Terry Pickering, on pharmacy-nursing integration

February 12, 2003

Few registered nurses work full time for the pharmacy department. How did that come about?

I noticed that some of our nurses were struggling with the new pharmacy technologies that were being introduced and I saw that there was no liaison between the pharmacy department, the nursing department and the technology vendors. So, I pointed out some of these issues and they asked me to help out for two weeks. I have now been in the pharmacy department for a year and a half.

What new pharmacy technologies are you working to implement?

We are using a number of new technologies including a new IV Mixture Robot-the first of its kind in the United States. As another example, a large number of medication errors occurs from manually programming pumps. The new B. Braun pumps [that we have implemented] are programmed automatically through the use of bar codes so the nurse can now just check the pump and accept or reject the programming-this second step is required as confirmation that the information on the bar coded label is the same as the order. These new pumps have the capability to send a message to the pharmacy department before a bag runs out so that the pharmacy can refill the medication without requiring the nurse to handle this step.

We are also one of about eight hospitals using the AcuScan Point of Care device, and we are the only children's hospital that has implemented it in all general care inpatient units. This system allows us to reduce medication errors because it is more precise than any human being could be-and that's critically important in a pediatric setting where nonstandard doses are commonly required.

How does it work?

First, we don't think of Point of Care as a pharmacy tool, but rather as a nursing tool. It's a system that performs a three-way match between the nurse, the patient and the medication to ensure accuracy. A nurse scans his or her employee badge and then scans the medication. The system verifies that the medication is correct for the right medication, dose, time and route. If everything is OK to this point, the nurse scans the patient's wristband as a final check. Soon, we will be testing an extension of this system that utilizes our handheld [PDAs] with a desktop view option.

What challenges have you encountered in this new role?

One of the biggest challenges is getting experienced nurses to trust the system. By contrast, we have some new grads who have never used anything but the Point of Care system. Overall, it has been a smooth and enjoyable transition for me. I leave my pager on 24/7 in case our nurses need assistance with the devices and, the fact is, I seldom get beeped.