Continued from Page 1

Hospitals today may require anywhere from 80 to 200 steps in the delivery of a single dose of medication, from order and verification to delivery and follow-up, according to the article.

Medication errors are "a pretty common problem throughout our nation's health system, and have been spotlighted during the past 10 years specifically," Thompson said.

A 1999 Institute of Medicine report "To Err is Human" first raised the public's ire about medication errors, claiming that 44,000 to 98,000 hospital deaths occur each year because of such preventable mistakes. Thompson said most hospitals, however, have been focused on reducing the problem since the early 1990s.

Shifting roles

At Lehigh Valley Hospital and Health Network in Allentown, Pa., the three-facility hospital developed an early unit-based pharmacist system in 1995 that introduced collaborative practice between nurses and pharmacists. Lehigh's Fred Pane, administrator of pharmacy services, said the pharmacists were taken out from behind the counter of satellite dispensing areas in the hospital, and began assisting nurses and physicians with drug administration and oversight from the floor. "We even participated in code blues," Pane said. "We ended up changing the job descriptions [of pharmacists] as more clinical and not as distributive."

The inclusion of pharmacists became a valuable resource to the nurses, said Lehigh Valley nursing administrator Molly Sebastian, RN, because their presence sped the delivery of medications and improved knowledge resources for nurses. "It was great to have the ability to just to talk to somebody about allergies, for instance, and what were the appropriate medication interactions to look for," Sebastian said.

Childrens Hospital Los Angeles established satellite pharmacies for the ICU and OR units a decade ago, placing pharmacists in a real-time consultation role. Nancy Blake, MN, RN, CCRN, the hospital's director of critical care services, said the integration model has become more critical in recent years with the complexity of drugs-such as chemotherapeutic and antifungal agents-that nurses dispense to their most ill patients. "Just the fact that many of the drugs have similar names, there's something new and different every month," Blake said.

The Health-Systems Pharmacists article stated that the learning curve is not a one-way street. "Pharmacists can learn from nurses as well," according to the report. "The move toward pharmaceutical care has placed pharmacists in direct proximity with nurses, patients and patients' families. Pharmacists should work to enhance their skills of caring and compassion by observing and learning from nurses."

Improved patient safety and professional enhancements for both professions is evident, but also pushing the integrated nursing-pharmacy model are the technology systems being adopted for medication management.

The Joint Commission on Accreditation of Healthcare Organizations, in its 2001 report on the nursing crisis "Health Care at the Crossroads," noted estimates of perhaps 20,000 medication orders written daily within inpatient units at urban hospitals.

Those kinds of daunting figures naturally point to the need for automation, with information systems and technology, according to JCAHO, pointing to electronic medical records, bar coding or automated drug-dispensing machines as solutions that drastically reduce nurses' workloads. The commission noted in one example how a charge nurse's medication administration time was reduced by nearly three hours per shift through automation.

The report also stated that hospitals that provide nurses with automated medication records reduce medication errors by 79 percent and save $300,000 a year.

"With human involvement, there will be the opportunity for errors, unfortunately," said Janet Harris, MSN, RN, national director of professional services for San Diego-based Pyxis Corporation Inc., which markets medication administration technology to hospitals. "The Joint Commission jumped on the bandwagon early, and said for [hospitals] to profile the patient's medication. That's very different from the way it's been in the past for us nurses."

JCAHO standards on medication management will substantially stiffen in 2004, and likely will require more automation and collaborative risk-assessment policies for attainment. Previous written standards that required undefined "safe medication prescription or ordering" procedures, for instance, soon will be determined through a checklist of six specific conditions regarding storage, administration, patient efficacy and necessity, as well as control procedures for high-risk and investigational medications.

"We're trying to help hospitals systematize their efforts," said Nancy Kupka, associate project director for the JCAHO division of standards. "I don't think these steps are new to practice, but are new to standards."