Department of Pharmacy 2019 YEAR IN REVIEW
MISSION
To extend the healing ministry of Christ through holistic,
people-centered health care by the core values of:
Quality, Innovation, Service, Integrity, Transparency
VISION
The department will be recognized for the highest quality of
pharmaceutical care & compassionate, Christian service.
We will provide clinical & operational service, professional
leadership, & educational excellence that exceeds customer
satisfaction.
We will move pharmacy health forward through innovative use
of technology, people & passion.
Our reputation will be one of collaborative teamwork, employee
satisfaction, & superior patient outcomes.
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Table of Contents 4–5
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Letter from Director
Our Team
The Work that We Do
Princeton in the News
Drug Information & Formulary Management
Procurement
Medication Safety
An Initiative for Improvement
Antimicrobial Stewardship
Partners in Patient Care
Pharmacy Residents
Pharmacy Students
Institutional Involvement
Local, State, & National Organizations
Publications & Awards
Presentations
Posters
Service Anniversaries
Looking Ahead to 2020
Message from the Director
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For 2019, the Princeton Department of Pharmacy chose the
phrase MOVING PHARMACY FORWARD: CHAPTER II
to highlight the groundwork necessary to support pharmacy
excellence. Much like the foundation of a building, a majority
of the day-to-day clinical and operational pharmacy work goes
unseen. Nevertheless, daily accomplishments have translated
into measurable metrics that led our facility to an “A” Leapfrog
score.
Our department welcomed an assistant director of pharmacy in
June. Dr. Tom Achey brings a wealth of innovative leadership
ideas. In particular, a walking gallery strategic planning session,
held in the fall, engaged all pharmacy staff and steered us
towards a robust, equitable Strategic Pharmacy Plan for 2020.
The team took on numerous leadership roles in local, state, and
national organizations! A clinical pharmacy specialist, Dr. Sarah
Blackwell, won a service award from the Alabama Society of
Health-System Pharmacists. I was honored to become the first
pharmacist in Alabama to pass the new Board Certification in
Sterile Compounding Preparations (BCSCP) exam!
The technician team rose to new heights by creating SMART
inventory goals. The technical staff was challenged to document
their inventory stewardship prowess; this culminated into a
national poster presentation. Led by Brandon Roberts, Inventory
Management Specialist, supported by senior pharmacy
technicians, Calvin Jackson and Marcia Harris, the team noted a
$1.4 million reduction in pharmaceutical spend and a 42
percent decrease in inventory-on-hand over the last 3 years!
(Continued on next page)
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Fostering the A.R.T. (Accountable, Reliable, & Transparent) of Safety
highlighted Medication Safety Committee scorecards, Hospital Improvement
Innovation Network (HIIN) metrics, emergency department culture follow-
up review implementation, and antimicrobial stewardship awareness.
Successful mock surveys focused on sterile preparations along with
controlled substance storage and monitoring. Six clinical pharmacy
specialists and three pharmacy residents documented over $9 million in cost
avoidance in FY19.
Auburn and Samford Colleges of Pharmacy sent 8 IPPE students and 50
APPE students to complete challenging rotations in institutional hospital
pharmacy, cardiology, internal medicine, antimicrobial stewardship, surgical
critical care and medical critical care. Team members stretched beyond
Alabama boundaries to teach students in adjacent states in subjects as diverse
as stroke education, inventory management, human capital, and innovation.
Three former students successfully matched to Princeton’s PGY1 residency
program!
These accomplishments would not be possible without the flexibility,
cooperation, and teamwork of the finest pharmacy staff members. We will
miss George Whorton, RPh, who resigned in December after 41 years of
dedicated service.
The future is bright! On the horizon lies an automated dispensing cabinet
upgrade, PGY2 residency expansion, nursing unit-based pharmacists, and a
myriad of leadership opportunities.
We look forward to “being the best”.
