Dennis Tribble

A step in the right direction

Robinson's discussion of interdisciplinary teamwork leads us in an appropriate direction. While it is refreshing to hear that the academic community is working toward training people for this environment, it seems naive to believe that this effort alone will be sufficient to change behavior in the field.

Sense of community must shift

What is needed is a shift in our sense of community in the workplace, a broadening of our sense of who we are and what our place is in the larger patient-care environment. This is a top-down process and requires departmental leaders to exhibit demonstrable changes in behavior. A department in which the leaders maintain a pharmacy-centered (as opposed to patient-centered) view of the hospital is unlikely to build this alternative sense of community. So too is a department in which the leaders continue to speak of nursing as the enemy or the source of all woes. Leaders are needed who are visibly and constructively involved with other disciplines and who actively model this alternative behavior.

Trading places

Recently, I attended the unSummit for Bedside Barcoding in Louisville, Ky., where individuals discussing the successful deployment of a barcode medication administration (BCMA) system mentioned that the interactions between pharmacy and nursing had generally improved because the system's implementation encouraged members of both groups to "walk a mile in the other person's shoes."

Indeed, one organization described a formal process in which nurses spent time in the pharmacy and pharmacists spent time on the floors, with members of each group seeking to understand the impact of their behavior on the other department.

While a BCMA project can serve as an excellent vehicle for such a program, it seems appropriate that such a program should have value in its own right, at least for the leadership teams in each affected area.

No more basement drugstore

Pharmacy cannot continue to be a hospital's "drugstore in the basement." As discussed in both the ASHP Vision Statement for a Technology-Enabled Practice and the materials for the recent ASHP Pharmacy Practice Model Initiative, we will not find the true value of pharmacy practice through sitting in the basement staring at a computer screen. We will find it when we actually engage with other healthcare providers in the design of medication therapy at the bedside.

Sufficient data are now available to demonstrate that clinical involvement at the bedside not only reduces error; it also reduces length-of-stay and readmission rates, the key sources of healthcare cost.

For collaborative design of medication therapy and other, related unified practices to go forward, hospital pharmacy leaders must embrace the notion of pharmacy as a significant (but not the only) contributor to safe and effective practice, and they must lead the way into the larger healthcare team.

Dennis Tribble is chief pharmacy officer at Baxa Corporation ( http://www.baxa.com/).