This article was downloaded by: [University of Montana] On: 08 April 2015, At: 16:51 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Hospital Topics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vhos20
Establishing a Computer Based Total Unit Terry W. Trudeau R.Ph.
a
a
Pharmacy Services Brokaw Hospital , Normal, Illinois, USA Published online: 13 Jul 2010.
To cite this article: Terry W. Trudeau R.Ph. (1976) Establishing a Computer Based Total Unit, Hospital Topics, 54:3, 40-44, DOI: 10.1080/00185868.1976.9950340 To link to this article: http://dx.doi.org/10.1080/00185868.1976.9950340
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
Establishing A Computer Based Total Unit bY Terry W. Trudeau, R.Ph. Director, Pharmacy Services Brokaw Hospital Normal, Illinois
Downloaded by [University of Montana] at 16:51 08 April 2015
The Pharmacy at Brokaw Hospital esta b Iis hed c o m m u n ica ti o n w i t h nursing and became patient rather than systems oriented.
I NTRODUCTION n 1960, Brokaw Hospital instituted a mechanical form of drug distribution commonly known as the Brewer System. This replaced a traditional floor stock system and provided a means of delivering doses of medication to the patient while assuring proper charging functions. Under this system, the nurse dispenses medication from a machine on the nursing unit filled with medication supplied from a larger stock in the pharmacy. The Addressograph printer on the vending machine stamps the patient name, the drug unit, and dispenses the medication. The nurse then places the drug in the corresponding patient drawer in the Brewer cart, available for administration. The major defect in this system was lack of pharmacy involvement in the medication process. Pharmacy received transcribed drug orders to be filled only if the drug unit was not carried in the Brewer machine. This contributed to a lack of patient awareness by pharmacy personnel. Due to the relatively small pharmacy staff maintained through the ~ O ' S ,this nurse oriented and maintained mechanical floor stock system was the best method of drug delivery available at the time. Now, however, due to the com-
I
40
plexity of modern drug therapy, without major and costly revisions, the Brewer System at Brokaw is considered unacceptable by today's standards. A Unit Dose study was designed and initiated to observe its merits and applications.
The Unit Dose System
As recommended by the Joint Commission on Accreditation, a direct physicians order form was next designed. Consisting of a plain original sheet backed by a scored sheet of NCR paper, a direct physician order could be Pharmacy Patient Awareness thus secured by pharmacy without change in the physicians' writing habits. This original copy formed The first step in the program the corner stone of the Unit Dose was establishing recognition by System. pharmacy personnel of their role in As described by many total patient care. To do this, it was author^,*-^ the system itself is indecided to involve both pharitiated by pharmacy receiving a macists and technicians in the direct physician's order from a day-to-day activity of the nursing ward. The pharmacist or techniunit. Each staff member was assigned cian in charge of preparing a nursing unit and instructed to medications for the ward then observe what transpired during the transcribed all medication requests course of a day. Each was en- on to a pharmacy patient cardex couraged to read charts and (Figure 11. Using this, the phardiscuss case histories with nurses macist or technician is able to and physicians on the nursing prepare dose by dose the medicaward. They were also told to ac- tion requirements of the individual company the medicine nurse while patients. He does so until autoshe passed medications noting all matically stopped or a stop order is administration procedures. The ex- received from the physician. periences were summarized a t The pharmacy day begins by a weekly staff meetings. pharmacist or technician arriving This phase of pharmacy involve- a t work at 8:OO a.m. The first thing ment proved critical in establishing done is to visit the ward to which a line of communication between he is assigned to pick up and check pharmacy and nursing. It also pro- for any new order added from the vided the pharmacy staff with night before. He then returns to tools enabling them to become pa- the pharmacy, "catches up" the tient rather than systems oriented. cardex, and proceeds to fill inHOSPITAL TOPICS
Downloaded by [University of Montana] at 16:51 08 April 2015
Dose Drug DistributionSystem
MAY/JUNE 1976
41
for medication distribution by the nurse. The staff member next returns to the pharmacy with the cassette and checks for any medication left in the drawers from the previous 24 hour period. If an omission other than a PRN dose occurs, he will question the medication nurse as to why that dose had not been given. He enters the reason for
Downloaded by [University of Montana] at 16:51 08 April 2015
dividual patient drawers in a cassette with Unit Dose for the 2:OO p.m. through 1:OO p.m. dosage schedules (24 hour period). Before 200 p.m. the cassette is checked by a pharmacist for filling accuracy. It is then taken to the nursing unit where it is exchanged in the dispensing cart for the cassette covering the previous time period. The cart is then ready
omission in his patient cardex and proceeds to indicate which medications were returned so they will not be later charged. Under this system not only the conventional dosage forms of tablets, capsules, and liquids are treated as unit dose, but also injectables and intravenous solution. Injectables, when not purchased in prefilled syringes, are drawn up in syringes pursuant to the physician‘s order. These are placed in patient drawers at time of cassette filling. The intravenous solution requirements of each patient are closely monitored by utilizing the pharmacy medication cardex. Bottles are automatically sent as needed with additives being mixed with the solutions in the pharmacy when so requested.