Best Regards,
Helen E. McKnight, PharmD, DPLA, MBA, BCSCP
Director of Pharmacy
MOVING PHARMACY FORWARD! Chapter II
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The Pharmacy Department consists of 52 caregivers,
including 29 pharmacists, 18 technicians, 3 pharmacy
residents, and two pharmacy interns. The central
pharmacy operates 24 hours a day, seven days a week.
Pharmacy specialists at Princeton Baptist Medical Center
are integrated into the Medical Intensive Care, Surgical
Intensive Care, Cardiovascular Intensive Care, Neuro
Intensive Care, Palliative Care, and Internal Medicine
patient care teams.
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11 Board-
Certified
Pharmacists Alabama’s first
BCSCP!
12 PTCB-
Certified
Technicians
37 FTEs
The team is responsible for ensuring regulatory compliance,
strategic planning, budget management, scheduling, staff
development & accountability, clinical and operational policy
& procedures, coordinating patient care activities, medication
and patient safety activities, and human resources practices.
We shall move pharmacy health forward through people, passion, and vision. 8
Average Turn Around Times
Overall Verifications 17 minutes
STAT Verifications 3 minutes
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Dispensed more than 1.7 million doses!
We shall integrate innovative technology advances that improve drug efficiency, safety, and delivery.
96% Medication
Scan Rate
(Goal >95%)
98% Patient
Scan Rate
(Goal >95%)
93% Smart Pump
IV Compliance
(Goal >90%)
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0
5000
10000
15000
20000
25000
INTERVENTIONS
Therapy Modification
Renal Dose Adjust
Lab Order
IV to PO
Anticoagulation
Antibiotics
0
5000
10000
15000
20000
CONSULTS
Restricted Abx
Other
Warfarin+Argatroban
TPN
Aminoglycosides
Vancomycin
We shall improve patient outcomes through the highest pharmaceutical care standards.
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106
Code Blue
Responses
350 ED
Cultures
Follow-Up
$9.2 million
estimated in
cost-avoidance
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This year, Princeton Baptist earned the #3
ranking of “2019-2020 Best Hospitals” in
Alabama by U.S. News & World Report.
Princeton Baptist Medical Center rated as
high performing in the areas of heart
failure, colon cancer surgery and chronic
obstructive pulmonary disease.
Princeton Baptist earned an ‘A’ for the Fall 2019
Leapfrog Hospital Safety Grade, a national distinction
recognizing the hospital’s achievements protecting
patients from harm and providing safer health care.
The score is based on performance in preventing
medical errors, injuries, accidents, infections and
other harms to patients in their care.
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Drug Information & Formulary Management Our staff provide expertise and support for health care
professionals throughout the hospital.
These services coordinate the clinical on-call program,
Princeton Baptist Medical Center Formulary, drug use
policy, medication evaluations, guideline development, and
drug shortages & recalls management.
These services support caregivers in taking care of patients.
166
New Drug
Shortages
2,124 Drug
Information
Questions
Major Drug Shortages
Antibiotics
Cardiovascular
CNS Agents
Contrast Media
Electrolytes
EENT
Topical Anesthetics
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0
10
20
30
40
50
60
2019 Formulary Activity
Added withRestriction
Deleted
Change inRestriction
Added
0
2
4
6
8
10
12
Cost Savings Initiatives
Formulary
Restrictions
Change in
Formulation
Removal
from
Formulary
Items Reviewed n
Medication use evaluation 7
Order Sets 3
Policies & Procedures 22
Guidelines 12
The P&T evaluates formulary requests, develops guidelines and
restrictions, reviews cost and utilization issues, and develops and
reviews outcomes projects and drug use evaluations. The Committee
meets monthly, jointly chaired by a member of the medical staff and
the assistant director of pharmacy serving as Secretary.
Drug Information & Formulary Management
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Procurement
Accomplishments
• Aligned IV fluid contract with Baxter
• Cost-savings using McKesson Indigent Reimbursement Program
• Changed OR workflow with vials to syringes
• Minimized waste with select package size optimization
• Streamlined Outpatient MRI contrast process
• Ensured minimum charge reliably applied to capture revenue
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Medication Safety Medication Safety coordinates a comprehensive program
dedicated to assuring excellence in medication safety and
quality.
