The safety benefits of implementing closed loop medication management are well documented. A medication “system” that supports safety and efficiency is a careful combination of policy, process, and workflow design that is enhanced through technology which includes the automation (Packagers, Storage, Distribution) and the Pharmacy Information System which is tightly integrated to the Hospital Information System.
As more and more organizations in Canada begin to work collaboratively, (sharing a health information system) a number of key items have percolated in the environment that require careful consideration in order to implement and support adoption of a safe and efficient medication management program.
- Formulary standardization – As organizations create standardized clinical content, required in a shared system including shared order sets, lack of formulary standardization creates a barrier. In a shared system the drug database is most consistently shared as well. If different products and sizes are on formulary and in inventory at the sites and standardization is not considered, the build team will need to create and maintain multiple versions of the same order set due to different products being carried on formulary at partner organizations. As organizations look to share their HIS systems with other partners – time and attention very early on to identify gaps in formulary and resolving those through a shared pharmacy committee can help streamline and support the order set development and review process.
- Procurement contracts – Further complicating the formulary standardization efforts is current buying contracts. An analysis to determine if your partnering organization has a different vendor for pharmaceuticals will help to identify if there will be potential impacts to formulary standardization efforts.
- Medication Management Model – We typically see 3 possible medication management models in the inpatient setting; Cart fill (patient bins); Hybrid (cart fill with the use of automated dispensing units (ADU) to store stock and narcotics) and Cartless (ADU only). Each model has different workflow implications for both pharmacy and nursing. Understanding your current model and potential changes to that model needs to be part of the overall workflow review.
- Use of automation beyond the EHR – Integration with ADU’s, IV and PCA pumps and pharmacy packaging equipment is complex and needs to be planned well in advance. Conversion of the drug libraries in the 3rd party software often requires resources from the vendor and includes additional costs. The cutover work for pharmacy is significant depending on the amount of automation and types of equipment your facility is using. When sharing an HIS, sites that have a shared vendor for automation (ADU’s and packaging equipment), can streamline the additional costs for servers and maintenance down the road.
Are you venturing down the path of a shared HIS? Don’t underestimate the impact on your medication management system