therapists, social workers, respiratory technicians, and dieti-
tians, thus eliminating the handwriting problem in this step of
the process.
The patient-care units were equipped with laptop and wall-
mounted personal computers to handle the increased number
of health care professionals who needed access to the new
charting system. With the physical structure and tools for the
unit-specific pharmacist system in place, we then had the op-
portunity to introduce a clinical program in which the phar-
macist was removed from the physical confines of the phar-
macy department in order to become more visible and
accessible to patients (Figure 1).
Because the hospital lacked many of the scientific resources
that were needed for original research and evaluation, we did
not have the guidance of research-design experts to facilitate
these goals. Despite these obstacles, however, we were not hin-
dered in our commitment to maximize effective and safe patient
care and to minimize medication "occurrences" (defined as ad-
ministration and dispensing errors, along with prescribing
and handwriting problems). In fact, our smaller size has al-
lowed us to communicate effectively within our multidisci-
plinary health care team and to react to our findings and ob-
servations quickly and efficiently.
After evaluating our resources and the tools at hand, we de-
veloped a campaign to prevent medication occurrences. The
program, which emerged in early 2001, has since expanded to
include clinical patient programs that were not initially in-
tended. It is still expanding dynamically, driven by needs aris-
ing from all of the various hospital disciplines.
ROLE OF THE UNIT-SPECIFIC PHARMACIST
When the program began, our hospital established the re-
duction of medication occurrences as its principal performance
improvement initiative; it remains the chief criterion today. Al-
though the literature has pointed to CPOE systems as a verita-
ble panacea, it may be many years before CPOE can be a reality
for all community hospitals. The unit-specific pharmacist fills that
void and is targeted at most of our institution's populations, from
psychiatric to medicalsurgical to oncology patients.
The program was organized to have an impact on the fol-
lowing areas covered in the Comprehensive Accreditation Man-
ual for Hospitals
: the care of patients, the continuum of care,
the improvement of organizational performance, and the man-
agement of information, medical staff, and nursing. Along the
INTRODUCTION
The Institute of Medicine (IOM) and the Institute for Safe
Medication Practices (ISMP) have highlighted serious hospi-
tal and medication errors, many of which have culminated in
fatalities. Health care institutions, along with the Clinton ad-
ministration, joined in a nationwide push to implement pro-
grams to prevent medication errors. On the governmental
level, task forces were developed and hospitals responded by
integrating efforts and mobilizing many departments (e.g.,
pharmacy, nursing, administration, information systems) to a
degree not seen before. Multilevel expectations increased ex-
ponentially, and computer prescriber order entry (CPOE), for
the most part, was only a futuristic idea.
The John T. Mather Memorial Hospital, with 248 beds, is
unique; it is not affiliated with any university hospital or with
any other multihospital system. Our staff strives for excel-
lence and provides modern, state-of-the-art health care services
to patients in the community. We responded to the challenge
to prevent medication errors by developing a unit-specific
pharmacist (USP) program.
To bring this program to fruition, we realized that careful
scrutiny of the limited, available resources was essential. Our
pilot program showed us that one full-time pharmacist could
effectively handle one floor of the hospital. This floor included
an intensive-care step-down unit, a coronary-care unit, a
telemetry area, and a medicalsurgical patient-care area. We
assumed that we could accurately keep the expenses in check
and that we could realize a return on our investment through
a proactive approach to pharmacy practice.
The hospital, like many others, was plagued with the prob-
lem of illegible handwriting--a factor often exacerbated by the
hospital-wide faxing system. Many of the common problems
outlined in pharmaceutical publications (e.g., medication ab-
breviations, look-alike and sound-alike drugs, trailing and lead-
ing zeros, and lag time from the actual order to the adminis-
tration of the medication as a result of unclear medication
orders) also needed to be addressed. Our management infor-
mation systems department had completed the first few phases
of a wireless charting system for the nursing staff, physical
Mr. Santorello is a Clinical Pharmacist in Clinical Pharmacy Services,
Ms. Larios is Director of Pharmacy Services, and Mr. Dougherty is a Clin-
ical Pharmacist in Clinical Pharmacy Services, all at John T. Mather
Memorial Hospital in Port Jefferson, New York.
Unit-Specific Pharmacists:
A Proactive Approach to the Continuum of Care
Jeffrey G. Santorello, MS, RPh, Olga Larios, MS, RPh, and Joseph Dougherty, RPh
ABSTRACT The need to respond to required mandates and
to improve patient care has prompted hospital pharmacies to
redefine their role as a part of a multidisciplinary health care
team. This article discusses one hospital's proactive approach
to satisfying these mandates while simultaneously enhancing out-
comes using the resources of a community hospital's pharmacy.
Using a unit-specific pharmacist (USP) allows smaller hospitals
to focus on patient care with greater flexibility and minimal in-
creases in staffing.
Vol. 28 No. 1 · January 2003 ·
P&T
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