New Pharmacy collection Survey Apr.16.12

Updated Feedback New Pharmacy collection

• Hello everyone. We would like some updated feedback in regards to how the collection process with the new pharmacy is going at your site, any concerns with the collection tool itself, the time involved to obtain the information, and any other suggestion or comments that you may have. Your feedback will help the ICU task team to evaluate and address new or continued issues you have come up against. Meeting of Task team is on the first week of May. Thank you everyone for your efforts with the new pharmacy.Trish Ostryzniuk 14:39, 2012 April 16 (CDT)

Last survey done: Jan.26.12

PROS

• Works well with EPR at St. B Lois
• I'm finding the tool good as well.SBGH Marla
• I much prefer it to the old pharmacy where doses had to be collected. Laura
• Has reduced workload due to the days counted versus doses. Lorri SOGH
• The tool works well. Counting treatment days only has reduced the workload of pharmacy collection. Marie
• I like the drugs all visible on the screen albeit it is small. The med sheets can be difficult to organize so sometimes it is easiest to just do one sheet at a time and add the drug or add to the count accordingly as I go through the sheets. Having the drugs all visible on the screen facilitates this. Also, it allows me to scan the drugs prior to completing to make sure I have not missed anything. It also saves a step by not having to pick from a dropdown. I find it is easy and fast. The thing that slows it down is the limitations of the med sheets themselves as is mentioned below but this has always been a problem. Mary Lou

CONCERNS

• All sites are not equal in the challenges of this study. It can be done at HSC but adds a great deal on to data collections time depending on the complexity of the case.Most of my MICU patients are complex. The CCU patients are not and the IICU patients the length of stay becomes challenging.

• Counting the days is much easier however I dont find the collection tool user friendly .It is hard to read,the print is micro tiny ,and it is very easy to put the days in the wrong category. I also agree with the above statement it does take time if you have a complex case.

• When doing complex sepsis patients in particular it is very challenging to capture all the antibiotics for all the days and the MAR's do not organize this very well so it is difficult even with the electronic MAR.--LKolesar 09:13, 2012 April 19 (CDT)

• Caution required for entering due to the limited space. It is very easy to enter accidentally in the wrong category--Lpruden2 10:08, 2012 April 19 (CDT)

• I believe Gail has identified the same concerns that I have in the HSC ICU situation. The trail of complex or longer stay patients is made challenging by the back and forth flipping through the various documents to follow any given drug through the chart since they are often stopped and restarted during the patient stay.--Jpeterson 11:38, 2012 April 20 (CDT)
  • Example: Coumadin (Warfarin). It is very difficult to count these days because the dose is dependent on the clotting times and often they will hold doses. This drug should be taken off the list unless he has very good reasons to keep it. It is very time consuming and all stroke pts, previous valve replacement and atrial fibrillation pts are on this drug.

• Question: Why do we need to count the days?

• Another general point about the pharmacy list is that it is too large and it is easy to miss a drug. I know I have been missing drugs and it is easy to do. I did not realize that Coumadin was one of the drugs on the list under vitamin K antagonist until recently for example. Laura Kolesar

• we also have the problem of patients who are discharged at HSC to the wards, the charts are thinned and thrown where they feel like throwing it. Some wards are better at putting them in binders,but many are not. At times the thinned sections have become separated and it takes time for the data collector to find. Once you find them you need to put them in order.

• • Questions: Why can't the drug study be done once the patient is discharged? Is it really that important to have current drug data??
  • what is the purpose of counting such and extensive list of drugs? Who is using the information for what purpose? Could we not just do short term project monitoring specific drugs when needed? Why can't the pharmacy department provide drug utilization information. (posted by trish from verbal comments given by staff).

• using PAPER forms to collect new pharmacy data because pharmacy screen is small and crowded, visually hard to work with, really easy to make mistakes plugging information into it also.

• Marie Laporte CONC SITE - pick up shift at HSC_MICU - NOTE: I found I had to rely on paper to keep track of the drugs--the information is not just on the MARS/med sheets. The format of the flow sheets requires an actual unfolding of each day rather than page flipping. Infusions are on the flow sheets then the other drugs are on three other med forms (these are assembled charts in MR). I see that it is indeed a huge workload based on the complexity of the pts at HSC. May 16.12

May 18, 2012

Reviewed at ICU Task meeting. The following pointers will be taken to next Database Steering meeting:

• reduce the number of medications and categories?
• change from the # of patient-days to just a Yes/No for each drug?
• figure out how to shift more data collector time/resources to the HSC site and/or if Critical Care is able to allocate more funding to do this?

First Survey

go to: New Pharmacy collection Survey Jan.26.12

Third Survey

go to: New Pharmacy collection Survey January 7, 2013