psnz conference 2019
TRANSCRIPT
PSNZ Conference 2019
“Towards Integrated Health”
Shark Tank session
By Catherine Wong & Helen Lo
Clinical Pharmacy Department, Middlemore Hospital (Counties Manukau Health)
Who are We?
• Helen Lo
• Acting Clinical Pharmacy Manager
• Now Medical Team Leader (since May 2019)
• Catherine (Cat) Wong
• ED-Admissions Team Leader
(since August 2018)
Background• 4 pharmacist FTEs
• Short-staffing – resources deployed
• Only targeted medical patients being admitted to inpatient wards
• Service gaps:
Working in silos
Medication history only
Delayed pharmacist
intervention
Missing opportunities
to input
Our Aspirations
The New Service Design
• Adjusting the extended hours of service
• Mon-Friday, 7am to 9pm, 5 FTEs(changed from 8am to 10pm)
• Introduced staggered shifts to cover peak admission times, increase efficiency & protect staff well-being
• Referral-based
• Open to all front-line clinicians • Doctors, Nurses & Allied Health
• Tailored approach to ED workflows & patient volumes
The New Service Design
• Wider coverage of ED and patients
• Main ED - MON/Resus, Adult Short Stay
• Admission Units - Medical & Surgical
• Targeting patients at risk of medication-related harm and/or requires pharmacist input
• Baseline service
• Optimised use of pharmacy resources
• Health equity
The Light Bulb Moment
Issues –relating to meds
Education
Poly-pharmacy
Our Referral Criteria
Education required on discharge
Poly-pharmacy
Issues relating to medications and/or
poor Compliance
Our New Team Name!
Early
Pharmacist
Intervention &
Care
1st On Pharmacist
• Dedicated referral phone
• Receive phone and face-to-face referrals & delegate PRN
• Dispensary queries/referrals
• Controlled drug refills
• Warfarin high INR report and reviews
Our Baseline Criteria
✓≥65 years (or ≥55 years in the Maori & Pacific population)
✓>4 regular medications
✓High-risk medication e.g. insulin, warfarin, medication requiring TDM such as aminoglycosides, lithium, phenytoin
✓Patients who meet the orthogeriatric inclusion criteria
✓Frequent presenters
• Bridge the health equity gap
• Aligns with HQSC eMR Quality Safety Marker
Consultations & Communications
Clinical pharmacy and dispensary
Doctors
• ED
• Medical
• Surgical
Nurses• ED
• MAU
• SAU
Performance MeasuresSince Nov 2018 till now
Number of referrals, per day 7 to 8 (up to 20)
Number of patients seen per pharmacist, per day 9 – 13
Number of services provided per pharmacist, per day 9 – 23 (average 11)
Average number of services provided per patient (MH, MR, clinical review, MI enquiry, discharge facilitation, education)
1.5
Seen by EPIC that have a MH or MR that are admitted to the ward
72%
MH finalised prior to seen by admitting doctor 58%
Case Medication
history
• Established overdosed amount & when last taken
• 30g over the last 20 hours
Medication error
• Electronic & paper chart
• Tramadol double charted & administered twice
N-acetyl-cysteine
• Corrected prescribing
• Protocol update
Clinical Review
• Medicines reconciliation
• Optimised therapy for diabetes
• NAC infused with 5% glucose
MDT & Discharge
• Dental review
• Patient education
• Liaise with community pharmacy
Can you see this patient?
Improvement Projects
Electronic Prescribing
Roll-Out in ED
Improving ED Patient Flow
Facilitating access of medications on
discharge
Antimicrobial Stewardship
(e.g. switching IV to PO antibiotics)
ED IV Opioid Policy
Development
Emergency Care Bundles
Medication Awareness Month – Medication May
Redback Spider Antivenom
Auckland Regional Agreement
Improving medications
stocked in Pyxis
Up-skilling of Pharmacists
Clinical Knowledge
•General exposure
•Training module
•Pharmacology teaching
•Case reviews
Cultural Awareness
•Maori & Pacific Health
Infection Prevention & Control
• Influenza vaccination eligibility
Smoking Cessation
•ABC
•Pharmacist NRT standing orders
Sharing of learning
•Pharmacist continued education session
• Integrated into the Emergency Department
• Raised pharmacy profile & appreciation
• Positive feedback
• EOIs from rotational pharmacists
• First pharmacist joining the NZ Medical Toxicology Forum
• CMH Allied Health Awards
• EPIC nominated for the Service Recognition Award
• Pharmacy Service won the Team of the Year Award
Where to
now…
Disaster Planning
NZ EDpharmacist
group
ResusPharmacist
Feedback
NZHPA conference
2019
Maori Health
Pharmacist
Acknowledgements
• Sanjoy Nand- former Pharmacy Service Manager
• Rebecca Lawn- current Pharmacy Service Manager
• Ian Hutchby- Senior Quality Improvement Advisor
• Debbie Hailstone- ED Quality Facilitator
• Jack Wang- Business Analyst
• Chip Gresham- ED SMO, Clinical Director of Medication Safety
• Jeremy Dryden- ED HOD
• Vanessa Thornton- ED Clinical Head
• Fraser Brooks- ED Charge Nurse Manager
• Sharon Cox- ED Associate Charge Nurse Manager
• Jessica Tonder- Resuscitation Pharmacist from US
• EPIC team pharmacists- Amy Khun, Jessica de Lambert, George Chen, Timothy Kim, Jason Zhou, Patrick Cutrupi
“WE WOULD BE LOST WITHOUT THEM!”Associate Clinical Nurse Manager, Emergency Care
“They are highly valued emergency department team members working to provide the best care possible to patients of one of the
busiest emergency departments in Australasia”Clinical Director of Medication Safety, Consultant Toxicologist, Emergency
Medicine Physician
“EPIC makes our jobs easier, is always proactive and provides care that we can always rely on”
Medical Specialist Pharmacist
“The addition of the pharmacy team has been excellent in ED with early intervention with medication compliance and review
of stock in the ED”Clinical Director of Emergency Medicine
“With improved teamwork and collaboration amongst the ED multi-disciplinary team, it can only be beneficial
for patients to receive integrated care”
EPIC Clinical Pharmacist
