How Rounds Reports and Mobile Computing Support the Role of the Clinical Pharmacist

Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.

How Rounds Reports and Mobile Computing Support the Role of the Clinical Pharmacist

Jerry Fahrni, Pharm.D.

Informatics Pharmacist

Kaweah Delta Health Care District


At the conclusion of this presentation participants should be able to:

Incorporate concepts and skills that assist in supporting clinical pharmacy

activities

Recommend strategies for collecting data necessary to build effective rounds

reports for pharmacists

Identify potential pitfalls and problems in preparing pharmacy rounds reports

Identify strategies for improving clinical pharmacy services.

Recommend strategies for selecting mobile computing platforms for various

healthcare practitioners.

Understand the infrastructure necessary to create a mobile clinical pharmacy

service.

Objectives


It is the policy of Corexcel and IMNE to ensure fair balance, independence,

objectivity, and scientific rigor in all programming.

In compliance with the American Nurses Credentialing Center (ANCC) and the

Accreditation Council for Pharmacy Education (ACPE), it is the policy of

Corexcel and IMNE that faculty disclose all financial relationships with

commercial interests over the past 12 months.

Jerry Fahrni has no conflicts of interest to disclose

Disclosures


Kaweah Delta Health Care District

Centrally located in the San Joaquin Valley, California

581 licensed beds

Variety of inpatient and outpatient services

Not for profit organization

70,000 emergency visits annually

9 locations within 25 mile radius

Serves population of 575,000 over 6,213 square miles


5

Five Licensed Pharmacies

Outpatient Pharmacy Services

Employee Pharmacy

Home Infusion Pharmacy

Inpatient Pharmacy Services

Main Campus (KDMC)

South Campus (Sub-acute, SNF)

West Campus (Rehab, Mental Health)


Pharmacy Operations

Decentralized pharmacy model 32 Pharmacist FTEs

ICU CVU Infectious Disease Nephrology / Anemia Management Pediatrics Oncology Other

34 Technician FTEs 1900 faxes received per day 2000-2500 orders entered per day Significant use of automated dispensing cabinets, i.e. we’re cartless Good use of automation and technology


Automation and Technology

AutoCarousel automated carousel storage AutoPack automated bulk packager AutoLabel labeling system Baxa Compounder Pharmacy Order Management System (POMS) Pyxis 3500 Siemens Soarian C6 SP11 Siemens Pharmacy 24.1 Siemens MAK 24.1 Alaris Smartpumps Draeger monitoring devices Cisco Voice over WLAN Solution Wireless infrastructure supporting over 760+ concurrent wireless devices


Clinical Services

Hybrid decentralized clinical model

Monitoring and protocols

Pharmacokinetics

Renal dose adjustment

Anemia Management

Warfarin Management

Pharmacist participation on rounds

ICU

CVU

Pediatrics

Other PRN


We cannot change the human condition, but

we can change the conditions under which

humans work

James Reason

Reason J. Human error: models and management. BMJ 2000. 320768–770.


Supporting clinical services

Pharmacist needs:

patient information

monitoring forms

drug information

protocols

policies

Anytime, anywhere intranet and internet connectivity

etc……

…..while remaining mobile during rounds


Fundamental problem

Gaining quick and easy access to everything you need when you

need it


The solution

Rounds Reports

Mobile Devices


Rounds reports

Goals: Get the pharmacists to lay down their “3x5 cards” Collect information from various sources and present it in a compact

format that is easily accessed and up to date Target the information to the needs of the pharmacist and make it easy to

read


Process

Determine what information you want on the Rounds Report Literature Ask the providers Personal Experience

Figure out how you want the information displayed Onscreen or on paper…perhaps both Don’t add too much Don’t leave anything out

Figure out how you want them delivered Automated Print / view on demand

Determine who needs to be involved


Pediatric rounds report … the first attempt

Demographics

Lab Values

Medications

Pharmacist Notes


Pediatric rounds report

Demographics

Allergies

Lab Values

Medications

Pharmacist Notes


Antibiotic Stewardship Report

“Pharmacists’ responsibilities for antimicrobial stewardship and infection prevention and control include promoting the optimal use of antimicrobial agents, reducing the transmission of infections, and educating health professionals, patients, and the public.” - Am J Health-Syst Pharm. 2010; 67:575-7

Demographics

Allergies

Lab Values

Antibiotics

Micro Results


Pharmacokinetics monitoring report


So what did we do about it


Mobile devices


Initial needs were small

Pharmacy wanted on-line access to drug information databases while on the nursing units of the main hospital.

