Pasco Regional Medical Center (PRMC) in Dade City, Florida has served the northern Tampa Bay area for more than thirty years. It maintains 120 acute care beds and provides health care services to adult and pediatric patients. PRMC is one of 58 hospitals managed by Health Management Associates, Inc (HMA) and the PRMC pharmacy department is staffed with 3.5 pharmacist FTEs and 4.5 technician FTEs, and operates one shift daily.
The Joint Commission’s mandate requiring pharmacist review of all medication orders prompted HMA pharmacy leadership to seek out a Web-based solution for formulary management so information could be efficiently communicated to the after-hours remote order-entry pharmacist. Ultimately, HMA selected Gold Standard’s FormChecker solution and deployed it to all 58 of its hospitals, including PRMC, as the majority of these hospitals serve suburban communities and do not maintain 24-hour pharmacy services. PRMC quickly embraced the FormChecker technology, as it provides benefits for pharmacy leaders, pharmacists, technicians, and front-line clinicians in a paperless format.
Formulary Control Benefits
The principle function we were seeking was a Web-based formulary management tool that would allow the pharmacy director or designee to control and update the hospital formulary from his or her desktop. In reviewing the available solutions, we discovered that FormChecker would allow for drugs to be added or removed from the formulary the day such decisions are made, as well as therapeutic interchanges to be linked, approved renal dosing protocols to be kept current, and warnings and alerts to be associated with formulary items including drug shortages. Another function of FormChecker allows pharmacy personnel to collect and maintain adverse drug reaction (ADR) reports, which can be filled out online by any hospital clinician registered on the system, and link to pertinent resources such as state or federal pharmacy laws or the Institute for Safe Medication Practices (ISMP). These links can be programmed to appear on the FormChecker homepage. Effectively, FormChecker keeps all our formulary and clinical drug protocol information in one place. The application is also accessible on smart phones and PDAs (Blackberry, iPhone, Droid, etc), which is particularly helpful while making rounds in the patient care areas or when receiving an after-hours telephone call from a nurse on the floor.
Our pharmacy technicians can keep track of area reviews and file monthly inspection reports online. In addition, they use FormChecker’s online refrigerator log feature to record temperatures from all medication refrigerators on the floors. Furthermore, the software stores extended stability beyond-use dating (BUD) data that can be uploaded, maintained, and referred to by pharmacists for commonly prepared IV admixtures.
Extending Benefits Beyond the Pharmacy
Front-line clinicians also have access to FormChecker. At PRMC we had our information systems department create a Drug Formulary button on our hospital Intranet homepage that links to the FormChecker application. Now, when the night shift has formulary questions, they have an up-to-date, online resource to refer to. Nurses, respiratory therapists, and physicians can access FormChecker to review approved therapeutic interchanges and during drug shortages, we can use FormChecker to keep our clinical staff informed. For example, we can apply alerts to formulary items in the event that a drug shortage has prompted the approval of an emergency auto-substitute. This worked well when we could no longer acquire prochlorperazine edisylate solution for injection and needed to communicate an emergency auto-substitute to the entire clinical staff.
After implementation of FormChecker in late 2008 and modification of the automated dispensing cabinet (ADC) floor stock, the number of times the on-call pharmacist had to return to PRMC was significantly reduced. From a baseline of 73 after-hours pharmacist returns in 2008, we reduced that to only 17 returns in 2009. In the first half of 2010, on-call pharmacist returns have occurred only 5 times. Payroll savings exceeded $6000 in 2009 and less returns to the hospital after hours have improved the on-call pharmacist’s quality of life. In addition, the ability to use FormChecker as a compliance dashboard to validate whether required inspections and logs are being completed on time has ensured 100% compliance with required monthly area inspections assigned to the pharmacy staff.
We plan to continue expanding the use of the FormChecker application, as Gold Standard has customized some features within the system specific to our requests. For example, we have been able to integrate clinical dose calculators for vancomycin and aminoglycoside from Gold Standard’s Clinical Pharmacology application to our FormChecker home page. In addition, we now have area-review inspection results emailed directly to nurse managers so they are kept informed of our inspection findings.
Overall satisfaction with FormChecker has been quite positive from all departments that use it. FormChecker provides our pharmacy leaders with a Web-based mechanism to record and maintain crucial pharmacy records and always keep our formulary, therapeutic interchanges, and protocols up-to-date. This information is available now at all times to all hospital personnel from any Internet connected computer; a sweeping function that has created an efficient, organized, and expansive formulary management system and thereby increasing patient safety and staff accountability. Furthermore, pharmacy leaders can use FormChecker as a dashboard to verify when pharmacy personnel have performed their designated medication inspections and ensure compliance with required documentation.
Jeff Anderson, RPh, MS, earned his pharmacy degree from the University of Florida and his graduate degree in clinical leadership from the George Washington University. Prior to his current role as director of pharmacy at Pasco Regional Medical Center, Jeff was a clinical pharmacist in Tampa Bay’s BayCare Health System. Jeff serves on the adjunct clinical faculty at the University of Florida College of Pharmacy and is an adjunct assistant professor at the George Washington University School of Medicine and Health Sciences.
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