There are a number of aspects that could be discussed; to give you some background, I would like you to review 2 documents. The first is the Joint Commission on Pharmacy Practice vision for the pharmacist of 2015. The other is a similar position statement from the American College of Clinical Pharmacy. Please review these documents and be familiar with the main points of each.
Additionally, please view the video below from InstyMeds and think about the use of technology and robotics. Threat or opportunity?
15 comments:
How has technology helped or harmed pharmacy and how can we as pharmacists improve it for better patient care?
How is patient care effected with the use of automated machines in the pharmacy?
Lauren Hawkins
l.m.hawkins@wingate.edu
If you had the power to actually change the profession for the better, what would you change and why?
Amber Lintz
a.n.lintz@wingate.edu
Do you believe that automation in filling prescriptions affects pharmacy as a profession and pharmacy's credibility and professionalism. For example, when you as a customer go to a retail store and a piece of equipment breaks down, do you feel that the person running it is less competent? And ultimately do you feel that they are 'less professional' because of it.
Do you believe that a robotic dispensing mechanism is a good alternative to an actual employee?
Andrew Hayes
a.r.hayes@wingate.edu
I think technology has helped pharmacy out to an extent. From a inpatient hospital stand point, robots help decrease medication fill errors and frees up the technicians to do other things that robots can not do like.
The future of pharmacy was my past discussion in my administration rotation. We discussed how no matter if we have robots filling, we as pharmacists will always be needed. There needs to be a licensed person to take responsibility of medications being dispensed even if it is from a robot. Pharmacy not only involves filling and dispensing but it has expanded to counseling patients and working with physicians to provided better patient care. I have doctors that I work with everyday come to us for drug information and help with dosing and following drug levels. Since the hospital I am at is a teaching hospital, we round with whole team of medical residents, doctors and many other people. On rounds one day a patient asked about why one narcotic has less side effects than another narcotics. Who better to answer that question than a pharmacist or a pharmacy resident :)? I have realized that pharmacists can help in so many ways and that the future of pharmacy has lots of room to expand and grow.
Just something to think about: Our administration assignement was to read an article titled: Will there be a pharmacy leadership crises? An ASHP Foundation Scholar-in-residence report. (Am J Health Syst Pharm. 2005 Apr 15;62(8):805.) It talked about future leaders of pharmacy and what would happen if a pharmacist wasn't the pharmacy director. In the article it talked about how there will be an increased demand for leaders such as directors of pharmacy because all different reasons such has pharmacy directors have little to no exposure to direct patient care and they take on more responsibilities. So what would happen to the future of pharmacy if the pharmacy director was a nurse or a person with a business degree with little to no healthcare knowledge or just someone that is not a pharmacist?
Ying-Tang Ng, Pharm.D.
Pediatric Pharmacy Practice Resident
Wolfson Children's Hospital
ytng22@gmail.com
RE: Ashley's post
As a community pharmacist, one of the most recent technological advances that impacts my practice on a regular basis is e-prescribing. e-prescribing was designed to revolutionize the practice of medicine, streamlining processes and ultimately benefiting the patient by decreasing prescribing errors. I can see where such a system would be appealing to prescribers – pull-down menus provide quick drug references that not even a PDR can match. However, as the pharmacist at the receiving end of this chain, I can honestly say that e-prescribing challenges me constantly – and sometimes, not in a good way. On a nearly daily basis, I receive e-prescriptions that are wrong. I fax in a refill request for metoprolol succinate 50 mg daily – I get back metoprolol tartrate 50 mg daily. I get new prescriptions for products that haven’t existed for years. We won’t even discuss the prescriptions that come through that say “Sig: 1 tablet by mouth daily” and then, farther down, say “Instructions: 1/2 to 1 tablet twice daily as needed.” Another example comes to mind – I had a prescription for “fluticasone propionate 50 mcg, 1 inhalation bid, #1” come across the e-prescribe system. The prescription was filled with Flovent, as the instructions indicate. Upon consultation, the patient asked why she was getting a medication for asthma and not allergies – she expected Flonase. The same prescriber did this three times before we had to call her and tell her to fix her e-prescribe system. All of these examples allude to the idea that without a pharmacist as gatekeeper, these prescriptions could have misused or misprescribed. I think e-prescribing, when done appropriately and with consideration, could be a great advance in terms of patient safety – prescribers can screen against major medical and drug interactions BEFORE sending the prescription in and pharmacists can counsel the patient on proper use of the medication. As pharmacists, we are ultimately responsible for patient safety – we’re the last line of defense that a patient has before they take a dose of medication. We should continue to push for technological advances that are relevant to practice; however, in doing so, we must remain vigilant in performing the functions of our profession and not allow technology to make us lazy.
