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Sometimes in medication safety the simplest solution is the best.
Two Philadelphia hospitals recently won The Hospital & Healthsystem Association of Pennsylvania's Delaware Valley Medi-cation Safety Award for very basic pharmacist-initiated measures. At one hospital, drugs are now stored in colored bins based on potential for confusion. At the other, an inpatient blood clot risk assessment form is attached to all patient charts.
The pharmacists began their initiative by extensively reviewing the literature and lists of highly confusing medications on the Institute for Safe Medication Practices Web site. "We separated drugs based on their risk of confusion," said William Grochowski, Pharm.D, associate director of pharmacy. "The system is neat, orderly, and well thought out."
After a testing period in the main pharmacy, the storage concept was replicated in all of the system's pharmacy satellites, and, according to Grochowski, the result was a significant reduction in dispensing errors.
"Sometimes the simplest approach is the most effective and the most easily adopted. That was true here," said Grochowski.
The form was created after an in-house survey showed that only 43% of patients who needed medications to prevent a blood clot were getting them, McDonnell said. "That wasn't acceptable, so we came up with a simple but effective solution built on evidence-based medicine."
The form states in its header that VTE is the "largest cause of preventable hospital mortality and morbidity." It identifies risk factors and provides a risk stratification table and a checklist for prophylaxis options. If a patient is at risk, doctors are asked to choose from devices such as com-pression boots and stockings, which encourage movement of blood in the legs. Medications that help prevent the blood from clotting are also suggested.
The positive effect of the form was evident almost immediately, said McDonnell. After two months, the committee found that Jeanes' rate of patients receiving appropriate medications for blood clot prevention increased to 69%. The result of that, plus the use of prophylaxis recommended on the form (such as compression boots), was that the hospital's rate of VTEs declined from 2.9% to 1.9% in the first six months following introduction of the checklist.
"A small number of physicians resisted at first," said McDonnell, "which is not surprising because they now have another form to deal with. But the results were so clearly favorable so fast that resistance quickly went away. This is a clear example of the value of pharmacists' involvement in disease-state management."