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At Children's in Dallas, Pickering is helping with a system in which automation is involved in the order entry, order processing and verification systems. Nurses carry portable scanners and handheld computer devices that contain all the information needed on a particular dose, with comparative data to ensure patient records mesh with the prescription order.

"It's so automated, the nurse can look at the point-of-care device and they know if the pharmacist has their order or they know it's a new med," Pickering said.

Pickering said the machines help nurses with more than portable, readily available information. They also are reminded through the machines' "forced functions" to verify orders, identities and security checks for narcotics and other controlled substances. Pickering said 86 percent of all medications dispensed by the hospital's health-system pharmacy are scanned and automated.

Pickering took his role as a "liaison" between nursing and pharmacy after he noticed many nurses struggling with pharmacy-based technologies that had been introduced to help fill orders. That continues to be a problem at hospitals nationwide, according to one pharmaceutical expert, who says nurses are sometimes distracted from patient care roles because of tending to drug vending machines or glitches in equipment.

Tech tools

"I think nurses ought to be involved in the technical components of medication administration," said Doug Miller, a pharmacy professor at Wayne State University in Detroit. "The technical component of getting the drugs to the nursing unit in a form that is ready to administer … is what the pharmacists ought to be doing."

Miller said many hospitals, even with heavy investments in technology, have only created problems by not fully integrating nursing and pharmacy technologies. As a result, even the safety components of automation are lost.

"Nurses, instead of just going to the unit at the time the medication is due, take all the medications for all of their patients and put them in their pockets," Miller said. "That does seem to obviate the purpose of the unit-dose, med-distribution system."

Hospitals that automate the full medication management process-order entry, processing and dispensing-run into the fewest headaches, Miller said. Those that add floor-unit pharmacists gain the further advantage of having a ready source of information and consultation.

Thompson said he and other members of the nursing-pharmacy coalition have not compiled data on how many hospitals have adopted integrated models. The purpose of the original panel was a "first-step" discussion that later will include other health care professionals in the medication management discussion, as well as lower-level state organizations in nursing and pharmacy. "We want to work together on this on how we can start moving forward with a shared vision," Thompson said.

Pickering said the cooperation between nurses and health-system pharmacists at Children's in Dallas has been a successful experiment thus far. The turf battles feared with the collaborative system have not materialized, and a system of mutual respect-and identity-has emerged.

"What I tell my nurses," Pickering said, "is that the pharmacists are the experts in med administration. We always felt we were as nurses, because we were always expected to do it. Once they understood, they felt, 'Hey, this is a great thing.' "

Contact Glen Fest at glenf@nurseweek.com