By Catalina Guran

Through a two and a half years transformation journey of its pharmacy services, Mackenzie Health is enabling healthcare providers to provide more hands-on care, to help provide excellent quality care to every patient, every time. The multi-tiered transformation of its pharmacy services has also allowed the organization to better adapt to the changing healthcare landscape and to create capacity to efficiently support the significant growth within its community.

The endeavour included several distinct projects such as the redesign of medication reconciliation and distribution processes, the expansion of centralized IV admixture and anti-microbial stewardship services, the redesign of the pharmacist and pharmacy technician roles, as well as several other initiatives, each aiming to improve the existing processes. Each of the initiatives delivered on clear outcomes articulated through an engaged process and a robust governance structure supported by meaningful input from key stakeholders, including patient and family advisors.

The journey began when Mackenzie Health started exploring the automation of pharmacy services throughout the organization to enhance patient safety. Following the implementation of automated dispensing units (ADUs) in the Emergency Department and the Intensive Care Unit in 2012, Mackenzie Health identified the need to further review the medication distribution model in order to optimize patients’ access to their healthcare providers.

The first significant change was evolving to a 24/7 medication distribution model. Stemmed from process improvement methodology and LEAN events, the new model showed a 23 per cent decrease in the time nurses needed to prepare medication and eliminated the night medication cupboard.

The new medication distribution model introduced ADUs in every patient care area of the organization and allowed for enhanced control of narcotic and controlled medications. The implementation of Central Pharmacy Automation and barcoding of all pharmacy inventory, set the foundation for a closed-loop medication system, an essential part of Mackenzie Health’s Smart Hospital Vision at both the existing Mackenzie Richmond Hill Hospital and the future Mackenzie Vaughan Hospital. This significant patient safety investment brought two new automated oral solid packagers and two MedCarousels® – vertical storage and dispensing systems that automate the medication management process, from order fulfillment to automated cabinet replenishment, to patient medication dispensing to restocking.

The project also includes the introduction of 14 automated Anaesthesia-RxTM carts to the Operating Rooms and to the Minor Surgery and Endoscopy areas. The automation allowed the Pharmacy department to barcode 100 per cent of the inventory in preparation for the pending implementation of a new electronic medical record that will bring Mackenzie Health to EMRAM level 7 and barcode medication administration.

Mackenzie Health also expanded the centralized IV admixture (CIVA) service to provide ready-made doses of IV medications to nurses, resulting in a 66 per cent decrease in the time spent by nurses on this task. Mixed by certified pharmacy staff in a sterile environment, the pre-prepared IVs also contribute to enhanced safety for patients. Nordia Carty, Registered Nurse at Mackenzie Health acknowledges that “CIVA allows for safer medication administration. It reduces time for reconstitution and drug calculation. It is also more efficient and overall improves time for nursing.”

With the regulation of Pharmacy Technicians through the Ontario College of Pharmacists during the same period, the two-year transformation lent itself to a redesign of the roles of the pharmacy technicians and pharmacists at Mackenzie Health. Optimizing the technicians’ roles in medication distribution and documentation of best possible medication histories allowed 3.4 hours per pharmacist per day to be redistributed to direct patient care activities, enhancing the clinical role of the pharmacists. This included the introduction of medical directives to delegate prescribing of certain antibiotics that required therapeutic drug monitoring. Pharmacists were also trained and certified to provide basic antimicrobial stewardship in all patient care areas of the hospital.

The Pharmacy Transformation further contributed to patient safety at Mackenzie Health through the redesign of the medication reconciliation process throughout the patients’ hospital journey. Pharmacy technicians were trained to take the best possible medication history from patients to facilitate medication reconciliation at the time that admission orders are being written by physicians. “Giving pharmacy technicians the opportunity to complete Medication Reconciliation at Admission has allowed us to work within our expanded scope and provide physicians with a comprehensive list of patients’ medications, making us an integral part of the care team and ensuring our patients are safe,” says Nisha Groodoyal, Registered Pharmacy Technician at Mackenzie Health. Pharmacists are also working collaboratively with the healthcare team at discharge to ensure patients are informed about changes to their medications as they transition out of hospital.

Mackenzie Health is committed to relentlessly improve care to create healthier communities and the Pharmacy Transformation journey is an example of improving patient safety, enhancing operational efficiency and delivering value to patients by maintaining momentum, adaptability in approach and change management techniques.

Catalina Guran is a Communications and Public Affairs Consultant at Mackenzie Health.