list and we check it against what they entered into CPOE. If there are any questions, it then just takes a moment of clarification from the tech or the patient using pharmacists' time. We put our stamp/time on it in CPOE and co-sign the techs' chart note.

It's a hell of a lot better, easier, and more efficient than asking an RN or an MD to do it correctly.

 

[rxlea]

Our ED pharmacy techs do it. They're mostly accurate, too. But, they never have the final entry of the list into our CPOE; they hand us their paper list and we check it against what they entered into CPOE. If there are any questions, it then just takes a moment of clarification from the tech or the patient using pharmacists' time. We put our stamp/time on it in CPOE and co-sign the techs' chart note.

It's a hell of a lot better, easier, and more efficient than asking an RN or an MD to do it correctly.

Do you have a pharmacist specifically for this task or do you incorporate this task into your normal workflow somehow?

 

[Glycerin]

Do you have a pharmacist specifically for this task or do you incorporate this task into your normal workflow somehow?

We ED pharmacists just incorporate it into our workflow. We're a 400+ bed facility (including pediatrics), and on most days, we have 2 pharmacists in the ED during evening shift, so the work get split between the two of us. Day shift only has 1 ED pharmacist, but he/she still incorporates medrec verification into the general workflow. On days where our evening shift is collapsed to 1 pharmacist, same thing. When we have codes/traumas/intubations, etc., the admitting docs know that there may be a delay in pharmacist verification of tech work, but that doesn't slow down our process. Sometimes they'll go ahead and order admitting meds off of tech work, and if we find a discrepancy when we can finally get to it, we'll page the MD and let him/her know; in general, admitting meds aren't verified in the ED anyway, so we have time to make changes when necessary.