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System-Wide Outpatient Pharmacy Management Gives Massachusetts General an Edge in SafetyBy Karen Ryle, MS, RPh Associate Chief of Pharmacy, Ambulatory Care Massachusetts General Hospital Boston, Mass.  Technology to Meet High Standards Massachusetts General Hospital (MGH) may be the third oldest general hospital in the U.S., the largest hospital in New England and consistently ranked among the top five hospitals in the nation by U.S. News & World Report, but we don't rest on our laurels. In fact, pressure is heightened for venerable institutions like ours. Patient safety is of the utmost importance to us. It drives every improvement we make. Two years ago, we had a specific challenge to surmount: not all of our outpatient pharmacies were using the same technology. We wanted to upgrade to an enterprise-wide pharmacy management system that offered greater functionality across our facilities. We waited for an outpatient pharmacy management solution that met our needs across the organization. Error-Reducing, Time-Saving Automation The MGH team includes 17 pharmacists and 25 technicians. We fill up to 1,450 prescriptions daily at our four pharmacies. With a workflow-based structure, each staffer contributes to increased patient safety. Three built-in features of our new system streamline prescription pre-verification and verification. They also enhance patient safety and save time for our patients and staff.  Bar-code accuracy scanning: By matching the barcode before generating a label, weensure we have the right product. Pill imaging: Staffers can verify contents of the patient's bottle against an onscreen image ofthe prescribed pill. Because they no longer need stock from inventory to do the comparison, we have reduced the number of open bottles and our overall bottle inventory. Prescription scanning: Scanning enables our pharmacists to verify data entry and drugutilization. It also ensures the script is readily retrievable with a keystroke, which is especially useful during audits. Plus, it has eliminated a lot of paper. Another huge benefit of the system is the ability to communicate via HL7. Both patient and physician data is automatically populated and updated into each record. This eliminates missing or wrong information, such as DEA or NPI numbers. That means fewer rejections from insurance — reducing rework and speeding reimbursement. Finally, we are able to process electronically transmitted prescriptions directly from a physician so patients don't have to bring in hard copies except in the case of controlled substances. Keys to Accelerated Implementation Several factors contributed to our swift and seamless conversion. The solution was Windows-based, so it was familiar to our mostly young staff. The new solution was greeted with enthusiasm by pharmacists and technicians because of thebenefits it would provide. Having a pharmacist on the vendor side that "spoke our language" (in addition to the IT experts)kept us on track during the switch. Unexpected Benefits — and Big Savings In the one year since we've implemented the new system, we've achieved the efficiencies we expected, but we've also had some welcome surprises as well. One area is in automatic ordering to maintain inventory. Previously, we didn't know if we had a medication on hand — someone had to search for it. Yet, we were overstocked with some drugs. Since implementing this technology, we've been able to better control and track our inventory, lowering our costs by about $200,000. And we're less apt to run out of medications. Another plus has been tracking medications used in our clinical trials, since many research drugs don't have NDC codes. We are able to label and track these medications more efficiently. For safety, we created alerts for high-risk medications such as opiods, anticoagulants, insulin and chemotherapy drugs. We added product notes, tall-man lettering and pop-up messages to encourage our staffers to verify these drugs. We've also produced alerts for sound-alike, look-alike drugs. Looking Ahead and Leveraging the System World-class patient care depends on continuous improvement. While we are very pleased with our gains thus far, we are working on two new initiatives. By summer 2010, thanks to enhanced reporting tools, we will be able to generate customized reports that better meet the needs of a hospital like ours, which services international and donor patients. And we are already in the review stages of a new Web site, scheduled for 2011, that will enable patients to securely order refills via the Internet. The ability to refill prescriptions with just a few clicks will be a reality for our patients in the near future. Karen Ryle is the Associate Chief of Pharmacy at Massachusetts General Hospital. She oversees three outpatient pharmacies and two ambulatory oncology pharmacies. Ryle was a member of the Massachusetts Board of Registration in Pharmacy for 10 years. She is currently a member of the Executive Committee of The National Association of Boards of Pharmacy. She is a recipient of the 2005 MCP College Metal and the 2008 recipient of the Bowl of Hygeia.   |
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