The Unit Dose Study For the study, a representative nursing unit was selected and placed on the Unit Dose System. Before this was done, all nursing staff on the unit were thoroughly inserviced as to system procedures. Physicians as well as hospital departments involved were briefed on how they were affected by the system. On day “one” and as necessary, a pharmacist was stationed on the unit t o provide assistance if questions arose. As the study progressed, a log was kept detailing day to day effects of the Unit Dose System on the ward. Any changes in the system were noted for future reference. For M o r e A d Facts Circle # 86 On Reply Card 42
HOSPITAL TOPICS
tions from pharmacy to business office provided a tremendous time saving device.
been useful in purchasing functions and formulary procedures.
Downloaded by [University of Montana] at 16:51 08 April 2015
An additional computer capability utilized was that of drug activity analysis. Monthly, a printout was received listing total units administered of each drug together with revenue produced. This has At the end of the predetermined study period (30 days) a report was compiled listing the results of the study. The report contained log notes, nurses‘ evaluation of the system, and a summary of the study by the members of the pharmacy department. A decision to extend the system to the remainder of the hospital (one ward a t a time) was made based on this report.
The Computer Base Since 1970, Brokaw had utilized a computer on a time sharing basis
from the McDonald Douglas Corporation. Initially leased for payroll and to provide itemized billing for patients, programs were made available to provide most hospital departments with computer capabilities if so desired. Pharmacy’s first step in this direction was to pick a program which allows assignment of a computer number to each drug carried by the department. The computer printout, or description index (Figure 2) formed the basis for the hospital f o r m ~ l a r y .Along ~ with the number, a unit price was assigned to each drug in keeping with the unit administered to each patie nt . Next, pharmacists and technicians were requested t o enter the computer code when placing a drug order in the patient cardex. Having all drug information on the cardex, the posting department was able to keypunch drug charges directly from this document on a daily basis. It was found that switching total charging func-
~~~
~
Heel, elbow protection
The new Heelbo eliminates stricture!
Tough-minded research has made our heel and elbow protection the best in the world. Straps and fasteners that can restrict circulation are eliminated. Rigid boots that make walking hazardous for semi-ambulatory patients are rendered obsolete. The shearing effect that creates painful ulcers between bone and tissue is thwarted by a simple bartacked Tricot-covered foam pad which allows the outer knit to move. (There are no seams to create pressure points or compression.) The f ire-retardant, was hable Heelbo fits all 100 to 270-pound patients without restriction. It’s an attractive, dignified “sock” that provides your patients with comfort and protection. Act now to update patient care with a collect call to me, Martin Shepherd at (312) 271-8500, or by writing:
Heelbo Corporation P. 0.Box 950 Evanston. Illinois 60204
For More Ad Facts Circle # 85 On Reply Card MAY/JUNE 1976
43
About the Author:
Terry W. Trudeau, Director of Pharmacy Services at Brokaw Hospital, Normal, Illinois. He received his B.S. in Pharmacy from the University of Illinois (1969)and is currently pursuing an M.B.A. at Illinois State University. His Professional Memberships include the American Society of Hospital Pharmacists, American Pharmaceutical Association, American College of Apothecaries, and the American Association of Poison Control Centers. He is a registered pharmacist in the State of Illinois.
