This hospital leveraged data and technology to improve the quality of care.
By Rebecca Ciaburri, M.H.A., B.S.N., RN; and Sarah A. Kelly, Pharm.D., M.H.A.
The pharmacy department at Yale New Haven Hospital in New Haven, Connecticut, was tasked in 2015 with building a 24/7 pediatric pharmacy to serve its children’s hospital inpatients.
Collaboration and data-sharing between the quality and safety and pharmacy teams identified a need for a pediatric-specific pharmacy to be in closer proximity to Yale New Haven Children’s Hospital’s 19-bed pediatric intensive care unit, 60-bed neonatal intensive care unit, and other specialty populations and areas in the hospital.
But the current pharmacy was in a separate building on the adult side of the hospital. The medication administration process relied heavily on bulk product automated dispensing machines for medication administration.
With the goal of decreasing delays and enhancing the safety of the pediatric medication use process, the teams collaborated to create a pediatric pharmacy space, a new workflow and staffing model that would improve patient outcomes.
The vision for the pharmacy included 24/7 pediatric pharmacist and technician coverage and new technology that would improve admixture of weight-based pediatric medication doses and aid in just-in-time delivery.
Improving the workflow
The team focused on leveraging technology with enhanced barcode scanning and automated workflow processes for intravenous and oral medications. The previous pharmacy workflow involved sending bulk oral medications to the units in pre-determined increments that were available in the computerized physician order entry (CPOE) system.
To reach the goal of just-in-time automated oral medication dose process, the hospital’s informatics team built patient-specific oral medication doses in a weight-based format in the CPOE. The pharmacy and quality teams then used just-in-time ordering, and input recipes into new technology that allowed for image capture and scanning capabilities.
This new process gave the hospital a more secure verification and validation of the correct recipe, medication and compound for the right patient.
All medication images were placed on the hospital’s server, and if needed, the quality team could go back and obtain the data regarding compounding. This was a great way to further communicate and enhance safety data.
The hospital also took best-practice IV medication preparation technology and adapted it to the preparation of oral medications. Yale New Haven Children’s Hospital was among one of the first children’s hospitals to adopt this safety process for compounding oral medications.
Creating a pharmacy to meet pediatric patient needs
With the pediatric pharmacy, the team improved operational effectiveness and increased risk-adjusted cost savings. Results of this work showed:
- Enhanced efficiency by decreasing time-to-medication availability by 28 minutes.
- Decreased time-to-order verification from 16 minutes to 12 minutes.
- Medications delivered 17 minutes faster than when they were prepared in the adult hospital pharmacy.
- Medication safety events decreased by 50% (from an average of 11 to 5 events per month).
Due to the project’s success, the team is replicating a similar process and technology investments to improve the safety of medication preparation for pediatric patients treated at the health system’s community hospitals. They are also evaluating their medication-related safety event and process data to create similar justification to gain financial support.
The new pharmacy has led to increased hospital system awareness of children’s hospital and the pediatric patient needs. Using safety and process data to create and add to the value equation demonstrates business and strategy implications when hospitals are developing programs and investing in new technologies.
Rebecca Ciaburri, M.H.A., B.S.N., RN, is system director, Quality Safety & Program Development, at Yale New Haven Children’s Hospital; and Sarah A. Kelly, Pharm.D., M.H.A., is system director of Pharmacy, Children’s/Women’s Services, at Yale New Haven Health.