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Reducing variation in other processes reduced risk for patients.
“Quite often, a pharmacist would pull medication out of the bag and review with the patient what it is, what it’s for and how to take it,” Norton pointed out. “That’s not just about educating the patient; it’s also a way for pharmacists to do one last check. If it’s not done, it introduces the possibility of errors ranging at the low end of risk from not giving a patient all their medications to, at the high end, giving the wrong directions or commingling two patients’ medications.”
With the new SOPs, all pharmacists perform the medication review “show and tell” the same way with patients, he noted.
In reviewing processes to identify best practices, the team found that some pharmacists would ask patients whether they were pregnant or lactating and some would look through a database for the information. One medical treatment facility (MTF) had a sign that asked patients to disclose to a pharmacy staff whether they were pregnant or lactating.
“We found that having the sign made it easier for pharmacy staff to bring up the subject. With the sign, the patient is prepared to be asked and realizes that it is important information that the pharmacist needs to know. We realized that if it were done across Navy medicine, it would support patient safety,” Norton said.
The new manual also gives pharmacy staff a tangible, consistent resource wherever they are.
“Anyone new to the Navy pharmacy community can go to the SOP and research what to do. It’s like following a cookbook,” he suggested.
The SOP lays out the division of tasks within the pharmacy. As a result, less training is required when pharmacy staff transfer.
“In some places technicians were expected to perform a little beyond the scope of their training, while at others, the pharmacists felt stifled. Now, all staff can be fairly confident that their duties will be the same at each facility,” Norton added.
Easing Joint Commission Review
As part of developing the manual, the team cross-walked Joint Commission accreditation standards with specific pharmacy processes. If the Joint Commission said “Organization has a way to store medications safely,” the SOPs spelled out what that means specifically for outpatient pharmacies, nursing facilities and hospitals.
“When the Joint Commission comes in, if they see four pharmacies following four different procedures, they know that one of them is better than the others. If they go from facility to facility and see that everyone follows the same Navy standard, that makes it easier for the pharmacy staff at each medical treatment facility,” Norton explained.
While the rollout of the new procedures is nearly complete, a few items may roll over into Fiscal Year 2014. Next year, the team will go out to sites to verify that they are following the SOPs and look at “front-end” or customer interaction metrics such as patient satisfaction, percentage enrolled and receiving prescriptions at Navy facilities, and medical adherence statistics.
So far, the response has been favorable, Norton said, “The recurring comment is that it’s great to have the SOP, guidance on how senior leadership wants us to do this. It helps to have an overarching Navy position to refer to whether questions come from local leadership or the Joint Commission.”