Conclusion This system, although simple in design and function, has accomplished the following objectives:
Downloaded by [University of Montana] at 16:51 08 April 2015
for total pharmacy 1. Allowed involvement in the medication proc0ss. 2 Shifted the burden of preparing medications from nursing to pharmacy, thus ellowing increased nursing time for direct patient care. 3 Allowed pharmacy to carefuliy monitor each patient’s drug therapy for potential drug interactions. 4. Decreased medicetion errors by instituting a series of pharmacy and nursing checks. 5. Eliminated medication returns by dispensing drugs only as needed by the patient. 6. Reduced cost to the hospital and the patient b y pharmacy monitored drug utilization.
As a result of informed involvement, the Unit Dose Program has met with overwhelming acceptance by physicians, the hospital staff, and hospital administration. These groups along with our number one concern, the patient, have benefited greatly from this most inclusive form of drug distribution.
REFERENCES
See you at the following conventions: San Diego; Los Angeles. For More Ad Facts Circle # 88 On Reply Card
44
Fraud, R.G.: A Centralized Unit Dose Dispensing Program. HOSPITAL PHARMACY, 3:13 (September) 1.W Latioleis, C.J.: A Pharmacy Coordinated Unit Dose Dlspensing end Drug Administration System - Philosophy, Objectives end Phermaceuticel Implicetions, AMERICAN JOURNAL HOSPITAL PHARMACISTS, 27: 8&?W (November) 19m Borry, C.C.: A Pharmacy Coordinated Unit Dose Dlspensing end Drug Administration System - Description of the System. AMERICAN JOURNAL OF HOSPITAL PHARMACISTS, 27: 890-897 (November) 19W Denbo, R.: Unit Dose In e 442 Bed Community Hospital With Four Phermecists, PHARMACISTS LIFE STYLE, 1:4 (June) 1974. Trudeeu, T.W.: How Our “Open-End” Drug Policy Serves M.D.s, The Hospital, end Patients, PHARMACY TIMES, 40: 66-68( J ~ l y l l 9 7 4 .
HOSPITAL TOPICS
Hospital Topics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vhos20
Establishing a Computer Based Total Unit Terry W. Trudeau R.Ph.
a
a
Pharmacy Services Brokaw Hospital , Normal, Illinois, USA Published online: 13 Jul 2010.
To cite this article: Terry W. Trudeau R.Ph. (1976) Establishing a Computer Based Total Unit, Hospital Topics, 54:3, 40-44, DOI: 10.1080/00185868.1976.9950340 To link to this article: http://dx.doi.org/10.1080/00185868.1976.9950340
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
Establishing A Computer Based Total Unit bY Terry W. Trudeau, R.Ph. Director, Pharmacy Services Brokaw Hospital Normal, Illinois
Downloaded by [University of Montana] at 16:51 08 April 2015
The Pharmacy at Brokaw Hospital esta b Iis hed c o m m u n ica ti o n w i t h nursing and became patient rather than systems oriented.
I NTRODUCTION n 1960, Brokaw Hospital instituted a mechanical form of drug distribution commonly known as the Brewer System. This replaced a traditional floor stock system and provided a means of delivering doses of medication to the patient while assuring proper charging functions. Under this system, the nurse dispenses medication from a machine on the nursing unit filled with medication supplied from a larger stock in the pharmacy. The Addressograph printer on the vending machine stamps the patient name, the drug unit, and dispenses the medication. The nurse then places the drug in the corresponding patient drawer in the Brewer cart, available for administration. The major defect in this system was lack of pharmacy involvement in the medication process. Pharmacy received transcribed drug orders to be filled only if the drug unit was not carried in the Brewer machine. This contributed to a lack of patient awareness by pharmacy personnel. Due to the relatively small pharmacy staff maintained through the ~ O ' S ,this nurse oriented and maintained mechanical floor stock system was the best method of drug delivery available at the time. Now, however, due to the com-
I
40
plexity of modern drug therapy, without major and costly revisions, the Brewer System at Brokaw is considered unacceptable by today's standards. A Unit Dose study was designed and initiated to observe its merits and applications.