___________________________
Erica Harms, Pharm.D., R.Ph.
Staff Pharmacist - Target Pharmacy
Charlotte, NC
eharms@carolina.rr.com
I have encountered technology in numerous ways in my pharmacy training. I do not feel technology has harmed pharmacy. Some have argued in the past that technology will replace pharmacists. I disagree. Technology allows us to provide expanded clinical services and improves patient care from a time and safety standpoint which also relates a potential cost and resource savings. Expanding and promoting our clinical services, improving safety and reducing cost are important jobs in all areas of pharmacy and will play a large role in the future of pharmacy.
Technology is not without its flaws and is subject to human error. Automated dispensing machines such as those used in community pharmacy require that someone load the correct medication in the correct bin. Bar-coding reduces error but does not eliminate it. The same is true to dispensing cabinets in hospitals (Omnicell or Pyxis machines). Bedside bar-coding can be used and medications are double checked but errors still occur, medications spill over into the wrong bin etc, nurses scan a barcode in their pocket or cart, not the pt wristband... I work with robots (they make TPNs and draw up pediatric syringes) and computerized physician order entry while staffing in my residency. We also order medications from our wholesaler that are picked by a robot and bar-coded deceasing the amount of medications checked manually (random 10% check etc.)
The clinics I work in at University of Maryland and the VA have electronic medical records which improve availability of information the continuity of care.
As some have posted, technology breaks down, more often than we like and can make for a stressful situation. I do not feel this makes us look unprofessional or incompetent. Always explain the situation and make the best of it. Society is used to technology and its drawbacks. I feel that we should embrace technology. It is a valuable tool that I use every day in my practice. It allows me to efficiently order medication and labs and improves documentation (especially my sloppy handwriting).
Lastly, we can always improve technology and for those interested there is an increased demand for pharmacists in this area and several pharmacy informatics residencies available for additional training.
Zack Deyo
PGY2 Am Care Resident
University of Maryland
zmdeyo@gmail.com
Going from a 1,000 bed community hospital with Pyxis machines and computers in every corner to Brooklyn, NY where there's only 2 Pyxis machines in the whole hospital, 1 computer on each unit, NO tubing system, and NO electronic pt medication administration system was a bit of an eye-opener at first. EVERYTHING is done on paper and most disturbing to me is that if a nurse is missing a pt's medication, she will just borrow another pt's because there is no wristband scanning system. Imagine the med errors that can arise?! At first I didn't think I would survive in such a low-tech hospital, but I've actually seen some advantages. With computers being sparse, you can't look up everything/anything when asked a question - so there's more pressure to know more about patients and drugs. Also, I see a lot more communication between different health care professionals, which makes for good teamwork!
Thy Le, PharmD
PGY1 Pharmacotherapy Resident
The Brooklyn Hospital Center
RxThy13@gmail.com
Technology has significantly helped pharamcy. Drug information is a few clicks away on the computer or PDA/Blackberry. Automation helps with everyday tasks and allows for personnel to be available for clinical tasks. I have been a pharmacist for a long time and have seen huge jumps in technology and how it has helped improve the practice of pharmacy.
We as pharmacists must make sure that our customers, (patients, nurses, physcians, etc) are aware that we do more than count tablets and fill vials. Every day you will problem solve, answer drug information questions, assist in DRUG PRODUCT SELECTION,make recommendations and educate those around you. I highlighted product selection above as I believe this is an area where pharmacists are extremely valuable. Daily I have to take into account the differences in metabolism and excretion between two medications based on the patient's overall function and status. Will there be drug interactions with what he is currently taking, how much weight gain will this product cause, are my calculations correct for his renal function, and what is my plan and goal for his therapy? These are only a few of the questions I go through when on patient care rounds and we are discussing the patient and treatment.
Technology helps with all of this, but you will be relied upon to make all of these decisions and justify your choices. The InstyMed is a scary thought and pharmacists will still be needed, but we must emphasize to our customers that we provide more than just bottle filling.
In response to the question by Anonymous and the readings on the advancement of pharmacy from this week, I think gaining more autonomy and becoming more involved in direct patient care would be the best future for pharmacy practice. I agree that requiring residency training is a good step for pharmacy education if you desire a clinical position, but I think the amount of available residencies and funding would be a huge barrier to overcome. I believe that the current PharmD programs provide you with the knowledge necessary to become a good clinical pharmacist, but I agree more expereience is needed for the majority of new pharmacists. I think once you gain a certain level of experience in the field that this can equal a residency, which helps you get to the same level faster. I believe pharmacy's ultimate goal should be to advance to the point that pharmacists are managing patients medications on all levels.
