Pharmacists and the technicians who assist them serve as the gatekeepers for accurate and responsible dispensing of medications including those taken by mouth, IV, injection or inhalation.

“Medication safety is always a primary focus of the health care team’s attention each day,” says John Walker, R.Ph., Pharmacy director at FirstHealth Montgomery Memorial Hospital. “Patient safety is a consideration in each step of the medication process.”

A winning team
“Our priority is the health and safety of the patient, but our services affect the nurses who deliver care at the bedside and the physicians who initiate the orders, too,” says Jason Joyce, D.Pharm., director of Pharmacy at FirstHealth Richmond Memorial Hospital. “In some ways, the pharmacist is the intermediate protector of all.”

Although each of the FirstHealth hospitals has its own processes for medication safety specific to its size and focus, some standards apply universally. Teams consisting of managers, nursing staff, physicians and other appropriate individuals monitor medication safety, trend any recorded data, and suggest methods to improve or modify policies and procedures at Moore Regional, Montgomery Memorial and Richmond Memorial.

“We effectively track drugs from the moment the physician writes a medication order to the time the medication is delivered to the bedside,” Walker says. “Acknowledging each step and the importance of everyone’s role helps us ensure medication safety. No single piece is more or less important than another.”

Checks and balances
An intricate web of checks and balances connects each step of medication management. When a patient is admitted to the hospital, his or her personal data is entered into a specialized information system. Each medication order is checked against known allergies as well as recorded health problems and existing prescriptions. Potential issues are flagged, and the Pharmacy staff works with the physician to create a safe, alternate plan as necessary.

Sometimes the best solutions to potential problems are also the most simple, logical steps to ensuring safety. When patients are admitted, all orders for medication originate with a physician.

“Often, orders are managed by phone,” says Sue Grady, R.N., administrative director of Patient Care Services at Montgomery Memorial Hospital. “By including a ‘read-back’ policy in our procedures, we double-check each order immediately. Each nurse who takes an order is required to first write it down and then read it back to the doctor.”

According to Grady, the nursing staff is required to use only approved abbreviations. “Writing out orders clearly avoids confusion and misinterpretation,” she says.

Before administering a medication, the nurse must verify the patient’s identity. This is done by comparing information of record on the patient’s wristband to at least two identifiers such as name, date of birth or medical record number.

Moore Regional Hospital is a pioneer in bedside scanning. “Less than 10 percent of all hospitals in the nation use the technology,” says Brad Pusser, R.Ph., the hospital’s Pharmacy director. “We’re about a third of the way through incorporating it throughout the hospital.”

Using a device similar to a retail bar scanner, nurses scan medication codes against patient wristbands to verify identification and help avoid possible interactions.

In addition, the hospitals now use unit dose packaging for most medications. This means that each dose is individually contained for distribution. The method reduces time spent stocking nursing units and helps eliminate the potential for inaccurate dosing.

Patient rights and responsibilities
Safely dispensing medicines actually begins with the patient and family. Just as most of us spend time reconciling bank statements each month, medical professionals employ a similar process with our medications.

“Patients, particularly the elderly, often take a variety of medicines prescribed by different specialists,” says Walker. “To be certain that we are not over-prescribing or creating the possibility of a drug/drug interaction, we need to know exactly what medicines are being taken.”

Joyce suggests maintaining an up-to-date list of prescriptions and overthe- counter products routinely taken, including dosage strength and usage instructions. “You can bring the bottles to the hospital with you, but it is more likely that a list tucked into a purse or wallet will be available in an emergency,” he says.

“Don’t be afraid to ask questions,” says Grady. “Before taking anything, know what it is and why it has been prescribed. If a pill looks different than what you remember or if something just doesn’t seem quite right, ask. You have a right and responsibility to help us keep you safe.”

Space-age technology
Each FirstHealth hospital also uses highly specialized equipment to promote safe service.

Moore Regional, Montgomery Memorial and Richmond Memorial all use McKesson Acudose equipment. “I like to think about the Acudose as an ATM for the hospital pharmacy,” says Joyce.

Acudose is a special, secure cabinet for storing medications on hospital units. Nurses enter specific patient information, and the correct dose of needed medications is dispensed through a drawer—much like retrieving cash from a bank using a personal identification number. The Acudose records information regarding the transaction for later review by the pharmacist.

At Moore Regional, some of the advanced technology seems a little out of this world. “Spensor,” who has logged his 10th year at the hospital, works 24-hours a day, seven days a week. Impossible? Not for a robot.

According to Pusser, “Spensor,” the dispensing robot, uses a bar code scanner to dispense around 95 percent of the oral medications and injectables used at the hospital.

Two other robots joined the staff late last year. The Tugs, so named because they tug carts through the hospital, use radio signals to summon elevators and open electronic doors as they deliver prescriptions to patient floors.