March 2010

1. Inpatient Pharmacy Management Reports March 2010

2. Objectives • Utilize Inpatient Pharmacy management reports effectively • Distinguish between various reports • Describe the utility of each report • Recall reports that should be run at scheduled intervals

3. Objectives (cont) • Describe implementation of major projects from a management perspective • Planning • Implementation Approach • Pitfalls & Lessons Learned • Maintenance & Fine tuning

4. Major Inpatient Pharmacy Projects • Examples • Inpatient Order Entry (by Pharmacy) • Computer based MARs • ADM (Pyxis or Omnicell) for drug distribution • ADM-RPMS Interface • Inpatient Electronic Health Record • Bar Code Medication Administration

5. Project Planning – ADM (Pyxis/Omnicell) as example • Initial considerations / research • Is one company better? • Capabilities of system • Size/types of machines, types of drawers • Customer service • Experience of your staff (e.g. at other hospitals) • Cost comparison • Rent vs. purchase • Ask company reps to give sales pitch

6. Project Planning – ADM (Pyxis/Omnicell) as example • Evaluate site to estimate needs • Number of wards/clinics/ED • Usage pattern of meds on each ward • Space available for machines? • Modification of med rooms necessary? • Infrastructure requirements • Identify Pharmacist(s) and tech(s) who will spearhead and maintain

7. Project Planning – ADM (Pyxis/Omnicell) as example • Prepare a written proposal • Emphasize benefits to patients & site • Medication security, accountability, reduced med errors and paperwork, Joint Commission standards • Provide overall cost estimate • Provide project options with cost estimates • Provide estimated time-line • Gain support of nursing dept. • Consider nursing perspective & concerns • Political clout of nursing department • Share proposal with administration

8. Project implementation – ADM (Pyxis/Omnicell) as example • Finalize contract with company • Establish delivery dates • Send staff to company HQ for training • Pharmacist • +/- Tech, +/- Nurse • Communicate issues to resolve • Engineering • Information Technology

9. Project implementation – ADM (Pyxis/Omnicell) as example • Ensure adequate time for staff to prepare: • Write policy / procedures • Prepare ADM Formulary • Establish override meds • Enter Users • Establish par levels for each med/ward • Configure drawers/pockets • Set-up batch reports • Load meds into machines

10. Project implementation – ADM (Pyxis/Omnicell) as example • Provide training (ADM Company can help) • Consider loading machines with candy • Have technicians practice refilling machines • Document competency • Ensure display of meds at station screens is understandable • Ensure everyone is comfortable and ready for “Go-live” date • E-mail widely to notify staff

11. Project implementation – ADM (Pyxis/Omnicell) as example • Provide support on Go-live date • Be available to answer questions • Ask for feedback • Make modifications as needed • Keep admin/supervisors in the loop • Send follow-up e-mail “progress report” • Recognize those individuals and departments that were instrumental

12. Project Evaluation/Maintenance – ADM (Pyxis/Omnicell) as example • Review reports daily • Who will do this? • Where will the reports be filed? • Review policy periodically • Work with nursing to update override list • Teach additional staff members to perform higher level tasks • Evaluate med error rates

13. Summary – Project Implementation • Research • Plan ahead as much as possible • Enlist support from other stakeholders • Communicate frequently • Provide staff with adequate time • Provide training • Be available on Go-Live date(s) • Celebrate accomplishment & recognize others • Monitor and fine-tune

14. ADT Reports IV Reports Unit Dose Reports Inpt Pharm Management Reports

15. ADPL (Average Daily Patient Load) Select time frame Sort by ward or service Provides total patient days & average census over time period selected Inpatient staffing is based on ADPL ADT Menu Reports – Statistical Reports

16. Inpatient Statistics by Ward Report of ADT activity, sort by ward or service Useful to evaluate LOS (length of stay) ADT Menu Reports – Statistical Reports

17. Current Inpatient Census Displays number of patients currently admitted Does not display patient information Useful to determine staffing ADT Menu Reports - Other

18. Current Inpatient Listings Report showing individual patient data Multiple pre-configured options – can select to print by ward, service, insurance data, severity of illness, etc. Useful to take to rounds, discharge planning meetings, etc. This example is by ward (includes all services) ADT Menu Reports - Other

19. Current Inpatient Listings (continued) If choose by service, list is condensed Less room for notes ADT Menu Reports - Other

20. View Admissions History View all admissions and discharges at your facility for a selected patient Only shows dates of admission & discharge, not diagnoses or other data ADT Menu Reports - Other

21. IV Menu – Auto-discontinue Set Up • Med orders are automatically discontinued for patients who are admitted or discharged • This cannot be changed • This option allows configuration of auto d/c upon transfer from one ward or service to another • e.g. transfers out of ICU to other wards • Recommendation: DO NOT activate these • Even if your policy requires orders to be re-written • Use renewal of orders under IOE instead • Will set up Auto-Discontinue in the EHR parameters

22. IV Menu – Management Reports: AMIS (IV) • List of all IV’s dispensed & average cost • User selects time frame • List sorted by ward • Within ward, by IV type (A, P, S, C, H) • Sub totals for each ward, grand totals • Recommendation: run report on regular basis, e.g. monthly • Periodically run one year data & divide by 12

23. Example of AMIS (IV) report • 30 day time period selected (June ’09) • Totals = workload data for selected time period

24. IV Menu – Management Reports: Drug Cost Report • # of doses (bags) dispensed, recycled, cancelled, & destroyed • Cost for each drug & totals • Can separate out by ward or skip ward data • Can print all drugs, by IV type, or only 1 drug • Lots of paper if you run the full report • 132 columns – use condensed print • Recommendation: use to look at only 1 drug

25. IV Menu – Management Reports: Drug Cost Report • Example – single drug (Daptomycin) chosen, past 30 days data

26. IV Menu – Management Reports: Patients on Specific Drugs (PSD) • List of all patients on one or more drugs • Choose IV, UD, or both • Choose orderable item, dispense drug, or VA drug class • Can choose more than one drug • Select “# of matches” • If looking for only one item, enter 1 • If looking for patients on both drugs, enter 2

27. Example 1: All patients with dispense drug Morphine 4mg syringe IV Menu – Management Reports: Patients on Specific Drugs (PSD)

28. Example 2: patients on both clopidogrel & omeprazole IV Menu – Management Reports: Patients on Specific Drugs (PSD)

29. Shows total # of doses dispensed, total cost, & ave cost per unit dose Time frame selected Broken down by ward with totals Recommendation: Run monthly Periodically run 1 year data & divide by 12 Unit Dose Menu Reports – AMIS (Cost per Ward)

30. Shows # of doses of each drug dispensed, and cost Time frame selected Can break down by ward or just show totals Can choose one or more drugs, orderable items, or VA Drug Classes Utility: to evaluate usage pattern of drugs for inventory purposes, or cost information Unit Dose Menu Reports – Drug (Cost / Amount)

31. Sorted by provider (one or more), then drug Total units dispensed for each drug, cost Grand total & cost, average cost Time frame selected Utility – “heavy” prescriber identification Unit Dose Menu Reports – Provider (Cost per)

32. Questions?