Every pharmacist that has worked in an acute care environment is familiar with documenting interventions. Information from captured interventions is often assigned a dollar value and used by pharmacy and hospital administration to justify pharmacy services or additional pharmacist FTEs.
Interventions captured can range from secondary issues like illegible handwriting and incomplete orders, to pharmacokinetic consults, renal dosage adjustment and prevention of adverse drug events caused by allergies, drug-drug interactions, disease-drug interactions, etc.
Several methods have been used over the years to capture pharmacist initiated interventions, and no two have been the same. I’ve worked at several facilities over the years, and the systems used have included a paper method, a Microsoft Access database, a PDA system built with Pendragon Forms for the Palm Pilot, a third party software system and of course the pharmacy information system (PhIS) itself. Each had advantages as well as disadvantages. The two things they had in common were that they cumbersome and lacked standardization.
Systems such as RxNorm and SNOMED CT are designed to standardize nomenclature; for medications and clinical terms, respectively. Something similar could be used for intervention documentation that would result in two immediate advantages: 1) comparable data across multiple healthcare systems and 2) faster entry for pharmacists.
All interventions require similar data: drug, intervention type, severity, action taken, acceptance, end result, among others. Each item often represents some form of drop-down menu or searchable field in most pharmacy information systems. Unfortunately this results in cumbersome intervention entry and pharmacist non-compliance.
Here’s something to consider:
Develop a list of standard data points to capture, i.e. drug, intervention, severity, etc.
Develop a standard order in which these data points will be captured.
Assign numbers to each item associated a data point. For example: INTERVENTION TYPE: 01=allergy, 02=pharmacokinetic consult, 03=renal dose adjustment, 04=order clarification, 05=IV compatibility quesiton, and so on – SEVERITY: 1=High, 2=Moderate, 3=Low – Etc.
Develop a standard input method for interventions.
Using the system above would result in an intervention like this:
VANCOMYCIN / PHARMCOKINETIC CONSULT / SEVERITY = LOW / ACTION = DOSE ADJUSTED DOWN / ACCPTED BY MD / THERAPY CONTINUED
becoming this:
vancomycin 0110713
Intervention capture could become extremely quick and efficient with such a system. This is especially true if you create a “hot key†in the pharmacy system that brings up an intervention window attached to the patient you have open with the drug you’re working on. Then the intervention simply becomes “0110713â€.
Many people will say that memorizing the numbers for a system such as this would be difficult, but I say that’s simply not true. You would be surprised at how quickly a system like this would become second nature with use. The upside to such an efficient system would be increased intervention capture as well as better benchmark data for comparison to other facilities.
Innovation in healthcare is at an all time high, which is a good thing because systems are becoming more robust and powerful. With that said, we need to remember to simplify and standardize where possible while developing these new systems so that they are not overly complex and cumbersome. Think about it.
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