Partnering With Nurses to Handle Personnel Shortages
Partnering With Nurses to Handle Personnel Shortages
Q: Our pharmacy department, like many others, is trying to cope with the shortage of pharmacists and nurses by emphasizing productivity and increasing the responsibilities of less critical personnel, such as nurses aides and pharmacy laboratory technicians. How have other hospital pharmacies handled this shortage?
A: In 1993, the pharmacy department at Port Huron Hospital in Michigan received approval for a pharmacist-on-wheels program. A special cart and computer were purchased to provide unit dose and emergency medications and support order entry, respectively. Pharmacy technicians were also available on the nursing units to prepare initial doses of medications. The purpose of this program was to launch staff pharmacists into more clinical roles, improve drug distribution, and create more time for nurses to provide direct patient care. Surveys conducted four months after the program was implemented revealed that nurses were extremely satisfied with the program. Feedback included the following:
Six months into the program, nursing supervisors requested a meeting with the pharmacy department to discuss improvements to the pharmacist-on-wheels program. They believed that the program could be enhanced by employing licensed practical nurses (LPNs) instead of pharmacy technicians. Although a pharmacy technician could assist the pharmacy in most aspects of dispensing, an LPN could assist both the pharmacy and nursing staffs. A trial period during which a nurse-on-wheels (NOW) program, consisting of two full-time-equivalent (FTE) LPNs and one pharmacist to serve the medical and surgical and intensive care units, was proposed and approved. It was important to select individuals who had demonstrated initiative because we did not have a road map to follow. We were depending on an evolution of the program based on the observations of the LPNs selected. The initial goal was for the LPNs to serve as a liaison between the pharmacy and nursing units, and we believed that a great deal of nurses' time could be saved by the NOW program.
The LPNs were responsible for starting i.v.'s, obtaining stat orders, ordering narcotics, charging for drugs, answering stat codes and patient calls, clarifying drug orders for the pharmacy, teaching patients, clinical monitoring of patients, and obtaining and clarifying allergy information.
The NOW program at Port Huron Hospital has been so successful that a third FTE LPN has been added. These three LPNs work four 10-hour days per week and every third weekend. Hours of coverage are 7:30 a.m.-6:30 p.m., seven days a week. Very recently, the LPNs were assigned to the pharmacy department and perform the following duties:
The activities of the LPNs assigned to the NOW program are one way to increase job satisfaction levels for registered nurses. Internal surveys revealed that the NOW program gives nurses more time to provide direct patient care. Phone logs revealed an 80% reduction in the number of phone calls to the pharmacy department, resulting in fewer interruptions and distractions for the pharmacist, which could aid in decreasing medication errors. Phone calls to nurses were also reduced. Medication issues are resolved quickly, and fewer interruptions and distractions for the pharmacist addresses one of the leading causes of medication error during the order entry process.
The NOW program has enabled clinical pharmacists to expand their role. The LPNs in the program are the most cross-trained individuals in the hospital, receive positive feedback on a daily basis, and have extremely high levels of job satisfaction.
Q: Our pharmacy department, like many others, is trying to cope with the shortage of pharmacists and nurses by emphasizing productivity and increasing the responsibilities of less critical personnel, such as nurses aides and pharmacy laboratory technicians. How have other hospital pharmacies handled this shortage?
A: In 1993, the pharmacy department at Port Huron Hospital in Michigan received approval for a pharmacist-on-wheels program. A special cart and computer were purchased to provide unit dose and emergency medications and support order entry, respectively. Pharmacy technicians were also available on the nursing units to prepare initial doses of medications. The purpose of this program was to launch staff pharmacists into more clinical roles, improve drug distribution, and create more time for nurses to provide direct patient care. Surveys conducted four months after the program was implemented revealed that nurses were extremely satisfied with the program. Feedback included the following:
Nurses could devote more time to participating in patient care and less time to locating drugs and i.v.'s;
Missing medications were no longer a problem, and new medications were administered more quickly;
Ordering narcotics became more efficient with fewer trips to the pharmacy;
Medication orders requiring clarification decreased, resulting in less phone calls to the pharmacy;
Less waste of i.v. solutions occurred; and
Pharmacists were more accessible to answer questions.
