When it comes to medications, patients are likely unaware of the level and complexity of training, care and time involved. The members of Sunnybrook’s Inpatient Pharmacy Services team work closely together to get medications custom-prepared, meticulously checked, uniquely barcoded, securely packaged and then delivered on time.
These pharmacists and pharmacy technicians – all certified by the Ontario College of Pharmacists – manage and prepare medications daily for more than 500 patients at the hospital’s main Bayview site. They also monitor medications for patients in specialized rehabilitation at St. John’s Rehab and for residents in long-term care at the Veterans Centre.
“We provide a vital medication distribution service to the hospital. We’re part of the care team. Our expertise helps ensure that patients are taking the most suitable medications at the different stages of their care,” says Scott Walker, director of Pharmacy Services. “And because we know it helps patients to adhere to their medications once they get home, we counsel them on how they should take them, manage dosages and avoid potential side effects.”
Medication orders, checks and balances
When patients arrive at Sunnybrook, Inpatient Pharmacy Services gathers data about their medications, using information from a range of sources as well as a careful interview with the patient. Known as a Best Possible Medication History (BPMH), this procedure gives valuable context on how patients’ medications will be ordered by their physicians and managed.
A precise process
Approximately 90,000 orders are downloaded every month, with pharmacy technicians carefully packaging medications according to the medication orders in each patient’s file.
Full-dose tablets that are safe to handle, such as ibuprofen, are packaged using a gravity-feed machine that drops each tablet into a clean single-pocket bubble pack that is then sealed.
Medications given to patients by intravenous methods or by injection must be sterile, and these are prepared and packaged by specially trained pharmacy technicians.
Safe handling and storage
Some medications are toxic to staff and to patients who have not been prescribed those products. To minimize exposure, many of these medications arrive at Pharmacy Automation, already individually packaged by the pharmaceutical suppliers. At Sunnybrook, to ensure safe handling, each medication is sealed with overwrapper, barcoded and then hung on storage pins in a large dispensing robot along with other robot-ready packaged medication.
The robot has a mechanical arm with a sensor. The arm reads the barcode of the medication that links to an individual patient’s file number and medication order. Using sensitive suction cups, the robot then gently pulls a day’s worth of medication off the pin for each patient before placing the medications into a dedicated bin.
Medication bins are then taken to satellite pharmacy locations in the hospital, where any updates are done. Throughout the patient’s care, pharmacists consult with physicians to recommend medication changes, check orders for potential drug interactions and allergic reactions, and ensure that medications are working well.
Photography by Kevin Van Paassen