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Root Cause Analysis: Improving Slow Medication Verification Times

Megumi Miyajima-Olguin RN

Bon Secours College of Nursing

Nur 3241: Quality Safety and Nursing Practice

Rani Sangha, DNP, MSN.ed, MBA, RN

February 6, 2021

“I pledge…”
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Introduction

I work at Richmond Community Hospital (RCH) Emergency Department and we do not

have central pharmacy during night shift (from 1900-0800). Richmond Community uses our

sister hospital, Memorial Regional Medical Center’s (MRMC), pharmacy at night to verify our

STAT medications remotely over Connect Care.

Not having our own central pharmacy at night can cause many issues for nightshift

including certain drugs not being available in the pyxis and nurses have to mix some infusions.

The main issue I am focusing on is the slower verification of STAT medications on nightshift.

MRMC pharmacy, except for code/emergent medications that can be overwritten, remotely

verifies ordered medications before they can be pulled from the pyxis and administered. Because

RCH does not have their own pharmacy at night, the verification process is slower and there can

be delays patient care. This essay will explore the causes of this issue, contributing factors to this

problem, and recommendations for improvement.

Problem Statement

There is slower verification of medications on nightshift at RCH from 1900-0800 by

MRMC’s pharmacy that may cause delays in patient care.

Causes of the Problem

Superficially, the root of the problem is MRMC’s pharmacy not verifying the medication

in a timely manner. As you look further in, you will see that MRMC has to take care of their own

hospital’s medications needs with the additional burden of RCH’s. These needs are exacerbated

by the COVID-19 pandemic.

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Richmond Community Hospital’s ED pyxis has a supply of essential medications and

medications we are known to frequently use. When our central pharmacy is closed for the night,

we can have specialty medications couriered from MRMC or the provider and the pharmacist

can improvise. If the provider wants a special drug or a drug in special concertation, MRMC’s

pharmacist has to accommodate the requests with what RCH has on hand. This can take up a lot

of time.

Pediatric medications can take more time to verify as they are dependent on height and

weight. It is important that the triage nurse puts that information in the pediatric patient’s chart in

a timely manner, or it causes further delays.

Contributing Factors

Memorial Regional’s pharmacy is dependent on other factors to do their job efficiently.

We use Epic’s ConnectCare software. It is how MRMC remotely verifies medications. It

has a messaging service on the MAR where nurses and pharmacy can communicate.

Unfortunately, these messages can be easily missed, especially if one is busy. Typically, we use

pharmacy’s phone service to inquire about medications. It is direct, you speak to someone, and

there is accountability. It does, however, take more time to answer the phone and look up the

chart.

Recommendations

There are some easy recommendations to improve the speed of pharmacy verification.

One, is to educate providers about the medications RCH has available in the pyxis overnight.

The providers come from many hospitals and order many different medications and/or

formularies that are not available at RCH overnight. This causes a delay in pharmacy verification
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because the pharmacist is trying to find suitable exchanges or make substitute suggestions. This

education program will help them order more of what we have unless there are exceptional

circumstances.

Another idea is to have nurses use the ConnectCare MAR messaging system and have the

pharmacists reliably respond. This reduces the time on the phone where the pharmacist is

looking up the patient. On the MAR message, that information is there.

The third recommendation involves the nurses’ role in timely imputing information into

the chart so pharmacists have it ready to verify. This is explained further in the next section.

Nurses’ Role in Recovery Process

As the nurse, the information we gather and put in the chart has a lot to do with the

verification time. The RN must put in a review of allergies for most any medication to be

verified. Pediatric patients and patients on certain infusions require an accurate height and

weight. Also, the nurse has to reconcile the patient’s home medication list to make sure the

treatments they are receiving in the hospital won’t have adverse effects with the patient’s current

regimen. Some medications need a pregnancy status or kidney function, for example. These are

all the nurses’ responsibilities.

Conclusion

The cause of slow medication verification time does not solely lie with the pharmacists.

The verification of appropriate medications is a collective effort. The nurses need to gather

pertinent information, the doctors have to order appropriate medications and/or tailor the orders

to RCH’s availability, and pharmacists need time to make sure the treatment is safe. We all play

a role and can try to make this process more efficient through better communication and training.
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Appendix