Management Dilemmas: Integrating

New and Established Practices

South Carolina Society of Health System PharmacistsSpring Symposium, 2008

Joel Melroy, PharmD, MSManager, Ashley River Tower Pharmacy ServicesMedical University of South Carolina

Ashley River Tower

Ashley River Tower 156 bed service line hospital

Heart & Vascular Service LineDigestive Diseases Service Line

Patient Tower: acute care + ICUs Diagnostic & Treatment: ORs, Cath labs, IR Chest Pain Center Clinics

Projected 60% capacity – budgeted staffing

Ashley River Tower Inpatient Pharmacy

Clinical and distributive services Inpatient units, procedure areas, clinicsAutomated Dispensing Machine (ADM) Service

Operating Room (OR) Pharmacy – Carole RussellPre-op, OR, PACU

Retail Pharmacy – Heather KokkoOutpatient & employee prescriptions

Overview Planning Resources Operations Clinical Practice One week prior to opening One week after opening One month after opening

Key Observations

A large project such as opening a new hospital requires teamwork

This feat could not have been accomplished without teamwork from the pharmacy director, management team, and staff

Planning BoP, DHEC, and DEA licensing

<797> and revision – 12/07 Facilities

Distribution Plan Point of Care medication

administration Hybrid cartfill-cabinet model Courier service ADM cabinets, configurations,

inventory Technology Implementation

BCMA, Smart Pumps, CPOE Inventory

Accounts, contracts

Dilemmas:

• New standards, unplanned facility surprises

• Robot/cartfill in a separate facility

• Dependent on another department to provide courier service

• BCMA, Smart Pump rollout

• Too much vs. not enough

Facility Surprises…

Resources Personnel

Attract and select the best people Train sufficiently Share resources, if necessary

Dilemma: Midnight Pharmacists

EquipmentPurchase redundant equipment?Support for new automation/technology

Dilemma: Medication Transfer Carts

OperationsTask MUH ART

UD prep X X

IV batches X X

Chemotherapy X X

ADM X X

24-hr cartfill X (completed at MUH)

TPNs X (completed at MUH)

Operations Daily order: delivered to ART ADM service

ART staffAdministrative/Superuser support provided by

MUH Courier service

Distribution Center, Compounding, AIP, ARTUp to 8 runs per day

Dilemmas: Incorporating workflow of two separate operations, ADM training, courier

Clinical Practice

Established model: specialistClinical pharmacists perform order entry

functions and specialists round with teams Desired model: integrated w. “coordinator”

Clinical pharmacists expand their roles and specialists coordinate activities, initiatives

Dilemma: changing practice models with practitioners with established roles

One Week Prior… Limited access to hospital Hospital DHEC licensing

Successful BoP inspection, DEA Licensed on 1/30 (Wednesday) 1st drug order: 1/31 Stocked 3 pharmacies + 50 ADMs

“Completion”: 2/3 Opened: 2/4We didn’t have time for dilemmas!

One Week Prior… Issues

Completing the initial drug order Used purchasing data from MUH Did not order non-formulary medications Planned to utilize MUH inpatient pharmacy for medications

not ordered initially (tube system) Medication security/transport

~50 to 90 patients expected to move to ART Medication transport bags and labels

Filling ADMs + inability to access hospital Midnight pharmacists not fully trained Smart Pump rollout – all IV medications to be

changed out at arrival to ART

Opening Incident Command Team – “Disaster”

Medication Staging – MUH Supply Team Leader – ART Daily meetings from Thursday until Sunday

Moved 59 total patients with 7 admissions in 5.5 hours

Pharmacists located on floors and in central pharmacy

Pharmacy team – extremely responsive to changing needs & stress on the floors

One Week After… Inventory stabilizing Decentralized pharmacists on floors Daily staff meetings Issues:

Courier service not consistent Medications needed for clinics IT issues (fax server, computers) Central pharmacy organizational patterns Distribution/paperwork Staffing Technician/pharmacist training

One Month After… Weekly staff meetings Ongoing training Courier/distribution becoming smoother Continuing issues

Staffing/trainingGaining resources for increasing staff levelsSome IT issues (fax machines)Changing to an integrated practice modelWorkload increasing – census above the

projected 60% level

Lessons Learned It takes many dedicated people working as a team to accomplish

such a large feat Some change can occur in a minute and other change takes more

time Listen to your staff and meet frequently – communicate Listen and respond to nurse/physician needs while remaining calm Be action-oriented and responsive Set up as many systems as possible prior to opening (e.g.,

distribution, courier, clinic meds) Complex problems require complex solutions…don’t settle for the

“quick fix” Be visible to your staff, nursing staff, and physician staff Be involved with multidisciplinary operations committees and other

teams before and after the move – you will gain insight on system issues and staffing patterns

Be flexible and open-minded Be surrounded by high performers

Staff Kristen Baker Nicki Balchin Courtney Bath Sharon Fahey Carrie Flippen Charles Garred Tom Gnau Phil Grech Chanda Harrison Mary Jo Jack Shantee Jacques Charlotte Johnson Bruce Keck

Kristen Baker Nicki Balchin Courtney Bath Sharon Fahey Carrie Flippen Charles Garred Tom Gnau Phil Grech Chanda Harrison Mary Jo Jack Shantee Jacques Charlotte Johnson Bruce Keck

Devin Matthews Crystal McKinley Kathryn Noyes Johnte’ Porter Emily Poston Becky Schneider Trish Schuler Dianna Sellers Kendra Seward Sam Solomon Walt Uber James Walker Joyce Warren Marina Williams

Management Team

Paul Bush Carole Russell Chris Fortier Heather Kokko Joe Mazur Matt Maughan Kelli Garrison

Questions?