They facilitate the continuous evaluation of the
medication management system to implement strategies
that reflect medication safety best practices and mitigate
or eliminate actual and potential system vulnerabilities.
Activities n
Reported medication safety events 646
Unit Inspections 720
Adverse drug events identified,
prevented, or treated 145
We shall use accountable, reliable, and transparent approaches to medication safety and just culture.
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An Initiative for Improvement The Hospital Improvement Innovation Network (HIIN) works at
the national, state, regional, and hospital system level to “sustain
and accelerate national progress and momentum towards
continued harm reduction.”
Goal: To reduce all-cause inpatient harm by 20 percent by 2019
Data collection involves chart review and root cause analysis for:
INR >5 for any patient on warfarin, naloxone administration for
any patient receiving an opioid, and blood glucose level <50 for
randomly selected patients on insulin.
Adverse Drug Events Reduction from Baseline
Anticoagulation 12.4%
Hypoglycemia 24.7%
Opioids 52.0%
Below AL
Average in
3 categories
Below U.S.
Average in
2 categories
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Clinical Activities
Daily activities conducted by the antimicrobial stewardship pharmacist:
· Assist with empiric antimicrobial selection
· Target therapy to specific pathogens
· Optimize antimicrobial dosing
· Shorten duration of antimicrobials
· Convert intravenous antimicrobial to oral administration
· Coordinate with infectious disease physician
· Review restricted antimicrobials
Accomplishments
· Publication of annual antibiogram
· Approval of surgical antibiotic prophylaxis protocol
· Adjustment in azithromycin stop time
· Participation in antibiotic awareness week
· Pharmacist achieved stewardship certification
· Meropenem dosage optimization
Medication Usage Evaluations
· Procalcitonin
Research Projects
· Vancomycin dosing in obese patients
Education
· Vancomycin nursing, pharmacy, and lab education module published
· Antimicrobial review for medical residents
· Emergency department fellow education
Antimicrobial Stewardship
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Formulary Additions
· Meropenem-vaborbactam
Guidelines for Use
· Voriconazole
· Itraconazole
· Amphotericin B (liposomal)
· Posaconazole
Antimicrobial Stewardship
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525
575
625
675
725
3Q 2018 4Q 2018 1Q 2019 2Q 2019 3Q 2019 4Q 2019
Total Antibacterial Utilization
Teaching Hospitals (n=29) Non-Teaching Hospitals(n=130)
Princeton Baptist Medical Center
Partners in Patient Care
Pharmacy is well-supported by a dedicated group of
clinical analysts that provide clinical informatics,
automation, and information systems support. They are
an invaluable part of our patient care team. We are
fortunate to have a dedicated group of employees
ensuring our technology remains online and up-to-date.
We shall provide a collaborative work environment among health profession disciplines.
The pharmacy is integrated in collaboration with our
physicians, midlevel practitioners, nursing staff, and
other allied health professionals.
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Partners in Patient Care Our Human Resources Team plays an integral role in
supporting pharmacy staff and leaders to provide optimal
care. The team not only aids in hiring excellent caregivers
but also ensures that those employees are protected and
have a safe and supportive work environment.
Our Pastoral Services Team diligently support our staff.
They routinely dedicate time to the department blessing the
team during our daily huddle and devotion.
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PGY1 Pharmacy Practice Residency Program
The purpose of our PGY1
Pharmacy Practice Residency
Program is to educate and train
pharmacists with the primary
emphasis on the development of
practice skills in a number of
specialized pharmacy practice
areas. A pharmacist completing
this program will be a
competent generalist who can
function in multiple roles
within a pharmacy system.