Six months into the program, nursing supervisors requested a meeting with the pharmacy department to discuss improvements to the pharmacist-on-wheels program. They believed that the program could be enhanced by employing licensed practical nurses (LPNs) instead of pharmacy technicians. Although a pharmacy technician could assist the pharmacy in most aspects of dispensing, an LPN could assist both the pharmacy and nursing staffs. A trial period during which a nurse-on-wheels (NOW) program, consisting of two full-time-equivalent (FTE) LPNs and one pharmacist to serve the medical and surgical and intensive care units, was proposed and approved. It was important to select individuals who had demonstrated initiative because we did not have a road map to follow. We were depending on an evolution of the program based on the observations of the LPNs selected. The initial goal was for the LPNs to serve as a liaison between the pharmacy and nursing units, and we believed that a great deal of nurses' time could be saved by the NOW program.
The LPNs were responsible for starting i.v.'s, obtaining stat orders, ordering narcotics, charging for drugs, answering stat codes and patient calls, clarifying drug orders for the pharmacy, teaching patients, clinical monitoring of patients, and obtaining and clarifying allergy information.
The NOW program at Port Huron Hospital has been so successful that a third FTE LPN has been added. These three LPNs work four 10-hour days per week and every third weekend. Hours of coverage are 7:30 a.m.-6:30 p.m., seven days a week. Very recently, the LPNs were assigned to the pharmacy department and perform the following duties:
Report to the pharmacy department at 7:30 a.m. and retrieve the unit dose cart;
Print special reports and discuss with a pharmacist any order clarifications, inspections, or nursing unit problems;
Pick up medications, including controlled substances, and sign-out sheets;
Print census and allergy list for all nursing units and gather names and telephone numbers of patients whose height, weight, or allergy data are not in the computer;
Discuss with the desk nurse any pertinent issues;
Check the medication room on the nursing unit, place drugs in appropriate patients' drawers, and deliver i.v. and i.v. minibag medications to patients' rooms;
Retrieve all discontinued and discharged patient medications and deliver or send them to the pharmacy by pneumatic tube;
Check the unit's inventory, including controlled drugs, and send reorders to the pharmacy;
Review all orders ready for delivery to the pharmacy, check for illegible and incomplete orders, and ensure that orders are sent to the pharmacy in a timely manner;
Monitor and distribute medications arriving from the pharmacy;
Serve as liaison between pharmacy and nursing units to resolve problems that may arise;
Pick up and deliver controlled-substance orders from pharmacy;
Attend stat codes (cardiac or respiratory arrest) and advise pharmacy of any drug needs;
Assist nurses with discrepancies in incident reports involving controlled substances, medication error reports, and adverse drug reaction reports;
Collect and return all i.v.'s to the pharmacy at discharge;
If discharged patients have scripts, collect data and patient insurance cards and deliver them to the retail pharmacy for dispensing;
Assist with patient care whenever possible;
Check "revise patient screen" on computer to locate patients over 65 years of age; determine if patients over 65 years have received pneumonia vaccine. If the patient meets all criteria, leave a physician order for pneumonia vaccine on the front of the chart for the physician to sign. Once approved, discuss the vaccine with the patient, administer the vaccine, and document;
Assist with pharmacy projects and attend nursing unit meetings. Conduct nursing unit inspection with the pharmacist;
Assist with returning operating room patients and new admissions, if time permits;
Check the dumbwaiter during rounds;
Assist the pharmacy technician with i.v. delivery and highlight bottle numbers to assist nurses in hanging the correct bag at the correct time; and
At the end of shift, collect all discharge and i.v. medications.
The activities of the LPNs assigned to the NOW program are one way to increase job satisfaction levels for registered nurses. Internal surveys revealed that the NOW program gives nurses more time to provide direct patient care. Phone logs revealed an 80% reduction in the number of phone calls to the pharmacy department, resulting in fewer interruptions and distractions for the pharmacist, which could aid in decreasing medication errors. Phone calls to nurses were also reduced. Medication issues are resolved quickly, and fewer interruptions and distractions for the pharmacist addresses one of the leading causes of medication error during the order entry process.
The NOW program has enabled clinical pharmacists to expand their role. The LPNs in the program are the most cross-trained individuals in the hospital, receive positive feedback on a daily basis, and have extremely high levels of job satisfaction.