The pilot project allowed support for 5 roaming HP iPAQs with Lexi-Comp drug information via 10 access points.


Handhelds

Cons

Limited screen real-estate

Very S-L-O-W

Lack access to many legacy application

Lack access to online applications, i.e. limited web capabilities

Easily misplaced

Pros

Portable

Lots of reference material available

Lots of 3rd party software available for documents

Semi-rugged, i.e. can take a punch

Good battery life


Fragile

Compatibility

Fragile

Screen size?Screen size?

Power? Power?

Portable

Power?

Form factor

Awkward shape

Mobile options

Laptop

Netbooks

Ultra-Mobile PC Smartphone

Tablet PC iPad

Screen size

Very portable

Ubiquitous

Screen size

Very portable

Form factor

Form factor

Touch interface

Screen size

Powerful

Screen size

Powerful

Portable Form factor

Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved. OQO Model 01 – No longer available

Ultra-Mobile PCs (UMPCs)

Power?

Screen size

Very portable


Smartphones

Screen size

Very portable

Ubiquitous


Screen size


Tablet PC pilot project

Goal

Easy access to hospital systems in a compact, yet powerful package

Solution

Tablet PCs

Fragile?

Form factorTouch interfaceScreen sizePowerful


Tablet PC assessment

Access to the hospitals wireless network

Fast enough to allow multiple native applications to run while accessing online resources

Tough enough to take the abuse of day-to-day use, but light enough to carry for extended periods

Battery life had to be long enough for use on rounds, i.e. > 2 hours


LE 1700

Pilot project - hardware

Motion C5


The good, the bad and the ugly

Some pharmacists thought the tablets were great

Wireless connectivity

Access to all our applications – Siemens pharmacy, Soarian, UpToDate, KDNet, etc

The pharmacists were skeptical, i.e. no “paper”

Required “too many” taps to open all the applications

On screen keyboard was slow for text entry

Handwriting recognition

The C5 was universally disliked because the screen was too small and it was too heavy

Battery life was an issue


Adjustments

Change the screen layout

Change the workflow on the device

Add batch files and “executable groups” for easier application access

Purchase newer tablets with better processors and battery life


Changing the screen layout and workflow


Semi-rugged J3400

Updating the hardware

Dell XT2

Slate model tablet PC Convertible model tablet PC

Windows Vista Business1.4 GHz Intel Core Duo Processor

2 GB RAM

Windows XP Tablet Edition –SP31.6 GHz Intel Core Duo Processor

2 GB RAM


Following changes

Improved workflow

“Faster” access to hospital systems

Positive feedback from pharmacists

Increased tablet PC use on rounds


Virtualization


Compatibility

Fragile

Screen size?

Power?

Portable

iPad Form factor


Lessons learned and conclusions

Reports

• Rounds reports are helpful, but they take a lot of work and someone always wants more

• Divide and concur

• Viewing date real-time on a mobile device is better than paper reports

Mobile Devices

• Tablet PC are an effective method of extending the reach of pharmacists

• Make the devices “dummy proof”

• Evaluate your options carefully and be sure to consider batterlife, system compatibility and ruggedness

• The jury is still out on the iPad


Thank you for attending this session.

Session #6How Rounds Reports and Mobile Computing Support the Role of the Clinical PharmacistJerry Fahrni, Pharm.D. – [email protected]

Slides available at: http://www.slideshare.net/JFahrni

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How Rounds Reports and Mobile Computing Support the Role of the Clinical Pharmacist

Health & Medicine

Transcript of How Rounds Reports and Mobile Computing Support the Role of the Clinical Pharmacist