Technology is good for pharmacy practice and our future because it does free up time for us to be involved with direct patient care. Overall, I think it is safer than humans alone, but technology does fail because we ultimately run the technology. I currently work with Pyxis, and we still have errors due to the machines being filled wrong or meds getting put in the wrong pocket, for a few examples. I think bar coding would catch most of these things if the med does not scan as it should, but then the nurses have the option to override the scan. So, I think technology is helpful and necessary IF we do not become dependent on the robotics/devices to think for us. We still have to use our critical thinking skills and be aware that technology fails.
In response to some of the comments on E-prescribing, I think that is one of the worst things I have experienced yet. The system does not work in a user-friendly fashion, and the prescriptions are constantly filled in inappropriately. I think E-prescribing could be beneficial in preventing handwriting errors, but physicians need more education for it or the system needs to be reevaluated.
In response to Ashley's question, when technology fails, I actually think it gives us opportunity to demonstrate our knowledge because we have to find ways around the problem that will allow us to continue to serve our patients. We feel incompetent when it breaks because we are so dependent on it, but then we realize that we can still function without all the technology.
One thing I believe we should all remember is that we are among the most trusted professionals according to our patients. This trust cannot and will not be replaced by technology. Patients and colleagues will need our advice and compassion, and this is impossible to get from a robot.
Automated dispensing as described in the video can be looked at two ways from the persepctive of a pharmacist: 1) it is an intrusion into our world and we must protect what is ours or 2) this will take the burden of an involved dipensing process away from us and open the door for advanced pharmacy practice. While the second response is the one that I would hope most of you embrace, it is understandable that some people would feel like the first statement. For many, many years that WAS pharmacy. You dropped off a piece of paper with some scribbling on it and the man/woman behind the counter deciphered it and counted it out and sold it to you. They could also answer some questions if needed. Those of us whom are late starters, myself included, don't hold this as dear as others and are happy to let the machines handle the manual labor for us while we take care of the more pressing issues of appropriate medication selection while factoring in all the other dynamic problems our patients have. These machines give us as professionals an opportunity to step away from the counting trays and make a real difference in the overall healthcare of our patients and our communities.
My retail experience is limited to only the 15 weeks (total) I spent in a Harris Teeter during my time as a student pharmacist while attending WUSOP. The technology employed at my site was minimal. I am aware that there are dispensing/counting machines utilized in the retail/community setting. I am aware that they come in many shapes and sizes and colours. I don't know how they impact patient care first hand but have heard more good than bad about them.
The hospital where I am employed utilizes many systems to limit the number of hands involved in the actual dispensing of medications. This has allowed us to utilize those personnel in ways never thought possible prior to any of these "wonderful toys." We are able to manage the bulk of the dispensing process with a single pharmacist. Our facility handles the after hour care for ~2500 beds spread over the Piedmont and Foot Hill regions of North Carolina. We are sending thousands of doses to multiple sites with the same staff that, prior to the addition of our "robot", would have needed all day to complete the same amount of work for our 250 bed hospital while being able to accomplish little more.
The technology has made the process of dispensing medications much more efficient and much, much less labor intensive. And we have only talked about dispensing.
I think the smartest thing we can do concerning automated dispensing is embrace it and help the system grow. The more of that taken away from us, the professionals, is more time that we have to push onward and upward with the new expanded roles available to us. Then all the didactic instruction can be loosed on the community no longer stymied by counting by 5 and selecting the appropriate Aux labels. Aminoglycosides will tremble with our new found time to rapidly and accurately dose these as necessary. New services will be born into a world where PharmD means "I don't count out your medications and put them in a bottle for you." One area I think we as pharmacists should really dig in and become entrenched is discharge medication reconciliation. Who is better qualified to pick through the chart piecing together the path that was drug utilization and then translating that into a medication discharge plan?
I could go on and on for days about this but can only imagine how quickly it will become tired to most if not all of you.
To try to sum this up and answer a few questions...@Ashley- tech has moved the experts away from the back counter and placed them in a setting best suiting an expert - using their knowledge to make a situation better.
@Lauren- When used properly tech can greatly improve patient care while growing upon the services provided to the patient.
@Ashley part II- Is a physician less of a professional because an RN takes a patients vitals and he analyzes them? I don't think so but some may. In my hospital we have carts that are wheeled around with all the equipment needed to take vitals. Cuff is placed on arm, probe is placed in mouth, button is pressed. Analyzing that data is key to diagnostics. And the MDs I work with are all revered for their professional knowledge.