The Unit Dose System
As recommended by the Joint Commission on Accreditation, a direct physicians order form was next designed. Consisting of a plain original sheet backed by a scored sheet of NCR paper, a direct physician order could be Pharmacy Patient Awareness thus secured by pharmacy without change in the physicians' writing habits. This original copy formed The first step in the program the corner stone of the Unit Dose was establishing recognition by System. pharmacy personnel of their role in As described by many total patient care. To do this, it was author^,*-^ the system itself is indecided to involve both pharitiated by pharmacy receiving a macists and technicians in the direct physician's order from a day-to-day activity of the nursing ward. The pharmacist or techniunit. Each staff member was assigned cian in charge of preparing a nursing unit and instructed to medications for the ward then observe what transpired during the transcribed all medication requests course of a day. Each was en- on to a pharmacy patient cardex couraged to read charts and (Figure 11. Using this, the phardiscuss case histories with nurses macist or technician is able to and physicians on the nursing prepare dose by dose the medicaward. They were also told to ac- tion requirements of the individual company the medicine nurse while patients. He does so until autoshe passed medications noting all matically stopped or a stop order is administration procedures. The ex- received from the physician. periences were summarized a t The pharmacy day begins by a weekly staff meetings. pharmacist or technician arriving This phase of pharmacy involve- a t work at 8:OO a.m. The first thing ment proved critical in establishing done is to visit the ward to which a line of communication between he is assigned to pick up and check pharmacy and nursing. It also pro- for any new order added from the vided the pharmacy staff with night before. He then returns to tools enabling them to become pa- the pharmacy, "catches up" the tient rather than systems oriented. cardex, and proceeds to fill inHOSPITAL TOPICS
Downloaded by [University of Montana] at 16:51 08 April 2015
Dose Drug DistributionSystem
MAY/JUNE 1976
41
for medication distribution by the nurse. The staff member next returns to the pharmacy with the cassette and checks for any medication left in the drawers from the previous 24 hour period. If an omission other than a PRN dose occurs, he will question the medication nurse as to why that dose had not been given. He enters the reason for
Downloaded by [University of Montana] at 16:51 08 April 2015
dividual patient drawers in a cassette with Unit Dose for the 2:OO p.m. through 1:OO p.m. dosage schedules (24 hour period). Before 200 p.m. the cassette is checked by a pharmacist for filling accuracy. It is then taken to the nursing unit where it is exchanged in the dispensing cart for the cassette covering the previous time period. The cart is then ready
omission in his patient cardex and proceeds to indicate which medications were returned so they will not be later charged. Under this system not only the conventional dosage forms of tablets, capsules, and liquids are treated as unit dose, but also injectables and intravenous solution. Injectables, when not purchased in prefilled syringes, are drawn up in syringes pursuant to the physician‘s order. These are placed in patient drawers at time of cassette filling. The intravenous solution requirements of each patient are closely monitored by utilizing the pharmacy medication cardex. Bottles are automatically sent as needed with additives being mixed with the solutions in the pharmacy when so requested.
The Unit Dose Study For the study, a representative nursing unit was selected and placed on the Unit Dose System. Before this was done, all nursing staff on the unit were thoroughly inserviced as to system procedures. Physicians as well as hospital departments involved were briefed on how they were affected by the system. On day “one” and as necessary, a pharmacist was stationed on the unit t o provide assistance if questions arose. As the study progressed, a log was kept detailing day to day effects of the Unit Dose System on the ward. Any changes in the system were noted for future reference. For M o r e A d Facts Circle # 86 On Reply Card 42
HOSPITAL TOPICS
tions from pharmacy to business office provided a tremendous time saving device.
been useful in purchasing functions and formulary procedures.
Downloaded by [University of Montana] at 16:51 08 April 2015
An additional computer capability utilized was that of drug activity analysis. Monthly, a printout was received listing total units administered of each drug together with revenue produced. This has At the end of the predetermined study period (30 days) a report was compiled listing the results of the study. The report contained log notes, nurses‘ evaluation of the system, and a summary of the study by the members of the pharmacy department. A decision to extend the system to the remainder of the hospital (one ward a t a time) was made based on this report.
