Sharing and adopting leading practices in the Military Health System is occurring across all levels of care, including in the pharmacy. Teamwork and collaboration across multiple care teams and locations is important to identifying these leading practices.

One way to identify leading practices is through tracers. The tracer methodology is used to follow the experience of care, treatment or service for patients through an organization's entire health care delivery process. These tracers are the cornerstone for Joint Commission accreditation.

Health care staff from the five clinics that make up the U.S. Army Medical Department Activity Bavaria participate together in quarterly tracers led by the Joint Commission Coordinators team. The tracers almost always reveal a leading practice that can be shared and adopted by other clinics.

Good labeling practices, proper storing of temperature sensitive medication products, maintaining an up-to-date policy binder, and following safety protocols when administering an injection are just a handful of the items being assessed during pharmacy tracers at the clinics in southern Germany.

Capt. William Kirby, chief of pharmacy at the Grafenwoehr Army Health Clinic, was participating in a pharmacy tracer being conducted at the Hohenfels Army Health Clinic when he noticed the clinic's well-organized immunization storage area. Adult and pediatric immunizations were separated and labels on the shelf identified when a vial had to be used before expiring.

"It's a perfect solution for vaccine storage in a medical area because it provides clear, color-coded details about the vaccine," Kirby said.

During the debrief at the end of the day, Kirby shared how impressed he was with the immunization storage practices. He learned the storage labels came from the Defense Health Agency Immunization Healthcare Branch and decided to adopt this leading practice at his pharmacy.

Other leading practices the immunization clinics in Bavaria have implemented to prevent patient harm include:

Putting important information such as age indications, uses, and route right on the labels.
Separating vaccines and medications that look and sound alike such as DTaP and Tdap.
Placing red alert sticker on high risk medicine bins.

Kirby explains "visual cues make key information obvious to the person stocking the shelves and the person administering the medicine. It's about making sure we're being safe every step of the way."

Maj. Victoria O'Shea, the pharmacy consultant with MEDDAC Bavaria and a medication management champion, is actively involved in the tracers to not only assess compliance, but keep an eye out for teachable moments.

O'Shea seeks opportunities for clinic staff to demonstrate how they carry out their day-to-day work. Through close observation, she finds teachable moments.

For example, at one clinic, she learned a staff member didn't know that Albuterol inhalers had to be primed. At another location she met a staff member who properly checked the EpiPen's expiration date, but didn't look to make sure the solution was clear and not discolored.

"The tracers are a way to make sure we observe how medication is handled throughout the facility and teach staff on the spot what they can do to improve," O'Shea said.

The sharing of leading practices during tracers is helping to standardize care around the region and help ensure high reliability.

Kirby believes the tracers are sustainable because the leadership at the five clinics and headquarters at MEDDAC are committed and they've been going strong. It started with a very small team in 2012 and has grown into a robust program today with representatives from all areas and service lines.

"It's on everyone's calendar because everyone is invested to make them happen," Kirby says. "If you're tasked to do a tracer, that is your main duty for the day."

For more information on MEDDACB clinics, visit http://rhce.amedd.army.mil/Bavaria/index.cfm