R.Ph.s can boost their hospitals' performance

Greater input by health-system pharmacists can help to raise the level of quality and safety in the nation's hospitals, especially in the areas of discharge counseling and curtailing the use of confusing abbreviations.

A recent Joint Commission report showed that hospital performance, in complying with The Joint Commission's National Patient Safety Goal requirements, has been variable. While most hospitals do well in using objective methods to identify patients before undertaking treatments, many find it challenging to put procedures in place to avoid medication mix-ups.

Croteau added that the problem for most organizations is the lack of pharmacist availability for discharge counseling duties. "Pharmacists are more knowledgeable than anyone else about drugs. It would be a real asset if they could participate in that area." Croteau added that beyond being able to do the actual counseling themselves, at the very least pharmacists should be involved in developing the guidelines for patient education and the medication-use process both for inpatients as well as discharged patients.

Patient safety experts concede that the lack of patient counseling upon discharge by a pharmacist is a huge problem. Drug compliance is vital especially for patients who are taking multiple medications. Croteau noted that inadequate counseling also interferes with the communication from one practitioner to another. "The patient is an important link in that communication. Patients need clarity as to why, when, and how they take their medications. Otherwise they can't communicate that to other providers."

The Joint Commission report also concluded that hospital compliance is so low for National Patient Safety Goal requirements that a "time out" is taken by the surgical team before surgery to confirm patient identity and correct procedure and to emphasize that certain potentially confusing abbreviations are not used in ordering medications. This is an area where a pharmacist's expertise could also come in handy.

Pharmacists, said Croteau, should play a role in identifying documentation practices, including limiting the use of dangerous abbreviations that could lead to errors. "Pharmacy has a very important role to play in designing processes and mechanisms to eliminate abbreviations," said Kasey Thompson, Pharm.D., director of patient safety at ASHP. However, both Thompson and Croteau agree that pharmacists shouldn't be the police force charged with changing the behavior of doctors who use dangerous abbreviations. "That's an organizational responsibility that has to happen at the medical/ executive leadership level," said Thompson.

Croteau pointed out that in many institutions, pharmacists have been put in the position of having to call the doctor every time a confusing abbreviation is used. "It's a source of irritation," said Croteau, who added that modifying physician behavior is not the pharmacist's responsibility but the responsibility of the medical staff. However, when an order is not clear, Croteau stressed, the prescriber has to be contacted. "No one should be guessing," he said.