Organizational factors that create job stress correlate with an increase in frustration and the perception of obstacles to patient care by both nurses and pharmacists. In the spirit of a shared governance model, Stanford Hospital and Clinics' Nursing-Pharmacy Liaison Committee addressed the problem of missing medications. With the proposed changeover from a centralized to a decentralized pharmacy distribution system, nurses were presented with a brief satisfaction survey. After the full implementation of the decentralized satellite pharmacy system, there was a significant increase in nursing satisfaction regarding the timely availability of medications. This change in organizational structure helped to fulfill the organizational attributes of the Magnet Recognition Program.®
Proposing a change
To facilitate better communication and problem-solving capabilities, a Nursing-Pharmacy Liaison Committee was established in Januar y 2006. The biggest frustration between the nursing and pharmacy departments was missing medications, which soon became the committee's first order of business. Members of the committee identified that the issue of missing medications had increased over time since the implementation of a centralized pharmacy system, with teams of clinical pharmacists who provided services to the various specialties and distribution pharmacists who managed distribution services with the aid of pharmacy technicians. Distribution services included compounding I.V. solutions, restocking the automated dispensing cabinets, and filling orders for medications not available from the cabinets. However, with space constraints within the hospital, changing the centralized system didn't seem viable.
Although budgetary constraints may favor a centralized pharmacy distribution system, a decentralized, satellite-based pharmacy distribution system is associated with a more efficient use of nurses' time.1–6 The newly hired director of pharmacy proposed a change in the pharmacy distribution model to a satellite pharmacy system in which geographic areas would have both clinical and distribution services. The pharmacy satellites are part of a decentralized pharmacy model that promotes pharmacist involvement in rounding, responding to cardiac arrest and rapid response calls, clinically assessing new orders, reviewing medication profiles, monitoring therapeutic drug levels, reporting adverse drug reactions, and educating patients on discharge medications. The pharmacy department felt that a decentralized program would optimize patient care, as well as provide prompt service to fellow healthcare providers. The committee decided this change in pharmacy model would be an excellent opportunity to measure nursing satisfaction with each type of pharmacy distribution system.
A nursing satisfaction survey tool was developed based on work flow and time management issues identified by the members of the Nursing-Pharmacy Liaison Committee. The goal was to create a simple, quick tool to ensure maximum participation. A brief satisfaction survey was distributed to the nurses on the Nursing-Pharmacy Liaison Committee who weren't serviced by a satellite pharmacy (the ICUs and the OR had pharmacy satellites). Those nurses took the surveys to the unit councils and distributed them, either via email or on paper, to the staff in May 2006. The anonymous responses were then collated (N = 305).
The geographic area pharmacy satellites were opened over a period of 20 months and went from two satellites to 10. Nursing units that came under the satellite system were surveyed again in November 2007 (N = 309). Every parameter showed an increase in nursing satisfaction from 10.17% to 35.79% (Figure 1).
Recognizing Magnet® excellence
One of the components of the Magnet Recognition Program is interdisciplinary collaboration so that all healthcare providers can incorporate professional, evidence-based, technologically current, safe continuity of care for patients.7 In the complex structure of today's healthcare setting, no discipline can achieve its highest level of practice in isolation. That's why interdisciplinary liaisons are so important in our workplace and fundamental to the shared governance model. A pharmacy distribution system has a profound impact on both nursing and pharmacist job satisfaction and performance. Technology can't replace personal communication.
There was a marked improvement in nursing satisfaction with the decentralized distribution system. In fact, satisfaction increased even in two questions that shouldn't have made a difference (availability of medications from the automated dispensing cabinets and availability of medications accessible via the override function) because neither of these functions changed in the transition from the centralized distribution system to the satellite distribution system.
Nursing satisfaction with pharmacy distribution services increased with the changeover from a centralized to a decentralized distribution system. This shift allowed for better allocation of time management and improved quality of care. The use of a survey was beneficial because it provided evidence-based information to the hospital administration, helping to prove that the switch was a success.
Always strive to improve
Because there are shortages in the nursing and pharmacist professions, job satisfaction plays a significant role in retention. This project was an example of not only how to achieve Magnet excellence, but also how to gauge employee satisfaction and what to do in cases where improvements must be made to help retain jobs and improve patient safety.
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