What if you had a full-time assistant double-checking for adverse drug effects or researching appropriate therapies while you work? How about instant, mobile access to patient records so you could keep track of their progress while you are on the move? Or a direct link to your institution's pharmacy system? What if you could be alerted to organisms not covered by current therapy as soon as your lab picked them up? Better still, how about all of these things in the palm of your hand?
With the advent of products such as Stellara (bioMerieux), Quantifi (HealthProLink), and MedStorm (Pharmacy Healthcare Solutions), this technology has become a reality for health care professionals across the country.
One such professional, Michael R. Broyles, PharmD, describes himself as "a clinical pharmacist striving to advance pharmaceutical care and improve patient outcomes," which goes some way to explaining why he brought this technology into his own hospital, Randolph County Medical Center, Pocahontas, Ark.
Broyles, who is director of clinical pharmacy services, explained his objectives: "Our goal was to provide better care by starting empiric therapies within expert guidelines [on admission, and not hours later when pharmacy had to intervene], reduce adverse drug events, practice better antimicrobial stewardship, monitor all patients better with real-time technology, reduce length of stay, use fewer hospital resources, perform better and be able to measure performance to the quality agencies [Joint Commission on Accreditation of Healthcare Organizations], and provide better patient and family satisfaction."
No small task, then! Broyles made inquiries at American Society of Health-System Pharmacists meetings, and at the Healthcare Information and Management Systems Society, and shopped around on the Internet, before he settled on Stellara, powered by TheraDoc, a bioMerieux product released this past January.
"There was nothing as advanced, robust, easy to implement, that could monitor patients as well, had very efficient documentation of activities, and was very flexible in connectivity, and allowed all activities to be done via palm devices," he said. "I use everything it was designed to do and have found things to use it for that they never designed it to do."
He explained how Stellara enabled him to follow the progress of a particular patient while he was traveling to a meeting. The patient was admitted on a Friday evening, critically ill with an infectious process. It was the weekend, and only one physician was on duty covering for the group. Twenty-eight hours after admission, the lab identified a multidrug-resistant organism from the site of infection.
"Since the physician had many patients to cover and was in and out of the hospital, they were not aware of the micro results," explained Broyles. "Stellara provided an alert, and we were able to immediately change therapies, since none of the empiric choices were likely to be beneficial."
Later that day, still off-site, Broyles was able to check on the patient again remotely. He found that an additional drug had been ordered that would have had a "severe" drug-drug interaction.
"This interaction was found in the alert review, and therapy was promptly changed. We continued to monitor, the patient did well, a potential adverse event was avoided, and the patient was placed on oral therapies, when possible, to reduce costs."
Staff at the hospital saw the benefits of the new system right away, with better patient knowledge, increased decision support, and proof of clinical functions. The result? More interventions with less time invested.
Broyles claims that Randolph County now completes 2 to 3 times more interventions since the introduction of the software. "I always know the status of my patients, all information is concurrent, old records for pharmacy, microbiology, lab, and previous interventions and adverse events are a few keystrokes away.?Basically I can take care of more patients, provide better care, and have documentation of all clinical activities."
The system has helped with his administration, too. Broyles can now provide evidence of all clinical functions with cost avoidance and better outcomes, making interaction with the "powers that be" easier to manage. It has paid off: "They can objectively see time, quality, and cost improvement over prior time frames."
But for Broyles, the most important measure of the product's success had to be improved patient experience. Evidence suggests that the new technology has passed with "reduced length of stay, fewer adverse drug events, better antimicrobial usage, cost reductions, and overall better quality of care."
He is a happy man. "Installation was much easier than adding a pharmacy system or electronic carts, and training was done on-site in a day." Financially, the introduction of the new system has been a successful enterprise for Randolph County Medical Center. As Broyles summed it up: "When you take care of the patients, the financial pieces will automatically fall into place."
Ms. Jerram is a freelance writer based in London, England.
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