Carilion Clinic hospitals dispense more than 14,000 doses of medication each day. Our clinical pharmacists actively participate in the care of our patients, reviewing each medication order to ensure that the medication and dose prescribed is safe and appropriate, including checking for allergies and drug interactions, reviewing lab results to identify anything that could interfere with the safety of the medication, and reviewing microbiology results to ensure the most appropriate antibiotic has been selected.
We follow each patient’s medications and lab results daily to ensure medications and doses are appropriately adjusted based on any changes to a patient's condition. Pharmacists collaborate directly with the medical staff at the bedside. Pharmacists also monitor our patient on anticoagulation medications. Between 2008 and 2010 we were able to decrease the number of patients requiring therapy to reverse over anticoagulation due to warfarin by half. Standards of Care Our facilities have implemented several technologies that have allowed us to simplify and increase the safety of medication distribution.
These include: CPOE (Computerized Prescriber Order Entry) The physician or mid-level provider enters orders for medications directly into the electronic medical record, minimizing the risk of transcription or handwriting errors and providing the provider with immediate feedback on potential allergy or drug-drug interactions. Electronic Medical Record Carilion Clinic is a national leader in Electronic Medical Record implementation. This initiative includes medication tracking and documentation. ADCs (Automated Dispensing Cabinets) Approximately 85 percent of all medications are distributed through ADCs. The rest are mostly intravenous medications. All of the ADCs are configured to require a pharmacist review of the medication order before a nurse can access the medication for administration. TPN (Total Parenteral Nutrition or Hyperalimentation) Compounding Machine Ordering TPN can be a complex process with different dosages needed for each patient.
Using automated compounding equipment ensures that the same ingredient volumes are used to make the TPN the same way every day for each individual patient. Bedside Barcode Scanning This process provides a series of electronic checks and balances during the administration of a medication. When patients enter the hospital, they get a bar-coded identification wristband that can transmit information to the hospital's computer. Nurses have computers and scanners on top of medication carts that they bring to patients' rooms. Nurses use the scanners to scan the patient's wristband and the medications to be given. The bar codes provide unique, identifying information about drugs given at the patient's bedside. If there is not a match between the patient and the medication or some other problem, a warning box pops up on the screen.
“Smart” Pump Technology Infusion-related medication errors expose patients to a high risk of harm. Smart infusion pumps with dose-checking technology help avert potentially harmful errors. The role of the smart pump is to "remember" the large number of "rules" (hospital-defined dosing limits and other clinical advisories) entered into the drug library, and to apply those "rules" during pump programming to warn clinicians about potential unsafe drug therapy. Leadership The Medication Safety Program focuses on all aspects of medication safety within the facility: Evaluating the product for efficacy and safety issues Presenting the product to the Pharmacy & Therapeutics Committee for formulary approval Receiving medication into inventory Handling and storage in the pharmacy Ordering the medication by the prescriber Reviewing the order by the pharmacist Dispensing to the patient Administering the dose Documenting the medication’s response Disposing the medication if not used Every month, a multidisciplinary team completes a review of all medication errors in order to learn where we can improve. We analyze errors that reach the patient, even when they don't cause any harm. As a result, we have clarified descriptions of medications in the EMR, revised educational materials, and standardized processes. Medication Safety Protocol at CMC Pharmacists at CMC are accountable for a number of clinical activities ranging from drug therapy consultations to patient education.
For drug therapy consults, pharmacists are responsible for the ordering of laboratory monitoring, making appropriate adjustments to dosage and frequency based on lab results and documenting all activities in the medical record. Currently, we provide consultative services for Vancomycin, aminoglycosides, direct thrombin inhibitors and warfarin.
Other services include:
- Antimicrobial Stewardship
- Service Patient Education and Discharge Counseling
- Anticoagulant and Renal Dose Monitoring
- Intravenous to Oral Automatic Interchanges Education
We have worked closely with regional schools of pharmacy in Virginia, North Carolina and West Virginia to offer experiential educational opportunities for students. Including both introductory and advanced learning experiences, there will be 46 student rotations completed at CRMH in academic year 2010-11. In 2008, we implemented a PGY1 Pharmacy Residency program with two residents, that will expand to four residents in 2011. Also, beginning in 2011 pharmacists from CRMH will take on an active role in teaching of the pharmacology curriculum for medical students at the Virginia Tech Carilion School of Medicine. These educational commitments, have created a strong learning environment within our department.