Clinical Pharmacist Rounds Reports and Mobile Computing

How Rounds Reports and
Mobile Computing Support the
Role of the Clinical Pharmacist
Jerry Fahrni, Pharm.D.
Informatics Pharmacist
Kaweah Delta Health Care District

Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.

Objectives

At the conclusion of this presentation participants should be able to:
 Incorporate concepts and skills that assist in supporting clinical pharmacy
activities
 Recommend strategies for collecting data necessary to build effective rounds
reports for pharmacists
 Identify potential pitfalls and problems in preparing pharmacy rounds reports
 Identify strategies for improving clinical pharmacy services.
 Recommend strategies for selecting mobile computing platforms for various
healthcare practitioners.
 Understand the infrastructure necessary to create a mobile clinical pharmacy
service.

Page 2 Copyright © 2010 Siemens Medical Solutions USA, Inc. All rights reserved.

Disclosures

 It is the policy of Corexcel and IMNE to ensure fair balance, independence,
objectivity, and scientific rigor in all programming.

 In compliance with the American Nurses Credentialing Center (ANCC) and the
Accreditation Council for Pharmacy Education (ACPE), it is the policy of
Corexcel and IMNE that faculty disclose all financial relationships with
commercial interests over the past 12 months.

 Jerry Fahrni has no conflicts of interest to disclose


Kaweah Delta Health Care District

 Centrally located in the San Joaquin
Valley, California
 581 licensed beds
 Variety of inpatient and outpatient
services
 Not for profit organization
 70,000 emergency visits annually
 9 locations within 25 mile radius
 Serves population of 575,000 over
6,213 square miles


Five Licensed Pharmacies

 Outpatient Pharmacy Services
 Employee Pharmacy
 Home Infusion Pharmacy

 Inpatient Pharmacy Services
 Main Campus (KDMC)
 South Campus (Sub-acute, SNF)
 West Campus (Rehab, Mental Health)

5


Pharmacy Operations

 Decentralized pharmacy model
 32 Pharmacist FTEs
 ICU
 CVU
 Infectious Disease
 Nephrology / Anemia Management
 Pediatrics
 Oncology
 Other
 34 Technician FTEs
 1900 faxes received per day
 2000-2500 orders entered per day
 Significant use of automated dispensing cabinets, i.e. we’re cartless
 Good use of automation and technology


Automation and Technology

 AutoCarousel automated carousel storage
 AutoPack automated bulk packager
 AutoLabel labeling system
 Baxa Compounder
 Pharmacy Order Management System (POMS)
 Pyxis 3500
 Siemens Soarian C6 SP11
 Siemens Pharmacy 24.1
 Siemens MAK 24.1
 Alaris Smartpumps
 Draeger monitoring devices
 Cisco Voice over WLAN Solution
 Wireless infrastructure supporting over 760+ concurrent wireless devices


Clinical Services

 Hybrid decentralized clinical model
 Monitoring and protocols
 Pharmacokinetics
 Renal dose adjustment
 Anemia Management
 Warfarin Management
 Pharmacist participation on rounds
 ICU
 CVU
 Pediatrics
 Other PRN


We cannot change the
human condition, but
we can change the
conditions under which
humans work

James Reason

Page 9 Reason J. Human error: models andSolutions USA, Inc. All 2000. reserved.
Copyright © 2010 Siemens Medical management. BMJ rights 320768–770.

Supporting clinical services

 Pharmacist needs:
 patient information
 monitoring forms
 drug information
 protocols
 policies
 Anytime, anywhere intranet and internet connectivity
 etc……

…..while remaining mobile during rounds


Fundamental problem

Gaining quick and easy
access to everything
you need when you
need it


The solution

Rounds Reports
Mobile Devices


Rounds reports

 Goals:
 Get the pharmacists to lay down their “3x5 cards”
 Collect information from various sources and present it in a compact
format that is easily accessed and up to date
 Target the information to the needs of the pharmacist and make it easy to
read


Process

 Determine what information you want on the Rounds Report
 Literature
 Ask the providers
 Personal Experience

 Figure out how you want the information displayed
 Onscreen or on paper…perhaps both
 Don’t add too much
 Don’t leave anything out

