Download Literature Review #1

Impacting Nurses’ Attitudes and Designing an IV Drip Reorder Form as
Initial Steps of Pharmacy Decentralization at
Loyola University Medical Center
Denisa Olarescu, Suman R Saini, Sandy Tiao, Charlene Yang, Maria Yu
Preceptors: Richard Ricker, RPh, MBA and Cheryl Gallagher, PharmD, MJ, CGP
Projected Outcomes
REGARDING IV DRIP DELIVERY TIME
Tracked reorder and delivery time of IV drips
Drug/[conc]/
drip rate
Pt Allergies:
Unit:
Date:
17:0
017:30
(Affix pt sticker here)
Authors’ Conclusions
Both parties agreed on decreased phone communications
and increased understanding of drug distribution process.
(Thompson DF, Kaczmarek ER, Hutchinson RA. Attitudes of pharmacists and nurses toward
interprofessional relations and decentralized pharmaceutical services. Amer Journ Hosp
Pharm 1988 Feb;45:345-51.)
Authors’ Conclusions:
With the satellite pharmacy, pharmacists spend more time
as ‘therapeutic consultants.’ Therefore more attention is
given to patient care.
(Poley MJ, Bouwmans CA, Hanff LM, Roos PJ, van Ineveld BM. Efficiency of different systems
for medication distribution in an academic children’s hospital in The Netherlands. Pharm World
Sci. 2004 Apr;26(2):83-9.)
Agree
Strongly
Agree
Neutral
Disagree
Strongly
Disagree
60
40
Pre-Survey
20
Post-Survey
0
Yes
No
Maybe
Responses
50
Maximum Wait Time for IV Drip
STRONGLY
DISAGREE
40
Percent (%)
DISAGREE
30
20
NEUTRAL
10
100
90
80
70
60
50
40
30
20
10
0
Pre-Survey
Post-Survey
m
in
16
ut
es
-3
0
m
in
31
ut
es
-4
5
46
m
in
m
ut
in
es
ut
es
-1
ho
ur
>
1
ho
ur
AGREE
0
Pre-Survey Post-Survey
Time of survey
The pilot project demonstrates the effectiveness of
pharmacist-nurse interaction as shown in the literature
reviewed.
Improvement in results of nurse communication level
satisfaction suggests a starting point to develop
successful interpersonal relationships between both
parties.
Nurses verbalized appreciation for the form that will
be utilized for the decentralized system
Implication of the form (Figure 1) is believed to:
Decrease in nurse waiting time
Decrease in order duplications
Increase nurse involvement with patient care
10 nurses/nurse managers surveyed
Reordering IV Drip Medications
STRONGLY
AGREE
Sources:www.pamf.org/images
Discussion
“What is the longest you have waited
for an IV drip?”
Source: www.uihealthcare.com
Time
Study Limitations
10 nurses/nurse managers surveyed
1: needs improvement
5: no changes needed
“How would you rate the IV delivery
system right now?”
10 nurses/nurse managers surveyed
1-3: needs improvement
4-6: average
7-10: satisfied with the IV delivery system
Communication Level: Post-Survey
IV Delivery System
The decentralized system has not been fully implemented
and presents certain limitations:
Lack of data on system effectiveness
Lack of data on technical support for the new
system
Surveys utilized in this pilot project presented some
limitations, in that there was:
Lack of quantitative data
Small sample size
Time restraints: five weeks for pilot project
External validity questionable due to limited pilot
units utilized in the study
Sources: www.bnn-online.co.uk
60
05:0
005:30
04:0
004:30
03:0
003:30
02:0
002:30
01:0
001:30
24:0
024:30
23:0
023:30
22:0
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21:0
021:30
20:0
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19:0
019:30
50
Drug/[conc]/
drip rate
Percent (%)
In Sophia Children’s Hospital in the Netherlands, a three
month study was conducted comparing the efficiency of
drug distribution between a ward stock system and a
decentralized pharmacy.
The average time was measured for the distribution
process such as preparing IVs and administering the
medications.
Study outcomes reported by authors:
Nurses spend more time (average 4 minutes) than
pharmacy technicians (average 2.42 minutes) preparing
medications.
POST-SURVEY
“I have to reorder IV drips often over 2-3
hours before the scheduled time.”
Communication Level - Pre-Survey
18:0
018:30
Literature Review #3: Comparison
of Medication Distribution Systems
Percent (%)
PRE-SURVEY
“How is the communication level between
yourselves (nurses) and pharmacists?”
IV Drip Reorder Form
16:0
016:30
Attitudinal surveys of nurses and pharmacists before and
after installation of satellite pharmacies were conducted, 9
months apart, at a 600-bed University of Illinois hospital.
Survey categories: role conflict, ambiguities,
communication obstacles and asymmetries
Study outcomes reported by authors:
Only 5 out of 13 pharmacists’ satisfaction scores improved
significantly.
In contrast, 10 out of 15 nurses’ satisfaction scores
improved significantly.
