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?
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