East coast connection
Having a meds to beds program involves working with all team members to collaborate on making the program successful. When we started our meds to beds program we met monthly to review lessons learned and avoid the situations that cause bottle necking and to assess growth
-scripts are sent first thing in the am prior to discharge or the day before
-patients with complex problems and having multiple prescriptions the process starts the 1-2 days before discharge where the discharge is started and meds are sent to the pharmacy to plan ahead and prepare the patient and family
-We also use telemedicine approach for pharmacists to talk with patients and families and do medication teaching
-The medication delivery is done by techs in the pharmacy right to the bedside however more complex regimens the pharmacist and or nurse will do the education
-our retail pharmacy that is in house utilizes separate staff for employee prescriptions opposed to patient prescriptions. This was a decision made by the pharmacy to help with though put
-The biggest impact that has made our program successful is having the providers put the scripts in several hours prior to anticipated discharge and also noting the time of expected discharge so the pharmacy can best prioritize which scipts need to be filled first.
I would make sure that you have enough FTE’s based on the square footage of space you have to clean
I also recommend staggering shifts especially during your busy time frames
Carts should be stocked at the end of each shift so that they are ready to go the next day or another option is having the night shift stock all carts since there is more downtime
Most hospitals are contracting out either EVS all together or contracting out managment of EVS so it can be run more efficiently.
Culture of your organization is very important. expectations should be presented upfront upon hire. In our organization the midlevels (NP’s/PA’s) are the most reliable group. Many of them are cross trained to cover different departments to fill gaps. We also utilize perdiem and part time staff to fill gaps as well. We do have a chief Midlevel provider that is responsible for the coordination of all the midlevel providers including scheduling. This position makes a world of difference and is worth its weight in gold.
Most of our staff is seasoned and experienced which also makes a big difference. Newer grads tend not to have the commitment and work ethic that our more experienced staff have.
A physician Assistant is a professional who practices medicine in collaboration or under indirect supervision of a physician. They are widely used in the US and undergo specialized training. The program is similar to a nurse practitioner but they are not Licensed to practice independently like NP’s.
This is a tough question. It does depend on what you want to get out of the process.
360 review in our organization is used to measure an employee’s strength and weaknesses, not performance. It is used as part of our overall feedback and performance management process. It has been met with controversy for the very reasons you have mentioned. Also due to the anonymous nature of the process many have argued that it teaches working people that the way to support and help one another is to complete anonymous, secret feedback forms for your colleagues and tell them what they need to improve in your opinion. You can tell them whatever you want without having to step up and own your comments or own relationship between you and the person you are “coaching” through the feedback. In some of our departments it has lead to lack of trust within the department. However other departments it has been well received and works well.
Advance practice practitioners have been in primary care and outpatient settings with great success. We have experienced decrease wait times, reduced cost of care and outcomes have been either equal or better.
Challenges have been poor role clarification and admitting patients to the hospital
Most of our challenges have been with physician assistants because they are not licensed to practice independently. We however have overcome this by using more Nurse practitioners in the outpatient settings because they can practice independently. We have used PA’s more in the inpatient setting where they will have more direct oversight by a physician.
Admitting patients to the hospital no longer has been a challenge now that we use a hospitalist group that will directly admit patients when needed.
We also utilize our pharmacists to monitor and dose in the anticoagulation clinic and do medication reconciliation
In our cardiology clinic Advance practice practitioners see patients first and depending on illness severity are then seen by the cardiologist