Inter-department communication can improve patient safety

Nursing and pharmacy staffs have operated independently for years, thus creating a communication gap that can be difficult to overcome.

Communication gaps cause departments to blame each other when an error occurs instead of working together to solve the problem, says Yolanda Smith, RN, MSN, CCRN, a member of the New York State Board of Nursing and president of YGS Medical Legal Consulting in Brooklyn.

“What I’m seeing right now is that nursing is doing its own thing and pharmacy is doing its own thing,” said Smith. “It’s definitely an advantage to have the pharmacy as part of the process. They have expertise that others don’t have.”

She recently presented a seminar titled, “Medication Administration and Patient Safety: Error Prevention for Nurses.”

Hospitals can prevent medication errors and improve treatment if they encourage collaboration between the pharmacy and other staff members.

Departments should communicate with pharmacy and nursing staff whenever a

• physician writes a medication order

• patient’s age is a factor

• nurse gives out medication for the first time

A pharmacist should always look at a physician’s orders for possible drug interactions or problems, Smith says.

Case: A patient has known allergies to penicillin and a physician prescribes ampicillin to treat an infection.

Solution: The pharmacist should alert the prescriber because ampicillin could cause some of the same allergic reactions.

In this case, the pharmacy staff should review what occurred with the medical staff. They should examine why the pharmacist intervened and what can be done in the future to prevent the need for interventions. Staff knowledge increases as a result of the interdisciplinary meetings.

Physicians should communicate a patient’s age to the pharmacy, as younger patients often require a reduced medication dosage because they cannot metabolize adult doses as quickly, Smith says.

Pharmacists should ensure that the physician prescribes the correct dose for the patient’s age and weight, if appropriate, to prevent complications.

Potential problems exist when nurses give out medications for the first time. Two patients died within one week at a New York hospital because they were given too much medication. The same physician wrote the orders for both, the pharmacy wasn’t given any background, and the nurse didn’t have enough experience to ask questions and know what warning signs to look for. The nurse should have checked with the pharmacy to ensure the correct dosage, Smith says.

TIP: Tell pharmacists to instruct nursing staff on how to properly administer medications, from ensuring that the medication is correct for the patient to making sure that the dosage is accurate. Tell the nursing staff to consult the pharmacy if they have any questions regarding the medication.

Bridge the communication gap among departments by urging pharmacists to make rounds through the units. The pharmacist can check laboratory data to make sure the patient is receiving the correct antibiotic or switch a patient from intravenous to oral therapy, if possible, for more effective and less costly treatment.

Pharmacists currently do not make rounds with nursing staff at Maine Medical Center in Portland, but it is something the hospital is considering in order to acquire Magnet status, says John Jurczyk, RPh, BS, MBA, director of pharmacy services. The American Nursing Credentialing Center awards Magnet status to high-quality nursing programs through a process similar to hospital accreditation.

There are 82 Magnet-recognized hospitals in the United States, according to the ANCC Web site, www.nursingworld.org/ancc.

If pharmacists start making rounds at Maine Medical Center, they will work with nursing and medical staff on patient care from admission to discharge. They will focus on monitoring the drugs rather than only compounding and mixing, and how to move patients from one care level to another, such as from surgery to rehabilitation, Jurczyk says.

Pharmacists can also provide valuable education to staff members in almost every department, says Jurczyk. Maine Medical Center’s clinical pharmacists specialize in cardiology, pediatrics, renal transplants, infectious diseases, and ambulatory care, among other areas.

Those pharmacists can educate staff members on selecting the correct medication for a patient and identifying possible complications that could arise from using a certain drug. “They do a lot of teaching,” Jurczyk says. “That’s a big piece of being proactive.”

Jurczyk hopes making rounds will help his pharmacists appear more accessible to staff members, perform more order reviews, and act as liaisons among patients, hospital staff, and the pharmacy.

Bridging a long-standing communication gap can be difficult, but forming an interdisciplinary committee is a good place to start. The committee should include pharmacists, nurses, physicians, and administration, Smith says.

In working together, the committee should draft safety policies and review incident reports when errors occur, Smith says. The group should review adverse drug events and develop ways to fix problems, rather than let individual departments blame each other for the error.

“A lot of errors could have been prevented had all the disciplines been working together,” Smith says. “They’ve got to get past [blaming each other] and focus on patient safety.”

The pharmacy and therapeutics committee at Maine Medical Center oversees several subcommittees that range from drug selection, adverse drug events and risks, financial requirements, and physician drug ordering procedures, Jurczyk says.

All of this change and cooperation requires work from every staff member. Pharmacists must work as a team and know when to question a physician about a prescription or dosage.

“It’s part of a cultural change,” Jurczyk says. “It’s not a flavor of the month. It’s small steps. When you change [the process] so many times, you develop a critical mass and you start to have a change in focus.”

TIP: Involve staff members in the decision-making process. Allow them to participate in interdisciplinary committees and help plan the hospital’s policy regarding the level of pharmacy/medical staff cooperation. Staff members will buy into the plan more if they assist in its creation, Jurczyk says.