Lastly @Andrew- In a lot of ways I do think this as long as you aren't loosing an employee to the machine. That frees up time for me and my staff to expand what we do and solidify our place in the healthcare team.
Jeffery Watson, PharmD
CMC-Mercy Hospital
Charlotte, NC
----------------------
JefferyEWatson@gmail.com
Technology, by far, has allowed pharmacist to make great strides in proving better patient care and healthcare in general. As with all new and “me-too” products, there will be good inventions which provide excellent advancements and some which should have never been implemented, but were, due to good marketing, kickbacks, or for some other reason. I will never forget when the institution I worked at decided to install a robotic system to fill patient cassettes. The big fear was: how many people would lose their job. Bottom line was, there was no reduction in head count. And ironically, our install turned into a costly drawn-out install. The machine was too tall for the ceiling, and upon raising the ceiling, asbestos was found and had to be removed. Talk about a mess and extreme increase in cost! But the best robotic pharmaceutical advancement, in my opinion, is the automatic compounders for TPNs. Love it!
I was intrigued by the article Dr. Nuzum had you read this week. There were several topics which struck my curiosity, and am wondering how others felt. For example, Position 3 says “ACIP-ASIM opposes independent pharmacist prescriptive privileges and initiation of drug therapy”. It goes on to say, that “physician training is rigorous and heavily relies on patient interaction” and that “pharmacist do not have the exposure and experience to diagnose and prescribe medications for patients.” But from a study from the Annuals of Epidemiology which I came across, it found many MDs failed to prescribe the recommended first-line treatment for cystitis and are prescribing antibiotics longer than the recommended 3 days. Almost 2/3 of the MDs did not follow this and only 37% prescribed Bactrim DS. Could we as pharmacist do better? The same? Worse?
Linda Drudick, RPh
Former Intensive Care Pharmacist
Now: NTPD Student University of Colorado
The first half of my comment seems to have been cut off...
Automated dispensing as described in the video can be looked at two ways from the persepctive of a pharmacist: 1) it is an intrusion into our world and we must protect what is ours or 2) this will take the burden of an involved dipensing process away from us and open the door for advanced pharmacy practice. While the second response is the one that I would hope most of you embrace, it is understandable that some people would feel like the first statement. For many, many years that WAS pharmacy. You dropped off a piece of paper with some scribbling on it and the man/woman behind the counter deciphered it and counted it out and sold it to you. They could also answer some questions if needed. Those of us whom are late starters, myself included, don't hold this as dear as others and are happy to let the machines handle the manual labor for us while we take care of the more pressing issues of appropriate medication selection while factoring in all the other dynamic problems our patients have. These machines give us as professionals an opportunity to step away from the counting trays and make a real difference in the overall healthcare of our patients and our communities.
My retail experience is limited to only the 15 weeks (total) I spent in a Harris Teeter during my time as a student pharmacist while attending WUSOP. The technology employed at my site was minimal. I am aware that there are dispensing/counting machines utilized in the retail/community setting. I am aware that they come in many shapes and sizes and colours. I don't know how they impact patient care first hand but have heard more good than bad about them.
The hospital where I am employed utilizes many systems to limit the number of hands involved in the actual dispensing of medications. This has allowed us to utilize those personnel in ways never thought possible prior to any of these "wonderful toys." We are able to manage the bulk of the dispensing process with a single pharmacist. Our facility handles the after hour care for ~2500 beds spread over the Piedmont and Foot Hill regions of North Carolina. We are sending thousands of doses to multiple sites with the same staff that, prior to the addition of our "robot", would have needed all day to complete the same amount of work for our 250 bed hospital while being able to accomplish little more.
The technology has made the process of dispensing medications much more efficient and much, much less labor intensive. And we have only talked about dispensing.
I think the smartest thing we can do concerning automated dispensing is embrace it and help the system grow. The more of that taken away from us, the professionals, is more time that we have to push onward and upward with the new expanded roles available to us. Then all the didactic instruction can be loosed on the community no longer stymied by counting by 5 and selecting the appropriate Aux labels. Aminoglycosides will tremble with our new found time to rapidly and accurately dose these as necessary. New services will be born into a world where PharmD means "I don't count out your medications and put them in a bottle for you." One area I think we as pharmacists should really dig in and become entrenched is discharge medication reconciliation. Who is better qualified to pick through the chart piecing together the path that was drug utilization and then translating that into a medication discharge plan?
Post a Comment