What if you had a full-time assistant double-checkingfor adverse drug effects or researching appropriatetherapies while you work? How aboutinstant, mobile access to patient records so you could keeptrack of their progress while you are on the move? Or adirect link to your institution's pharmacy system? What ifyou could be alerted to organisms not covered by currenttherapy as soon as your lab picked them up? Better still, howabout all of these things in the palm of your hand?
With the advent of products such as Stellara (bioMerieux),Quantifi (HealthProLink), and MedStorm (Pharmacy HealthcareSolutions), this technology has become a reality forhealth care professionals across the country.
One such professional, Michael R. Broyles, PharmD,describes himself as "a clinical pharmacist striving toadvance pharmaceutical care and improve patient outcomes,"which goes some way to explaining why hebrought this technology into his own hospital, RandolphCounty Medical Center, Pocahontas, Ark.
Broyles, who is director of clinical pharmacy services,explained his objectives: "Our goal was to provide better careby starting empiric therapies within expert guidelines [onadmission, and not hours later when pharmacy had to intervene],reduce adverse drug events, practice better antimicrobialstewardship, monitor all patients better with real-timetechnology, reduce length of stay, use fewer hospitalresources, perform better and be able to measure performanceto the quality agencies [Joint Commission on Accreditation ofHealthcare Organizations], and provide better patient andfamily satisfaction."
No small task, then! Broyles made inquiries at AmericanSociety of Health-System Pharmacists meetings, and at theHealthcare Information and Management Systems Society,and shopped around on the Internet, before he settled onStellara, powered by TheraDoc, a bioMerieux productreleased this past January.
"There was nothing as advanced, robust, easy to implement,that could monitor patients as well, had very efficientdocumentation 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 havefound things to use it for that they never designed it to do."
He explained how Stellara enabled him to follow theprogress of a particular patient while he was traveling to ameeting. The patient was admitted on a Friday evening, criticallyill with an infectious process. It was the weekend, andonly 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 wasin and out of the hospital, they were not aware of the microresults," explained Broyles. "Stellara provided an alert, andwe were able to immediately change therapies, since none ofthe empiric choices were likely to be beneficial."
Later that day, still off-site, Broyles was able to check onthe patient again remotely. He found that an additional drughad been ordered that would have had a "severe" drug-druginteraction.
"This interaction was found in the alert review, and therapywas promptly changed. We continued to monitor, thepatient did well, a potential adverse event was avoided, andthe patient was placed on oral therapies, when possible, toreduce costs."
Staff at the hospital saw the benefits of the new systemright away, with better patient knowledge, increased decisionsupport, and proof of clinical functions. The result?More interventions with less time invested.
Broyles claims that Randolph County now completes 2 to 3times more interventions since the introduction of the software."I always know the status of my patients, all informationis concurrent, old records for pharmacy, microbiology, lab, andprevious interventions and adverse events are a few keystrokesaway.?Basically I can take care of more patients, provide bettercare, and have documentation of all clinical activities."
The system has helped with his administration, too.Broyles can now provide evidence of all clinical functionswith cost avoidance and better outcomes, making interactionwith the "powers that be" easier to manage. It has paidoff: "They can objectively see time, quality, and cost improvementover prior time frames."
But for Broyles, the most important measure of the product'ssuccess had to be improved patient experience. Evidencesuggests that the new technology has passed with "reducedlength of stay, fewer adverse drug events, better antimicrobialusage, cost reductions, and overall better quality of care."
He is a happy man. "Installation was much easier thanadding a pharmacy system or electronic carts, and trainingwas done on-site in a day." Financially, the introduction ofthe new system has been a successful enterprise forRandolph County Medical Center. As Broyles summed it up:"When you take care of the patients, the financial pieces willautomatically fall into place."
Ms. Jerram is a freelance writer based in London, England.