FOR 20 YEARS I WAS A MINISTER. OVER THE PAST 11 years, I have been studying, writing and consulting in the field of medication-use automation. Along the way, I have discovered that, more often than not, hospital purchasing decisions have been vendor-driven, rather than visionbased. And that makes me want to preach.

It has been a while, but I have a pretty good text for a sermon—a policy position statement taken from the ASHP Bible:

Optimizing the Medication-Use Process:
“To urge health-system pharmacists to assume leadership responsibility and accountability for the quality, effectiveness, and efficiency of the entire medication-use process (including prescribing, dispensing, administration, monitoring, and education) across the continuum of care, further;

“To urge health-system pharmacists to work in collaboration with patients, prescribers, nurses, and other health care providers in improving the medication-use process.”1

My sermon needs but three points and a poem.

Each Christmas, our family puts together a jigsaw puzzle. While some folks may consider it cheating, once we have turned all the pieces right side up, we fight over the box. We need a vision for the puzzle before us. Applying automation to the medication-use process is like putting a jigsaw puzzle together.

1) A clear vision is needed.
The medication-use process may be made more or less safe by applying technology. When automating any part of the process, here is the axiom: Any system being implemented should be as safe or safer than the system being replaced. In other words, the new way should make it easier for caregivers to do right, and make it harder for them to do wrong.

The automation picture we are putting together ought to result in improving the medication-use process.
In addition to a clear vision...

2) A shared vision is essential.
This shared vision should be the result of pharmacists collaborating with prescribers and nurses.

Safe medication practice begins with the physician assessing and ordering, followed by the pharmacist reviewing, approving and (if necessary) consulting, and then proceeds with the nurse verifying, administering, and documenting. Too often, this process ends up being a series of disparate handoffs between the three parties, without a clear and shared vision to unify the process.

Likewise, too many automation decisions are made in isolation. Physicians focus on obtaining order entry systems, while pharmacists zero in on distribution technologies and nurses become absorbed with dispensing cabinets and/or pointof-care scanning systems. Bits and pieces of automation are independently selected and installed without a master plan, as if three separate puzzles were being put together.

When all three professions bring their puzzle pieces to the same table, the impact on medication safety stands to be greater than the sum of their individual contributions.

However, such collaboration does not just happen.

3) Leadership is required.
One Saturday night, a preacher was reviewing notes for his Sunday sermon, when he wrote in the margin: weak point, yell like hell. There is no need for me to yell about this third point.

If pharmacy does not provide the leadership, your hospital may never formulate the clear and unified vision required for a safer medicationuse process. Likewise, without intentional leadership from the pharmacy, automation will probably be applied in a way that frustrates— rather than fulfills—that vision.
From lack of such leadership, too many hospitals settle for automation decisions that are, as previously noted, vendor-driven, rather than vision-based. This is simply unacceptable.

There is not enough holiday time for any one person in our family to do the Christmas puzzle alone. So I am grateful that everyone pitches in. Yes, we fight over the pieces. But we feel good when, along the way, the sections we are working on fall together with our neighbors’. One yahoo always claims he did more work than the rest, and another holds out the last piece to boast that she finished the project. But we all are satisfied when the picture is complete.
As for me, well, I take credit for this, at least: I am the one who gets everyone into the living room to put the thing together.

In conclusion—as promised—a poem:

Who will convene the collaboration to avoid an automated elaboration of the past?
If not the pharmacist you then I must persist who?

I hope I am preaching to the converted.

Mark Neuenschwander is president of the Neuenschwander Company and a recognized expert in medication-use automation. He can be reached at mark@hospitalrx.com.

1 Position Statement ASHP Council on Administrative Affairs (9903)