Transcript Management Dilemmas: Establishing

Management Dilemmas: Integrating
New and Established Practices
South Carolina Society of Health System Pharmacists
Spring Symposium, 2008
Joel Melroy, PharmD, MS
Manager, Ashley River Tower Pharmacy Services
Medical University of South Carolina
Ashley River Tower
Ashley River Tower

156 bed service line hospital
 Heart
& Vascular Service Line
 Digestive Diseases Service Line
Patient Tower: acute care + ICUs
 Diagnostic & Treatment: ORs, Cath labs,
IR
 Chest Pain Center
 Clinics

Projected 60% capacity – budgeted staffing
Ashley River Tower

Inpatient Pharmacy
 Clinical
and distributive services
 Inpatient units, procedure areas, clinics
 Automated Dispensing Machine (ADM)
Service

Operating Room (OR) Pharmacy – Carole
Russell
 Pre-op,

OR, PACU
Retail Pharmacy – Heather Kokko
 Outpatient
& employee prescriptions
Overview
 Planning
 Resources
 Operations
 Clinical
Practice
 One week prior to opening
 One week after opening
 One month after opening
Key Observations
A large project such as opening a new
hospital requires teamwork
This feat could not have been
accomplished without teamwork from
the pharmacy director, management
team, and staff
Planning

BoP, DHEC, and DEA licensing



<797> and revision – 12/07
Facilities
Point of Care medication
administration
 Hybrid cartfill-cabinet model
 Courier service
 ADM cabinets, configurations,
inventory
Technology Implementation


• New standards, unplanned
facility surprises
Distribution Plan


Dilemmas:
BCMA, Smart Pumps, CPOE
Inventory

Accounts, contracts
• Robot/cartfill in a separate
facility
• Dependent on another
department to provide
courier service
• BCMA, Smart Pump rollout
• Too much vs. not enough
Facility Surprises…
Resources

Personnel
 Attract
and select the best people
 Train sufficiently
 Share resources, if necessary
Dilemma: Midnight Pharmacists

Equipment
 Purchase
redundant equipment?
 Support for new automation/technology
Dilemma: Medication Transfer Carts
Operations
Task
MUH
ART
UD prep
X
X
IV batches
X
X
Chemotherapy
X
X
ADM
X
X
24-hr cartfill
X
(completed at MUH)
TPNs
X
(completed at MUH)
Operations
Daily order: delivered to ART
 ADM service

 ART
staff
 Administrative/Superuser support provided by
MUH

Courier service
 Distribution
Center, Compounding, AIP, ART
 Up to 8 runs per day
Dilemmas: Incorporating workflow of two separate
operations, ADM training, courier
Clinical Practice

Established model: specialist
 Clinical
pharmacists perform order entry
functions and specialists round with teams

Desired model: integrated w. “coordinator”
 Clinical
pharmacists expand their roles and
specialists coordinate activities, initiatives
Dilemma: changing practice models with
practitioners with established roles
One Week Prior…
Limited access to hospital
 Hospital DHEC licensing

 Successful
BoP inspection, DEA
Licensed on 1/30 (Wednesday)
 1st drug order: 1/31
 Stocked 3 pharmacies + 50 ADMs

 “Completion”:
2/3
Opened: 2/4
We didn’t have time for dilemmas!

One Week Prior…

Issues
 Completing the initial drug order
 Used purchasing data from MUH
 Did not order non-formulary medications
 Planned to utilize MUH inpatient pharmacy for medications
not ordered initially (tube system)
 Medication security/transport
 ~50 to 90 patients expected to move to ART
 Medication transport bags and labels
 Filling ADMs
+ inability to access hospital
 Midnight pharmacists not fully trained
 Smart Pump rollout – all IV medications to be
changed out at arrival to ART
Opening

Incident Command Team – “Disaster”
Staging – MUH
 Supply Team Leader – ART
 Daily meetings from Thursday until Sunday
 Medication



Moved 59 total patients with 7 admissions in 5.5
hours
Pharmacists located on floors and in central
pharmacy
Pharmacy team – extremely responsive to
changing needs & stress on the floors
One Week After…




Inventory stabilizing
Decentralized pharmacists on floors
Daily staff meetings
Issues:
 Courier
service not consistent
 Medications needed for clinics
 IT issues (fax server, computers)
 Central pharmacy organizational patterns
 Distribution/paperwork
 Staffing
 Technician/pharmacist training
One Month After…
Weekly staff meetings
 Ongoing training
 Courier/distribution becoming smoother
 Continuing issues

 Staffing/training
 Gaining
resources for increasing staff levels
 Some IT issues (fax machines)
 Changing to an integrated practice model
 Workload increasing – census above the
projected 60% level
Lessons Learned











It takes many dedicated people working as a team to accomplish
such a large feat
Some change can occur in a minute and other change takes more
time
Listen to your staff and meet frequently – communicate
Listen and respond to nurse/physician needs while remaining calm
Be action-oriented and responsive
Set up as many systems as possible prior to opening (e.g.,
distribution, courier, clinic meds)
Complex problems require complex solutions…don’t settle for the
“quick fix”
Be visible to your staff, nursing staff, and physician staff
Be involved with multidisciplinary operations committees and other
teams before and after the move – you will gain insight on system
issues and staffing patterns
Be flexible and open-minded
Be surrounded by high performers
Staff













Kristen Baker
Nicki Balchin
Courtney Bath
Sharon Fahey
Carrie Flippen
Charles Garred
Tom Gnau
Phil Grech
Chanda Harrison
Mary Jo Jack
Shantee Jacques
Charlotte Johnson
Bruce Keck














Devin Matthews
Crystal McKinley
Kathryn Noyes
Johnte’ Porter
Emily Poston
Becky Schneider
Trish Schuler
Dianna Sellers
Kendra Seward
Sam Solomon
Walt Uber
James Walker
Joyce Warren
Marina Williams
Management Team
Paul Bush
 Carole Russell
 Chris Fortier
 Heather Kokko
 Joe Mazur
 Matt Maughan
 Kelli Garrison

Questions?