When nurses on a step-down unit at Cleveland Clinic’s main campus began considering areas for improvement, one area came up frequently – pharmacy. “Nurses expressed concern that medications took too long to be delivered and they were never sure when medication would arrive,” says Megan LoBello, MHA, BSN, RN, Nurse Manager on the unit.
A multidisciplinary team was formed in the summer of 2016 to look into the nurses’ concerns. The team included LoBello, the assistant nurse manager, staff nurses, the unit’s clinical nurse specialist, the unit’s nursing professional development specialist, pharmacists, a pharmacy technician, the assistant director of pharmacy and continuous improvement specialists. Together, they created a solution to improve medication delivery.
Interdisciplinary team studies issues, implements solutions
The team, which met every other week for approximately six months, loosely dubbed their work the “medication delivery project.” Very early on, the team realized that nurses’ perceptions of delays in medication delivery didn’t match reality: They believed it took hours to receive medication, when pharmacy data indicated that the average delivery time for most medication was under an hour.
Still, it was important to address those perceptions and find ways to improve the process. In one month, the step-down unit had more than 7,200 total medication dispenses.
As the multidisciplinary team studied the medication delivery process – the steps it entailed and everyone’s role in it – they discovered a few key issues, then instituted strategies to address them.
Issue: Nurses didn’t fully understand pharmacy’s workflow.
Solution: A team of nurses visited pharmacy, where they saw the steps taken by the staff to deliver medications across main campus. “Seeing what everyone’s role is was an eye opener,” says LoBello. “For example, the nurses learned that pharmacy techs aren’t just med runners. They are incredibly knowledgeable and a really great resource.”
Issue: Nurses never knew how long it would take for medication to arrive.
Solution: The step-down unit began using a cloud-based set of workflow management tools. “Now we can see where the medication is in the process,” says LoBello. “That helps nurses know if they can expect the med in the next 10 minutes or an hour, for example.” The unit posted log-in information for the tool on each workstation on wheels.
Issue: Nurses called pharmacy to place medication orders, then often called back to check on the status. “Answering so many phone calls slowed things down on pharmacy’s end,” says LoBello.
Solution: Rather than call pharmacy, nurses now send a message via the electronic medical record system to order medications and check on the status using the suite of workflow management tools. The step-down unit placed signs on its phones and the automated medication dispensing system reminding nurses to message pharmacy rather than call.
Issue: Cleveland Clinic’s main campus uses a pneumatic tube system (much like bank drive-up windows) for some medication delivery, but the step-down unit isn’t one of the destinations. Medication gets delivered to a neighboring unit and doesn’t always get taken to the step-down team in a timely fashion.
Solution: In order to improve medication delivery from the neighboring unit’s tube system, a sign was placed on the tube station reminding caregivers to promptly deliver medications to the step-down unit. The neighboring unit’s nurse manager also educated her staff on the importance of timely medication delivery.
Process improvements and communication lead to success
The steps taken to improve the medication delivery process have worked. The key to the project’s success, says LoBello, was the interdisciplinary approach. “There was no other way to achieve this,” she says. “We wouldn’t have had the pieces that pharmacy brought to the project, and they wouldn’t have known nursing’s concerns. It would’ve been an impossible task without collaboration.”