Nursing shortage affecting hospital pharmacies
Just as there is a pharmacist shortage, a paucity of nurses also exists in hospitals. How has the nursing shortage affected pharmacy operations? Drug Topics put this question to hospital pharmacists across the country, and here are their responses:
Ferena Salek, Pharm.D., pharmacy director at El Dorado Hospital in Tucson, said, " We have a big shortage of nurses at our hospital. We're not to the point of pharmacists administering drugs, to which some institutions have resorted. However, the nursing shortage has hindered the ability of pharmacy to grow more as a profession. For example, because of the lack of nurses at the patients' bedside, nurses are not as flexible using automated dispensing units for the majority of their patients' drugs.
"But the nursing shortage has also caused our pharmacists to grow, as a profession, in some areas, because pharmacists can now become more involved in direct patient care activities. They are also relied upon more for drug information questions. It's definitely a give-and-take and just depends on the situation," she said.
At the University of Kentucky Hospital in Lexington, Kimberley Hite, M.S., Pharm.D., associate director of inpatient pharmacy services, said that one thing pharmacy has done to help alleviate the nursing shortage is "to utilize our automated dispensing machine to improve the drug turnaround time. We also have pharmacists up on the patient care units. They have a computer PC, but, basically, they're decentralized pharmacists who go between units. They're still responsible for order entries, but they are either rounding with physicians or interacting with the nurses and the patients to provide drug information and answer questions."
At the Medical Center in Columbus, Ga., Lynn Chestnutt, R.Ph., quality management coordinator of the pharmacy department, told Drug Topics that, although the possibility of pharmacists helping out by administering drugs has been considered there, so far such procedure has not actually been activated. "The nursing shortage has a direct effect on patient care," she said. "The pharmacy can have medication prepared and ready, but if there's no nurse to take it from there and administer it to the patient, the patient suffers. At our hospital we've already implemented a nurse-to-patient ratio, and we sometimes have to defer patients."
Concern over the nursing shortage is so keen in California that the state has passed a law requiring a nurse-to-patient ratio of one to six; the law takes effect next year. Several other states are considering pushing through similar legislation.
Ronald Imoto, Pharm.D., manager of Fresno, Calif.-based Community Medical Center's University Medical Center pharmacy department, is acutely aware of the nursing shortage's effect on patient care. He said, "Once orders for medication are filled by the pharmacy and sent back up to the proper floor, the nurses may not have time to meet the deadline on drug administration. This can lead to medication errors. We are trying to assist the nurse and patient care by improving our turnaround time from when the physician writes the order, pharmacy processes the medication, and sends it back to the nurse. This will allow the nurse to be more efficient with her patient care time management."
Several pharmacists contacted said that, in light of the nursing and pharmacist shortage, it would help matters if regulations pertaining to technicians were liberalized to allow pharmacists to use more of these assistants. As Steven Kozel, Pharm.D., at Encino-Tarzana Regional Medical Center in Southern California's San Fernando Valley, explained, "You have pharmacists performing lots of repetitive, mundane tasks that technicians could do, with appropriate oversight. This would free up the pharmacists to do more of what they do well, which is to review the efficacy and safety of all the medication orders physicians are prescribing, to protect the patient welfare."
Shirley Lee. Nursing shortage spurring changes in pharmacy operations.