By Julie Cullen, Managing Editor, American Nurse Today
I thought the best way to answer that question would be to speak to a nurse and a pharmacist, so I reached out to Jessy Thomas, PharmD, and Ann-Marie Taroc, MSN, RN, to see what they had to say. Jessy is the clinical pharmacy manager for CompleteRx and director of pharmacy at Driscoll Children’s Hospital in Corpus Christi, Texas. Ann-Marie is a staff nurse at Seattle Children’s Hospital. They both agree that these two critical parties to patient care struggle with communication, but they offer slightly different proposals for solving the problem: improved technology and more face-to-face time. I suspect that combining these two approaches is the ultimate solution.
What do you see as the primary stumbling blocks to communication between nurses and hospital pharmacists?
Thomas: Sometimes the “language” we speak can create communication blocks between nursing and pharmacy staff. While both disciplines are focused on the needs of the patient, there are fundamental differences in our operations and focus that can affect how we communicate with each other. It would be beneficial if pharmacists could shadow and
spend a day in the nurses’ shoes and vice versa. Better understanding brought about through such an effort could serve to break down barriers and allow us to communicate using the same language.
Taroc: I believe the primary stumbling blocks to communication between nurses and hospital pharmacists starts with the lack of face-to-face interaction. In the acute-care setting, the pharmacists and their team operate in separate locations. Nurses are unfamiliar with the workflow of the pharmacy department. A great example of this is when our organization experienced a repeated surge in census. The pharmacy department (along with other departments) struggled to meet patients’ needs. To better prepare for upcoming patient needs, the pharmacy department prepared an expensive chemotherapy for a planned admission. Unfortunately, there was no bed available for that patient. I cannot
say which issue comes first: the lack of a shared understanding of workflow or the lack of communication, as likely each impact the other. Each party’s expectations, may at times, be so different. Add the fact that there may be little to no rapport due to the lack of face-to-face interaction and you have two team players, of different disciplines, who may struggle to communicate effectively.
How do these communication challenges effect patient care? Is there any bottom line impact to the healthcare organization?
Thomas: When all departments are able to play a direct role in the patient’s care, we’re able to communicate more easily. If barriers between disciplines aren’t managed well, however, patient care could be impacted. Since the overall patient experience is directly tied to the potential revenue flowing from Medicare into hospitals, improving working relationships can be an important strategy in maintaining or improving a hospital’s bottom line. Facilities with a multidisciplinary approach to patient care are armed with the best tools to manage any potential communication challenges. Outside of potential communication challenges between two departments, healthcare leaders need to take note of the overall culture of the hospital, as it plays an even greater role in staff satisfaction and, ultimately, patient satisfaction.
Taroc: Communication challenges impact patient care by causing mistrust and delaying care. Let me use an example many nurses have experienced: requesting a replacement medication via the electronic medical record. The pharmacist may prepare and send that medication but there are times I never receive said drug. I become frustrated as an hour or two passes, and when I reach out to the pharmacist, they’re similarly frustrated as they indicate the dose was verified and sent. Ultimately, the patient’s treatment is delayed when they don’t receive their medication in a timely manner.
The bottom line impact to the healthcare organization is likely multifaceted. In my example of requesting a replacement dose (for a missing scheduled or as needed medication) can result in increased cost to the organization. Refilling multiple doses, to ensure delivery, is costly as the organization must absorb the expense of the missing drug and incur the cost of additional man hours for dispensing. However, in periods of surging hospital census, an hour or two delay in medication can have far reaching impacts on the length and quality of a patient’s hospital stay.
What can each party do to improve communication and collaboration? Can you share specific examples from your own experience?
Thomas: Aligning the goals of both the nursing and pharmacy team is important to improving communication. In our case, pharmacists are fully integrated with the teams that they serve through a decentralized pharmacy model. This strengthens the relationship between physicians, nurses, and other members of the medical team. It also helps to identify potential issues and solutions. For example, in our hospital, the pharmacy team has improved its order sets, refined infusion pump data, and assisted nurses to educate patients about specific medication questions.
Taroc: I believe face-to-face interaction is helpful for improving communication and collaboration. For example, in the new wing of the hospital I work at, pharmacy technicians deliver medications to each patient’s room on a schedule. The approach to this new workflow was to allow the technicians to fill each patient’s medication cupboard without delay. Though the same technicians come to the department every day, many nurses don’t know their names and there’s no camaraderie. Personal connection is key for developing trust
During the week, some inpatient services round with a pharmacist, and this face-to-face interaction is enlightening. I may advocate for a different medication (lozenge versus liquid). Attending providers are receptive to nursing suggestions to improve medication administration, but having a pharmacist present allows the team to understand future problems (the cost of a lozenge medication in the outpatient setting). Suddenly, a new dimension to patient care presents itself with the pharmacist’s contribution—continuity of care (with medications) and cost. I find that since this interaction all occurred face-to-face, I could see how the pharmacist agreed with improving the patient’s experience, but helped me understand how the impact would be short-term (insurance will only approve the liquid formulation).
Are there any tools or technologies that might help in terms of medication tracking and distribution/administration? If so, how has your organization used them? What benefit have you seen?
Thomas: We’re working on implementing a new medication tracking tool. Results are still in the early stages, but we’re looking forward to the improvements it may bring us, the nursing team, and the broader hospital.
Taroc: Recently, our organization implemented medication tracking within the electronic medical record, along with a timeframe for medication requests (for example, 60 minutes or 15 minutes). To date, the only change I’ve noticed is a faster turnaround time from request to refill.