2019-2020 Residents
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Achievements
New PGY2 Internal Medicine position planned in 2020
Realigned orientation experience
Enhanced focus on preceptor scholarship
Increased cohesiveness of longitudinal experiences
Incorporated pharmacy interns into research project(s)
• Emily Johnson, PharmD, BCPS
• Emergency medicine pharmacist; UAB Hospital (Birmingham)
• Alston Poellnitz, PharmD
• Clinical pharmacist; DCH Regional Medical Center (Tuscaloosa)
• Elizabeth Wood, PharmD
• Pharmacist; Vanderbilt Wilson County Hospital (Lebanon, Tenn.)
2019 Graduates
• Carrie Ellison, Auburn University
• John Michael Herndon, Auburn University
• Alyssa Osmonson, Auburn University
Current Residents
We shall foster a teaching environment for the next generation of healthcare providers.
12th Class
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Pharmacy Students
Princeton Baptist Medical Center offered over 50 advanced
pharmacy practice experience (APPE) rotations to multiple
pharmacy schools in Alabama. There are also introductory
pharmacy practice experiences offered to students.
Students work alongside our pharmacists to learn operational
and clinical components of pharmacy practice. They participate
in activities such as dispensing medications, taking medication
histories, answering drug information questions, and
participating in clinical rounding.
Members of our team lectured at schools in Alabama, Florida,
and Wyoming on hospital inventory management, human
capital for healthcare leaders, applied pharmacoeconomics, and
literature evaluation and application.
We shall prepare the next generation of pharmacy students and residents for excellence through education and preceptorship.
3,250+ Hours
of Education
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Institutional Involvement
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Antimicrobial Stewardship Committee Patient Safety Committee
Baptist Physicians Alliance – Medicine Patient Safety Rounds
BBH Pharmacy Directors Council Product Conversion Committee
BBH Pharmacy Standardization
Committee Performance Improvement Council
Code Blue Committee Pharmacy & Therapeutics Committee
Core Sepsis Committee Princeton Heart Institute
Department of Medicine Rapid Response/Event Analysis
ED Sepsis Task Force Readmissions Team
Facility Research Committee Residency Advisory Committee
Hospital-Acquired Infection
Committee Residency Research Committee
Infection Control Committee Special Care Committee
Interdisciplinary Diversion Team Stroke Committee
Medical Executive Committee Surgical Site Infection Committee
Medication Safety Committee Tenet ADM Steering Committee
Metabolic & Bariatric Surgery
Committee Tenet AL/TN Pharmacy Group
Nursing Council TJC Preparation Committee
Local, State, & National Organizations
• Alabama Infectious Diseases Society
• Alabama Society of Health-System Pharmacists
• Director of Organizational Affairs – Sarah Blackwell
• InPharmative Quarterly Editorial Board – Nathan Pinner
• New Practitioners Committee Chair – Sarah Blackwell
• New Practitioners Committee – Natalie Tapley, Mary Katherine Stuart
• Newsletter Committee – Helen McKnight
• Programming Committee – Natalie Tapley
• American Association of Colleges of Pharmacy
• American College of Clinical Pharmacy
• Clinical Administration PRN Annual Meeting Planning Committee – Tom Achey
• Clinical Administration PRN Education & Research Subcommittee – Tom Achey
• Critical Care PRN Membership Committee – Sarah Blackwell
• American Society of Health-System Pharmacists
• Section of Clinical Scientists and Specialists Midyear Clinical Meeting
Programming Committee – Nathan Pinner
• Section of Pharmacy Practice Leaders New & Emerging Leaders Advisory Group
Vice-Chair – Tom Achey
• Section of Pharmacy Practice Managers Innovation Management Advisory Group
– Tom Achey
• Society of Critical Care Medicine
• Vizient University Health System Consortium
• Supply Chain Optimization Committee Member – Tom Achey
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Publications Achey TS, McEwen CL, Hamm MW. Implementation of a workflow system with
electronic verification for preparation of oral syringes. Am J Health-Syst Pharm.
February 2019; 76(suppl 1):S28-33.
