More Related Content Similar to How Rounds Reports and Mobile Computing Support the Role of the Clinical Pharmacist (20) More from Jerry Fahrni (20) How Rounds Reports and Mobile Computing Support the Role of the Clinical Pharmacist1. How Rounds Reports and
Mobile Computing Support the
Role of the Clinical Pharmacist
Jerry Fahrni, Pharm.D.
Informatics Pharmacist
Kaweah Delta Health Care District
Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
2. Objectives
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.
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3. Disclosures
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
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4. 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)
5
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6. 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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7. 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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8. 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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9. We cannot change the
human condition, but
we can change the
conditions under which
humans work
James Reason
Page 9 Reason J. Human error: models andSolutions USA, Inc. All 2000. reserved.
Copyright © 2010 Siemens Medical management. BMJ rights 320768–770.
10. 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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11. Fundamental problem
Gaining quick and easy
access to everything
you need when you
need it
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12. The solution
Rounds Reports
Mobile Devices
Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
13. 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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14. 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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15. Pediatric rounds report … the first attempt
Demographics
Lab Values
Medications
Pharmacist Notes
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16. Pediatric rounds report
Demographics
Allergies
Lab Values
Medications
Pharmacist Notes
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17. Antibiotic Stewardship Report
Demographics
Allergies
Lab Values
Antibiotics
Micro Results
“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
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19. So what did we do about it
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21. 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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22. Handhelds
Pros Cons
Portable Limited screen real-estate
Lots of reference material Very S-L-O-W
available Lack access to many legacy
Lots of 3rd party software available application
for documents Lack access to online
Semi-rugged, i.e. can take a applications, i.e. limited web
punch capabilities
Good battery life Easily misplaced
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23. Mobile options
Laptop Ultra-Mobile PC Smartphone
Powerful Very portable Ubiquitous
Screen size Screen size Very portable
Awkward shape Power? Screen size
Form factor
Netbooks Tablet PC iPad
Portable Powerful Form factor
Form factor Screen size Portable
Power? Touch interface
Power?
Screen size? Form factor
Screen size?
Fragile
Fragile
Compatibility
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24. Ultra-Mobile PCs (UMPCs)
Very portable
Screen size
Power?
Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.
Page 24 OQO Model 01 – No longer available
25. Smartphones
Ubiquitous
Very portable
Screen size
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26. Screen size
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27. Screen size
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28. Tablet PC pilot project
Powerful Screen size Touch interface Form factor
Fragile?
Goal
Easy access to hospital systems in
a compact, yet powerful package
Solution
Tablet PCs
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29. 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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30. Pilot project - hardware
LE 1700 Motion C5
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31. 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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32. 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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33. Changing the screen layout and workflow
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34. Updating the hardware
Slate model tablet PC Convertible model tablet PC
Semi-rugged J3400 Dell XT2
Windows Vista Business Windows XP Tablet Edition –SP3
1.4 GHz Intel Core Duo Processor 1.6 GHz Intel Core Duo Processor
2 GB RAM 2 GB RAM
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35. Following changes
Improved workflow
“Faster” access to hospital systems
Positive feedback from pharmacists
Increased tablet PC use on rounds
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37. iPad Form factor
Portable
Power?
Screen size?
Fragile
Compatibility
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55. 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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56. Questions?
Thank you for attending this session.
Session #6
How Rounds Reports and Mobile Computing Support the
Role of the Clinical Pharmacist
Jerry Fahrni, Pharm.D. – jfahrni@kdhcd.org
Slides available at: http://www.slideshare.net/JFahrni
Please take a few moments to complete your evaluation
form before you leave.
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Editor's Notes Fit our immediate needs at the time, but we quickly outgrew what thy could provide…. Talk about initially using natively installed applications and the trouble we had after upgrade with finding missing these devices on rollout.