how rounds reports and mobile computing support the role of the clinical pharmacist
DESCRIPTION
Presentation covering UDA report design and the use of mobile computing devices for clinical pharmacy services.Delivered at Siemens Innovations 2010 on Tuesday, August 10, 2010.TRANSCRIPT
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
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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
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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
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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
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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)
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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
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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
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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
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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.
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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
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Fundamental problem
Gaining quick and easy access to everything you need when you
need it
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The solution
Rounds Reports
Mobile Devices
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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
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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
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Pediatric rounds report … the first attempt
Demographics
Lab Values
Medications
Pharmacist Notes
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Pediatric rounds report
Demographics
Allergies
Lab Values
Medications
Pharmacist Notes
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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
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Pharmacokinetics monitoring report
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So what did we do about it
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Mobile devices
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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.
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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
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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.Page 24 OQO Model 01 – No longer available
Ultra-Mobile PCs (UMPCs)
Power?
Screen size
Very portable
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Smartphones
Screen size
Very portable
Ubiquitous
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Screen size
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Screen size
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Tablet PC pilot project
Goal
Easy access to hospital systems in a compact, yet powerful package
Solution
Tablet PCs
Fragile?
Form factorTouch interfaceScreen sizePowerful
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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
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LE 1700
Pilot project - hardware
Motion C5
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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
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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
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Changing the screen layout and workflow
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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
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Following changes
Improved workflow
“Faster” access to hospital systems
Positive feedback from pharmacists
Increased tablet PC use on rounds
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Virtualization
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Compatibility
Fragile
Screen size?
Power?
Portable
iPad Form factor
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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
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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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