Core A, Pinner N, Bethea B, Starr JA. Timing of anticoagulation in atrial fibrillation
status post cardioembolic stroke. J Pharm Pract. Jan 2019.
Phelps P, Achey TS, Mieure KD, Cuellar L, MacMaster H, Pecho R, Ghafoor V. A
survey of opioid medication stewardship practices at academic medical centers.
Hospital Pharmacy. February 2019; 54(1):57-62.
Pinner N, Oliver W, Veasey T, Starr J, Eudaley S, Hutchison A, Wargo K. Frequency
of β-blocker use following exacerbations of COPD in patients with compelling
indication for use. South Med J. November 2019; 112(11):586-590.
Awards Service Award, Alabama Society of Health-System Pharmacists - Sarah Blackwell
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Presentations NATIONAL
Aspiration Exasperation: Antibiotics often Exploited. Clinical pearl for Infectious Diseases
Hot Topics at the ASHP Midyear Clinical Meeting. December: Las Vegas, NV. Blackwell S..
COPD: Are Eosinophils Really a Thing Now?. Clinical pearl at the ASHP Midyear Clinical
Meeting. December: Las Vegas, NV. Pinner N.
From Insight to Action: Developing a Data-Driven Culture. Educational session at the ASHP
Midyear Clinical Meeting. December: Las Vegas, NV. Achey TS, Hill JD, Bruce BD.
Single- vs. Dual-Antiplatelet in the Acute Phase of Stroke. Clinical pearl for Therapeutic
Debates 2019 at the ASHP Midyear Clinical Meeting. December: Las Vegas, NV. Starr JA,
Mucksavage J.
REGIONAL
Beliefs, Values, and Ethics, Oh My! An Administrative Case Study. Educational session for
Alabama Society of Health-System Pharmacists webinar series. October: Birmingham.
Achey TS.
Goal Setting and Delegation. Presentation to collegiate members of Theta Chi Fraternity
Theta Chi University conference. February: Athens, GA. Achey TS.
It Begins Now: Preparing for Post Graduate Residency Training. Presentation to pharmacy
students at Samford University MSOP. March: Birmingham. Blackwell S.
Leadership 101. Presentation to collegiate members of Theta Chi Fraternity Theta Chi
University conference. February: Athens, GA. Achey TS.
Utilizing Learners in Your Practice Site. Presentation for Preceptors Forum at the ALSHP
Summer Meeting. July: Point Clear, AL. McKnight H, Maxson R., Roberts M.
Weathering the Chill: The Pharmacist’s Role in Targeted Temperature Management.
Educational session for Alabama Society of Health-System Pharmacists webinar series.
April: Birmingham. Blackwell S.
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Presentations LOCAL
Anticoagulant Reversal. Presentation to emergency medicine fellows and physicians at
Alteon Health, Alabama Central Division. December. Stuart MK.
Assessment of Clinical Outcomes following Guideline-Directed Sepsis Care in a Private
Tertiary Hospital: A Retrospective Cohort Study. Presentation to hospital administrators,
physicians, and nurses at Princeton Baptist Medical Center. February – April. Blackwell S.
Hyperglycemic Crises and Insulin. Presentation to emergency medicine fellows and
physicians at Alteon Health, Alabama Central Division. April. Germain K.
Intranasal Medication Administration. Presentation to emergency medicine fellows and
physicians at Alteon Health, Alabama Central Division. December. Germain K.
Pain, Agitation, and Delirium: Operationalizing the ABCDEF Bundle. Grand Rounds
Presentation to physicians, residents, and pharmacists at Department of Medical Education,
Princeton Baptist and Grandview Medical Centers. September. Blackwell S.
The Sepsis Circus: Juggling Care and Quality Measures. Presentation to emergency
medicine fellows and physicians at Alteon Health, Alabama Central Division. September.
Blackwell S.
The Sepsis Circus: Juggling Care and Quality Measures. Grand Rounds Presentation to
physicians, residents, and pharmacists at Department of Medical Education, Princeton
Baptist and Grandview Medical Centers. September. Blackwell S.