The Computer Base Since 1970, Brokaw had utilized a computer on a time sharing basis
from the McDonald Douglas Corporation. Initially leased for payroll and to provide itemized billing for patients, programs were made available to provide most hospital departments with computer capabilities if so desired. Pharmacy’s first step in this direction was to pick a program which allows assignment of a computer number to each drug carried by the department. The computer printout, or description index (Figure 2) formed the basis for the hospital f o r m ~ l a r y .Along ~ with the number, a unit price was assigned to each drug in keeping with the unit administered to each patie nt . Next, pharmacists and technicians were requested t o enter the computer code when placing a drug order in the patient cardex. Having all drug information on the cardex, the posting department was able to keypunch drug charges directly from this document on a daily basis. It was found that switching total charging func-
~~~
~
Heel, elbow protection
The new Heelbo eliminates stricture!
Tough-minded research has made our heel and elbow protection the best in the world. Straps and fasteners that can restrict circulation are eliminated. Rigid boots that make walking hazardous for semi-ambulatory patients are rendered obsolete. The shearing effect that creates painful ulcers between bone and tissue is thwarted by a simple bartacked Tricot-covered foam pad which allows the outer knit to move. (There are no seams to create pressure points or compression.) The f ire-retardant, was hable Heelbo fits all 100 to 270-pound patients without restriction. It’s an attractive, dignified “sock” that provides your patients with comfort and protection. Act now to update patient care with a collect call to me, Martin Shepherd at (312) 271-8500, or by writing:
Heelbo Corporation P. 0.Box 950 Evanston. Illinois 60204
For More Ad Facts Circle # 85 On Reply Card MAY/JUNE 1976
43
About the Author:
Terry W. Trudeau, Director of Pharmacy Services at Brokaw Hospital, Normal, Illinois. He received his B.S. in Pharmacy from the University of Illinois (1969)and is currently pursuing an M.B.A. at Illinois State University. His Professional Memberships include the American Society of Hospital Pharmacists, American Pharmaceutical Association, American College of Apothecaries, and the American Association of Poison Control Centers. He is a registered pharmacist in the State of Illinois.
Conclusion This system, although simple in design and function, has accomplished the following objectives:
Downloaded by [University of Montana] at 16:51 08 April 2015
for total pharmacy 1. Allowed involvement in the medication proc0ss. 2 Shifted the burden of preparing medications from nursing to pharmacy, thus ellowing increased nursing time for direct patient care. 3 Allowed pharmacy to carefuliy monitor each patient’s drug therapy for potential drug interactions. 4. Decreased medicetion errors by instituting a series of pharmacy and nursing checks. 5. Eliminated medication returns by dispensing drugs only as needed by the patient. 6. Reduced cost to the hospital and the patient b y pharmacy monitored drug utilization.
As a result of informed involvement, the Unit Dose Program has met with overwhelming acceptance by physicians, the hospital staff, and hospital administration. These groups along with our number one concern, the patient, have benefited greatly from this most inclusive form of drug distribution.
REFERENCES
See you at the following conventions: San Diego; Los Angeles. For More Ad Facts Circle # 88 On Reply Card
44
Fraud, R.G.: A Centralized Unit Dose Dispensing Program. HOSPITAL PHARMACY, 3:13 (September) 1.W Latioleis, C.J.: A Pharmacy Coordinated Unit Dose Dlspensing end Drug Administration System - Philosophy, Objectives end Phermaceuticel Implicetions, AMERICAN JOURNAL HOSPITAL PHARMACISTS, 27: 8&?W (November) 19m Borry, C.C.: A Pharmacy Coordinated Unit Dose Dlspensing end Drug Administration System - Description of the System. AMERICAN JOURNAL OF HOSPITAL PHARMACISTS, 27: 890-897 (November) 19W Denbo, R.: Unit Dose In e 442 Bed Community Hospital With Four Phermecists, PHARMACISTS LIFE STYLE, 1:4 (June) 1974. Trudeeu, T.W.: How Our “Open-End” Drug Policy Serves M.D.s, The Hospital, end Patients, PHARMACY TIMES, 40: 66-68( J ~ l y l l 9 7 4 .
HOSPITAL TOPICS
