Lynn Eschenbacher
Medication Safety Officer
Duke University Hospital
“What is very interesting about the role is that any time a medication is involved in anything, it comes to me.” (1:12)
My name is Lynn Eschenbacher. I am the Medication Safety Officer at Duke University Hospital. Duke University Hospital is part of a health system; it’s Duke University Health System or Duke Medicine. We have a community hospital, which is Durham Regional, and Duke Health Raleigh, which is another regional hospital, and then the actual hospital I work at, Duke Hospital, is over 900 beds. It’s a private hospital, but it’s a not-for-profit hospital.
I’ve been the Medication Safety Officer for about three years now. What is very interesting about the role is that any time a medication is involved in anything, it comes to me as well. Medications are provided to patients every minute of the day, so I get involved in a lot of different things. But basically Medication Safety Officer is anything from understanding proactive approaches, [such as understanding what to do when] we get a new medication in, to reactive — an event has happened, what was the root cause of the event, how can we prevent the event from happening in the future, understanding what systems failed in the event, and what designs we can do to make it better for the next time so that the event doesn’t happen again. And then, of course, all the other work of safety initiatives — culture of safety, just culture, things like that.
“It’s exhilarating, but also challenging at times. Because…nobody understands what the role is capable of doing.” (1:30)
I’m the type of person that, when I was the clinical pharmacist on the floor, I would see something not so right and I would feel frustrated because I wouldn’t know how to fix it, and I wouldn’t know who the right people were to talk to, to fix it. And I would know that if it didn’t get fixed on my shift, it wouldn’t get fixed for any other shifts. So I knew all along that this is what I enjoyed doing, and I have a passion for taking care of our patients. I mean, those are our mothers, our fathers, our brothers, our sisters, and you know, our own colleagues, our own nurses and pharmacists, who may be patients at some time. So I didn’t know that I’d be called a Medication Safety Officer, but I knew that I would be doing this type of work.
It’s exhilarating, but also challenging at times. Because, since it’s never been done, nobody understands what the role is capable of doing. I think that’s why I get involved in everything, because we’re still trying to define the role. Where can I be most effective? Where is my biggest impact? I’ve become sort of a central hub of a lot of information. So we implement smart pumps, and we’re doing technology for nursing documentation, and we’re working on, you know, medication reconciliation. I’m sort of like an internal consultant who has a vast amount of knowledge about a lot of different pieces of the puzzle.
There’s actually an association of Medication Safety Officers. There’s a web group that’s started. Sometimes they’re called Medication Safety Coordinators, or they’re pharmacists who have other responsibilities who have an interest in medication safety. What we’re really pushing for in the pharmacy world is that it’s a dedicated, full-time position because there is the work for that.
“One of the things that we recognized was, as senior leadership, we talk a lot about safety, but the front-line wasn’t quite feeling it the same way we were.” (1:47)
One of the things I’ve been most effective with is relationships, and I know the right people to go to when we need to get something done. So that’s one of things that I’m most proud of. The other is the system changes and the culture of safety such that when we know that we have an event associated with opiates, or we’re proactive about opiates, we have done a complete Failure Modes and Effects Analysis around patient-controlled analgesia; and we’ve been able to identify why errors happen and respiratory depression occurs. We’ve been actually able to make some system changes that have decreased the number of respiratory depression events that have happened at the hospital.
The third thing that I’m most proud of is that we’ve started something new called “Safe Choices,” and it’s a program talking about the behavioral choices that our front-line staff makes on a daily basis and how that directly impacts the patient. Because one of the things that we recognized was, as senior leadership, we talk a lot about safety, but the front line wasn’t quite feeling it the same way we were and didn’t quite get it. And so we recognized that we see the events all the time, and we talk about it and that’s all we talk about; but the front-line staff is busy taking care of the patients and caring for their needs. So how do we bring what we know to them?
So the thinking would be, “take an extra step or pause — that I’m doing something critical and important that could impact the outcome of this patient.” You know, we’re supposed to check two patient identifiers before giving a medication to the patient. If they don’t, there’s a likelihood that an adverse event may happen. The patient may get the wrong drug, the wrong dose may be given to the wrong patient; and so what we’d hope by the Safe Choices is that people would recognize that the choice they make to check an ID or not actually impacts the patient.
“I think that one of the most important things is to listen to the front-line and hear what they’re saying because they know how to fix the problems.” (1:04)
I have what’s called a Medication Safety Leader who is embedded in each clinical service line, and I work with them directly to make sure that they know what events have happened in their area. And I make sure that we work collaboratively so I know what they’re working on so that I can share it with the next clinical service line. One of my big focuses is to make sure that we’ve empowered the front-line. I can’t do it all. I’m here to facilitate, to bring the information together, to get the information out to those who need it, but the most important is that locally embedded, operational front-line resource that is able to make the change. And who better to make the change than those people who live it on a daily basis? I think that’s one of the most important things is to listen to the front-line and hear what they’re saying because they know how to fix the problems. I just help to identify where they are, bring whatever techniques and principles I can to it; but at the end of the day, they have to practice it on a daily basis. It has to fit into their workflow, and so I work really closely with these Medication Safety Leaders that are embedded throughout the organization.
“Our pharmacists round, make recommendations, enter the orders, so they’re a complete part of the team.” (1:18)
I think at Duke Hospital we definitely have a very proactive model with our pharmacists. We’re very lucky that we have a decentralized model, and a decentralized model means that we have clinical pharmacists on the floors, rounding with the physicians, all of our pharmacists have a laptop, and we have an integrated model such that our pharmacists round with the physicians but also enter their orders. So we don’t have a separation. Some pharmacies have a separation where there’s just a corps of pharmacists in a remote or other location who just enter orders all day. Our pharmacists round, make recommendations, enter the orders, so they’re a complete part of the team. If the pharmacist isn’t there, they [the physicians] notice that the pharmacist isn’t there, and they’ll page them, and they’ll say, “Where are you? We’re starting rounds.” Because they know how essential their pharmacist is to the team.
We’re an academic medical center, and so often the attending changes, the residents change, the interns change, nurses change on a daily basis; but what we find is that our pharmacists are assigned to an area, and so they become very specialized or highly educated on that patient population. And they may know that patient who’s been there for 20, 30-plus days, and they’re able to provide the oncoming physician team history about that patient. So when we talk about handoffs and communication, our pharmacist is really there to help it along the way.
05/07/2008