 Figure out how you want them delivered
 Automated
 Print / view on demand

 Determine who needs to be involved


Pediatric rounds report … the first attempt

Demographics

Lab Values

Medications

Pharmacist Notes


Pediatric rounds report

Demographics

Allergies

Lab Values

Medications

Pharmacist Notes


Antibiotic Stewardship Report

Demographics

Allergies

Lab Values

Antibiotics

Micro Results

“Pharmacists’ responsibilities for antimicrobial stewardship and infection prevention and control include
promoting the optimal use of antimicrobial agents, reducing the transmission of infections, and educating
health professionals, patients, and the public.” - Am J Health-Syst Pharm. 2010; 67:575-7


Pharmacokinetics monitoring report


So what did we do about it


Mobile devices


Initial needs were small

Pharmacy wanted on-line access to drug information databases while on
the nursing units of the main hospital.

The pilot project allowed support for 5 roaming HP iPAQs with Lexi-
Comp drug information via 10 access points.


Handhelds

Pros Cons

Portable Limited screen real-estate
Lots of reference material Very S-L-O-W
available Lack access to many legacy
Lots of 3rd party software available application
for documents Lack access to online
Semi-rugged, i.e. can take a applications, i.e. limited web
punch capabilities
Good battery life Easily misplaced


Mobile options

Laptop Ultra-Mobile PC Smartphone
Powerful Very portable Ubiquitous
Screen size Screen size Very portable
Awkward shape Power? Screen size
Form factor

Netbooks Tablet PC iPad
Portable Powerful Form factor
Form factor Screen size Portable
Power? Touch interface
Power?
Screen size? Form factor
Screen size?
Fragile
Fragile
Compatibility

Ultra-Mobile PCs (UMPCs)

Very portable

Screen size

Power?

Page 24 OQO Model 01 – No longer available

Smartphones

Ubiquitous

Very portable

Screen size


Screen size


Tablet PC pilot project

Powerful Screen size Touch interface Form factor

Fragile?

Goal
Easy access to hospital systems in
a compact, yet powerful package

Solution
Tablet PCs


Tablet PC assessment

Access to the hospitals wireless
network

Fast enough to allow multiple native
applications to run while
accessing online resources

Tough enough to take the abuse of
day-to-day use, but light enough
to carry for extended periods

Battery life had to be long enough
for use on rounds, i.e. > 2 hours


Pilot project - hardware

LE 1700 Motion C5

The good, the bad and the ugly

Some pharmacists thought the tablets were great
Wireless connectivity
Access to all our applications – Siemens pharmacy,
Soarian, UpToDate, KDNet, etc

The pharmacists were skeptical, i.e. no “paper”
Required “too many” taps to open all the applications
On screen keyboard was slow for text entry

Handwriting recognition
The C5 was universally disliked because the screen
was too small and it was too heavy
Battery life was an issue


Adjustments

Change the screen layout

Change the workflow on the device

Add batch files and “executable groups”
for easier application access

Purchase newer tablets with better
processors and battery life


Changing the screen layout and workflow


Updating the hardware

Slate model tablet PC Convertible model tablet PC

Semi-rugged J3400 Dell XT2
Windows Vista Business Windows XP Tablet Edition –SP3
1.4 GHz Intel Core Duo Processor 1.6 GHz Intel Core Duo Processor
2 GB RAM 2 GB RAM


Following changes

Improved workflow

“Faster” access to hospital systems

Positive feedback from pharmacists

Increased tablet PC use on rounds


Virtualization


iPad Form factor

Portable

Power?

Screen size?

Fragile

Compatibility


Lessons learned and conclusions

Reports
• Rounds reports are helpful, but they take a lot of work and someone
always wants more
• Divide and concur
• Viewing date real-time on a mobile device is better than paper reports

Mobile Devices
• Tablet PC are an effective method of extending the reach of
pharmacists
• Make the devices “dummy proof”
• Evaluate your options carefully and be sure to consider batterlife,
system compatibility and ruggedness
• The jury is still out on the iPad


Questions?

Thank you for attending this session.
Session #6
How Rounds Reports and Mobile Computing Support the
Role of the Clinical Pharmacist
Jerry Fahrni, Pharm.D. – jfahrni@kdhcd.org

Slides available at: http://www.slideshare.net/JFahrni

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