The University of South Alabama Children’s and Women’s Hospital, (USACW) located in Mobile, Ala., has an average daily census of about 190 patients, and its pharmacy department encompasses 35 FTEs, half of whom are pharmacists and half of whom are pharmacy technicians.
What’s more, USACW, a teaching facility for the University of South Alabama College of Medicine and an extension site for Auburn University, and a sister hospital to the University of South Alabama Medical Center, serves a high-acuity patient population; USACW’s neonatal intensive care unit is a level 3 NICU, the highest level type, and has an average daily census of 80 babies. USACW is the leading option for high-risk-pregnancy deliveries in southern Alabama, and regularly handles multiple births, pre-eclampsic mothers, addicted mothers, and other high-risk cases.
Given all this, it’s not surprising that the USACW pharmacy staff has been involved in clinical performance improvement work for a number of years. In that context, Robby Smith, R.Ph., M.S., the hospital’s director of pharmacy for over four years, has been leading a multi-year patient safety initiative, with a special focus on such areas as liquid medication storage, optimization of barcoded medication labeling, and automation-facilitated medication administration. USACW has been working with the Mountain View, Calif.-based Omnicell to implement technologies to support optimization in all of these areas. Smith spoke recently with HCI Editor-in-Chief Mark Hagland regarding his team’s efforts in this critical arena. Below are excerpts from that interview.
Tell us about your hospital’s journey towards optimizing medication safety.
We have an average daily census in our NICU of 80 babies. There’s probably not another one that big anywhere in our area. You’d have to go to Birmingham or Atlanta to see another one that size. We also have pediatric intensive care and pediatric hematology and oncology, so those areas treat very high-acuity patients. And we also take care of the moms. And being a part of a university setting, a lot of the more complex, high-risk pregnancies come here—triplets, quadruplets, pre-eclampsic moms, addicted moms, come here. That’s the kind of environment that we have.
So we have a satellite pharmacy dedicated to the neonatal intensive care unit, and we have specialized pharmacists in that area, who work there seven days a week. We also have a clinical pharmacist who works primarily with the pediatric hematology/oncology group, but also with some of the other areas. And then Auburn’s pharmacy school will have some of their faculty instructors come through occasionally, including to the pediatric intensive care unit.
So from a safety standpoint, about five years ago, we started moving forward with several clinical information system implementations that we wanted to try to accomplish. And the first thing we wanted to accomplish was bedside barcode scanning.
Robby Smith, R.Ph., M.S.
Do you have an EMR?
Our electronic medical record really just started. We were a Siemens Invision customer. This spring, we switched from Invision to Soarian; we’re now live on Soarian, and all of our electronic nursing documentation is done in Soarian. So we have a system-wide electronic medical record. But even before that, we had gone live with bedside barcode scanning about five years ago, with a separate system. That was really challenging for pharmacy, and it still is a challenge, as far as culture, for nursing. Nursing wants to see it as a documentation tool, but really, it’s a safety tool.
And we have eCare, which encompasses an electronic medication administration record (eMAR), an EMR and computerized physician order entry, and nursing physician documentation.
Who’s the vendor for your eMAR?
It’s Siemens, except for the Pyxis system, which will change to Omnicell. We also using a program called CribNotes for our nurses, and we use a program called OB TraceView in our labor and delivery rooms, because Soarian isn’t robust enough in those very unique areas. The OB TraceView shows the mom and baby together, for example.
How does that play out in practice?
The nurses have to understand that you have to scan the medication before you’ve given it, because if you scan it after you’ve administered it, you could have made a mistake. So if your view is that this is a tool to document what we’re already done, then you’re missing the point. And you constantly have to keep that in front of the nurses, and that you have to scan your medication before you administer it. From a pharmacy standpoint, it means that every product that leaves the pharmacy has to have an accurate, scan-able barcode on every dose of every medication.
How does that play out in terms of hand-mixed liquids, etc.?