Interprofessional Education Topics
Antimicrobial Review
Crash Cart
Medication Histories & Reconciliation
Pneumonia
Urinary Tract Infections 30
Posters Assessing discharge prescribing patterns after heart failure exacerbation at Princeton Baptist Medical
Center. Presentation at the ASHP Midyear Clinical Meeting. December: Las Vegas. Osmonson AJ, Starr
JA, Germain K, Stuart MK.
Assessment of outcomes in patients with end-stage renal disease and congestive heart failure following fluid
resuscitation for sepsis and septic shock. Presentation at the ASHP Midyear Clinical Meeting. December:
Las Vegas. Herndon JM, Holder H, Achey TS, Blackwell SB.
Assessing the impact of pharmacist led interventions on rate of severe hypoglycemia in hospitalized patients
on insulin. Presentation at ALSHP Fall Clinical Meeting. October: Birmingham. Germain K, Autrey M.
Evaluating clinical outcomes associated with ceftriaxone monotherapy in non-obese versus obese patients.
Presentation at the ASHP Midyear Clinical Meeting. December: Las Vegas. Patel U, Chaudhari A, Tapley N.
Evaluation of antifungal consumption and adherence to recommendations for use in a tertiary care hospital.
Presentation at the ASHP Midyear Clinical Meeting. December: Las Vegas. Harding B, Alkire J, Blackwell
S, Pinner N.
Evaluation of cefazolin dosing among obese and non-obese patients. Presentation at the ASHP Midyear
Clinical Meeting. December: Las Vegas. Lee C, Elston R, Autrey M, Tapley N.
Evaluation of cefepime dosing among obese and non-obese patients. Presentation at the ASHP Midyear
Clinical Meeting. December: Las Vegas. Archer A, Holder M, Germain K, Tapley N.
Evaluation of oral anticoagulant prescribing for hospitalized patients with nonvalvular atrial fibrillation at
a community teaching hospital. Presentation at the ASHP Midyear Clinical Meeting. December: Las Vegas.
Patel KN, Uichanco MT, Rusk R, Autrey M, Stuart MK.
Impact of pharmacist-led antibiotic discharge service on pneumonia readmission. Presentation at the ASHP
Midyear Clinical Meeting. December: Las Vegas. Ellison C, Autrey M, Tapley N, Germain K.
Impact of Pharmacy Technician-Led Inventory Stewardship at a Community Hospital. Presentation at the
ASHP Midyear Clinical Meeting. December: Las Vegas. McKnight H, Roberts B, Jackson C, Harris M.
Utilization of procalcitonin to guide antimicrobial therapy. Presentation at the Southeastern Critical Care
Summit. April: Atlanta. Subramanyam S, Wood E, Tapley N, Wynne D.
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Service Anniversaries Celebrating 10 Years
April Marlin
Celebrating 5 Years
Megan Autrey
Brandon Roberts
Celebrating 3 Years
Hillary Holder
Helen McKnight
Kristy Sanders
Mary Katherine Stuart
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Looking Ahead with Strategic Planning
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Many team members participated in our two-week strategic planning
session incorporating a walking gallery with opportunity to
brainstorm, prioritize, & strategize departmental goals for next year!
COMING IN 2020 For next year, Princeton Baptist Medical Center will implement a
clinical pharmacist to provide 8 hours of coverage in the Emergency
Department. This position, in addition to a new internal medicine
clinical pharmacist, will reduce inappropriate medication use, improve
patient outcomes, and reduce the number of discrepancies in the
admission medication reconciliation process.
In turn, their contributions will drive the efficiency of order verification
for patients being admitted and reduce the number of medication-related
adverse events seen as a result of inaccurate medication histories.
Our post-graduate residency training program is growing with the
addition of a PGY2 Internal Medicine residency!
HCAHPS scores regarding communication about medications will be an
area of focus for widespread influence by our pharmacy team.
We look forward to our future successes in the coming year!