Sources: http://root.main.uab.edu
15:0
015:30
(Ross MB, Ryan ML. Nurses’ attitudes toward pharmaceutical services before and after
decentralization. Amer Journ Hosp Pharm 1988 Feb;45:351-6.)
14:0
014:30
Overall, the change in nurse attitude was not significantly
influenced by medication delivery time but rather, pharmacistnurse interaction
80
10 nurses/nurse managers surveyed
CCU: 30-35 minutes
MICU: 30 minutes
HTU: 30 minutes
2nd floor ICU: 25 minutes
4th floor ICU: 30-40 minutes
IV drip medications were patient-specific and
individually titrated according to appropriate lab
parameters
Reviewed patient charts for IV drip titration
rates
Created an IV drip reorder form that
pharmacists will use upon implementation of the
decentralized system
13:0
013:30
Authors’ Conclusions
100
Rating
Initial IV Drip Reorder and Delivery Time
Through Chi-square analysis (p<0.05), the authors detected a
SIGNIFICANT differences in all DECENTRALIZED floors
Literature Review #2: Installation of
Satellite Pharmacies
50
40
30
Percent (%)
20
10
0
Percent
AFTER
66.1%
64.6%
78.2%
79.3%
76.4%
12:0
012:30
BEFORE
47.4%
67.7%
45.9%
40.0%
80.6%
REGARDING NURSE ATTITUDES
Communicated with nurses and administered
survey (09/29/04) to assess their attitudes
about the current system
Sample size = 10 nurses/nurse managers
Shared new information with the nurses about
the outcomes of this pilot project, including the
new IV reorder form and the future of the
decentralization system
Administered post-survey to assess any
difference(s) in nurse attitudes (10/20/04)
11:0
011:30
Units
6th & 7th floors (decentralized)
8th floor
9th floor (decentralized)
Psychiatric wards (clinical RPh)
Mott’s
Implementation of Decentralized System
Timely Delivery of IV Drip Medications
IV drip delivery system
In the current IV delivery system, there was a decrease
(50% to 20%) in rating 1-3 and an increase (20% to
50%) in rating 7-10
Timely delivery of medications:
20% agreed in post-survey about timely delivery of
medications
20% strongly disagreed and 50% disagreed in presurvey while 10% strongly disagreed and 40%
disagreed in timely delivery of medications
For IV medication delivery wait time, there was a 20%
increase in 16-30 minutes, 30% increase in 46 minutes –
1 hour, and a 50% decrease for > 1 hour.
Communication level between nurses and pharmacists
40% increase in nurse rating of communication level = 4.
No nurses rated the current communication level as 5 (no
changes needed)
Decentralized system implementation
In pre-survey, 10% stated “MAYBE” but in post-survey,
100% agreed on benefits of implementing the
decentralized system
<1
5
Satisfaction levels of nurses
10 nurses/nurse managers surveyed
10 nurses/nurse managers surveyed
Specific Study Objectives
Creation of an IV drip form will improve
medication delivery time
Improving nurse attitudes towards
pharmacists will lead to successful
interprofessional relationships
“A new decentralized system will provide better
and more efficient delivery of medications.”
“Most of my IVs come to the unit on
time.”
Coronary Care Unit (CCU)
Medical Intensive Care Unit (MICU)
Heart Transplant Unit (HTU)
nd
2 floor Intensive Care Unit (ICU)
4th floor Surgical ICU
10:0
010:30
A nurse survey prior to and after decentralization was
administered in a three-year study at both University of
Michigan hospital and Mott Children’s Hospital.
Study outcomes reported by authors:
A decentralized pharmacy will improve
patient outcomes
Pilot Units of Loyola
University Medical
Center:
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009:30
Literature Review #1: Nurse Impact of
Decentralization
Global Goal
Each student shadowed one or more nurses in the
individually assigned unit over five weeks
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007:30
Background Information
Pilot project conducted is the primary step
in the decentralization process
More efficient IV drip delivery time should:
Improve patient outcomes
Decrease medication errors
Be cost-effective
06:0
006:30
Improving IV drip delivery time is
important because it improves patient
health outcomes and nurse-patient
contact time
Improving communication between
nurses and pharmacists is vital for
Increased satisfaction between
health care professionals
IV drip delivery turnaround time to
be improved
Results
Results From Six Survey Questions
Methods
08:0
008:30
Introduction
40
Pre-Survey
30
20
10
0
1 to 3
1
(Affix pt sticker here)
Figure 1
Pt Allergies:
Unit:
Date:
2
3
4
5
1
2
3
4
5
Study Implications
Future Research Avenues
Post-Survey
4 to 6
Rating
7 to 10
After reviewing the existing literature available
and conducting the pilot project, a
decentralized system should in long-term:
Benefit patients
Benefit health care providers (HCPs)
Improve working relationships between
HCPs
Provide higher quality patient care
Follow-up on the:
Nurses’ attitudes toward the pharmacists
Interpersonal relationships between
nurses and pharmacists
Effectiveness of the IV drip order form
(Figure 1) in terms of medication delivery
created in this project
Process of decentralization
Future challenges with the new decentralized
system once implemented