Courtesy of Lehigh Valley Hosptial and Health Network	More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
Clinical pharmacist Janine Barnaby (left) of Lehigh Valley Hospital and Health Network based in Allentown, PA, works in a collaborative program with Erin McCarty, RN (center) and Jennifer Hook, RN.

To the nurses at Children's Medical Center of Dallas, hospital pharmacists once were like "Check Engine" lights: You only thought about them when something was wrong.

"When I first came to Children's, it was so fragmented," said Terry Pickering, RN, who worked in the hospital's emergency room. "You called and talked to the pharmacists on the phone, but you never saw them. They were in a locked department and they never got out of that department."

Less than four years later, the walls have fallen. Nurses and pharmacists now work on a face-to-face and first-name basis. Pharmacists walk out of the apothecary doors to roam the floors with nurses on regular rounds, counseling patients and reviewing drug orders. Nurses at Children's, in turn, provide immediate feedback to their pharmacy counterparts on medication efficacy or unexpected patient reactions.

Pickering is stationed inside the Children's health system pharmacy, having moved from the ER a year ago to a desk job overseeing technology systems and equipment used by nurses and physicians in administering medications.

This newfound community zeal at Children's is not from an organizational feng shui exercise, but a byproduct of a deliberate integration of medical management functions at the 348-bed hospital. Administrators at Children's-like those at several hospitals across the country-have slowly removed departmental doors to team their nurses and pharmacists in collaborative medication administration programs that improve delivery and reduce medication errors.

It is a trend driven by technology, new regulations, updated accreditation standards and the push for higher-quality patient outcomes at hospitals. A panel of five nurse and pharmacy trade associations recently put forth the idea of standardizing the integrated nursing-pharmacy model at hospitals.

New partnerships

Although it may encroach on some traditional roles for nurses in dosage administration, nursing and pharmacy experts say the new approach alleviates the growing pressure on nurses working under increasingly complex medication systems and "zero tolerance" policies for medication errors.

"For modern health care systems, what we're trying to do is move to a more team-based system," said Kacey Thompson, director of patient safety for the American Society of Health-System Pharmacists. "But by and large, we practice in silos. Information doesn't move effectively from practitioner to practitioner and patient to patient when it should."

Hospitals also play the "blame game" of punishing nurses or personnel to whom an error can be traced, although not necessarily faulted, Thompson said. "[Errors are] not so much the fault of the well-intentioned people-it's the process that we've established."

Thompson and his organization were part of the nursing-pharmacy coalition that was impaneled to study and recommend methods on how integrating functions could improve patient care. (Included on the panel were nursing officials from the American Association of Colleges of Nursing, the American Nurses Association and the American Organization of Nurse Executives.)

The coalition published a white paper in the May issue of the American Journal of Health-Systems Pharmacists explaining that the traditional role of a registered nurse in bedside drug dosage is becoming fraught with complexity and a greater emphasis on error reduction and analysis. Only by creating team-based medication management systems, on which drug administration decisions would be made with evidence-based consensus, can hospitals achieve the highest levels of patient safety and therapy effectiveness, the report stated.

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