ANAHEIM, CALIF.—Combine the clinical knowledge of pharmacists with the latest information technology tools and what do you have? A powerful one-two punch for reducing the risk for medication errors, according to a growing body of evidence.

A case in point was the study by pharmacists at Advocate Illinois Masonic Medical Center in Chicago presented at the American Society of Health-System Pharmacists Midyear Clinical Meeting in December.

The study, led by Karen E. Trenkler, PharmD, MS, BCPS, demonstrated a dramatic increase in the number of pharmacist interventions after the pharmacy department launched a series of automated reports designed to streamline monitoring activities and improve patient safety.

Using a stand-alone documentation system from Health ProLink/Pharmacy OneSource, Dr. Trenkler and her coauthor, Mark L. Franklin, PharmD, worked with a programmer to develop reports that could drill down into the wealth of clinical information stored in the hospital’s Cerner Millennium database and organize it into concise, patient-specific reports.

“We have a very good understanding of how databases work and how to mine information,” said Dr. Franklin, director of pharmacy at the 551-bed community teaching hospital. “So we gave [the programmer] the report format, the triggers and any variables we wanted to monitor. He programmed it for us, and we worked very closely with him to work out the bugs.”

The reports targeted a variety of data, including microbiologic, anticoagulation, lab evaluations, parenteral nutrition, renal dosing and pharmacokinetics, Dr. Franklin said. Other reports in development include ones specific to critical care units; medication profiles tailored to specific patient populations, such as oncology and geriatric patients; and reports targeting particular disease states.

The reports have greatly increased efficiency, in part by integrating information from multiple systems, including pharmacy, laboratory, microbiology, clinical documentation and demographics. “A pharmacist can look at that one-page report and make a very concise, quick decision about what intervention might be needed, if any,” said Dr. Franklin. Without such integrated reports, he added, “it would take significantly longer to gather all that information.”

The study is a practical example of how informatics can be easily applied to the day-to-day work of pharmacists, said Brent I. Fox, PharmD, PhD, visiting professor at Auburn University’s Harrison School of Pharmacy in Auburn, Ala. “Medical informatics is the science focused on the use of information in patient care to produce better outcomes.Ê… Information technology is a key component of medical informatics,” Dr. Fox said. “This report is a practical example of how informatics can be easily applied to pharmacists’ activities. Pharmacy systems contain a rich data set that, with the appropriate tools, can be employed to improve the care they provide. The next logical step from this study is to evaluate the pharmacists’ impact on patient outcomes.”

Pharmacist Interventions Up

After the reports became available, the number of pharmacist interventions leaped. In the first six months of 2006, there were 11,899 interventions compared to 4,767 in the same period a year earlier—an increase of 150%. In one category, antibiotics/microbiology, the number of pharmacist interventions went from 88 in the first six months of 2005 to 1,408 in the same period the following year. In the same time frame, anticoagulation interventions increased from 190 to 1,335. “We have more information ready to make those interventions,” Dr. Franklin said.

The next step, he said, will be to look at cost savings associated with the interventions. “I’m not sure that many pharmacists understand that the database is there, and we need to use it to help save us time and work more efficiently in the interest of patient care and patient safety.”

The Advocate Illinois Approach

The renal dosing report developed at Advocate Illinois Masonic Medical Center in Chicago is an example of how various information sources are integrated into one easy-to-use report. Triggers include patients who are 65 and older and/or have a serum creatinine level greater than 1.5 mg/dL, and who are taking a medication or have active metabolites identified as renally eliminated, nephrotoxic or contraindicated in renal impairment.

The report format includes: