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Electronic pharmacy solutions

March 1, 2010
by J. Wayne Brannock, CPHQ, CPHRM
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J. wayne brannock, cphq, cphrm
J. Wayne Brannock, CPHQ, CPHRM


Education prior to implementing an electronic pharmacy is the key to success. Many electronic pharmacy solutions have proven to be cost-effective by enhancing formulary compliance, decreasing the amount of drugs dispensed, eliminating salary burden for order reconciliation, and most importantly, increasing resident safety to decrease risk liability.

Electronic pharmacy solutions are now becoming commonplace offerings by pharmacy and electronic medical record vendors to the long-term care industry. The challenge for the long-term care provider is to determine what solution best fits the organization's needs.

Electronic pharmacy solutions are comprised of four basic components:

  1. Computerized Physician Order Entry (CPOE)

  2. Drug delivery and packaging

  3. Electronic Medication and Treatment Administration Records

  4. Reporting, communication, and dashboard solutions

Computerized Physician Order Entry, commonly known as CPOE, is the basis of the electronic pharmacy/medical record solution. When evaluating this component there are several factors to consider. CPOE should enhance resident safety by providing an intuitive methodology for the basic order entry functions that provides a logic-based approach to the order entry process. The process should involve a minimum of free text typing for the entry of the drug name and the ability to customize this process to include various types of customizable formularies is extremely important. The use of drop-down boxes, preset dosing, duration, and frequency should also be evaluated. Most importantly, you should not be able to enter an order that will cause harm to the resident. The logic in the CPOE system should, at a minimum, have alerts for allergies, drug-drug interactions, over/under dosing, and incorrect route of administration. In short, you should not be able to order “Aspirin 2GM via IV q2hours.”

Computerized physician order entry systems make the drudgery of the end of month order reconciliation go away. Since the orders are in real time, your orders are always current.

Cost effectiveness

The drug delivery and administration system should be cost effective by limiting the amount of medication delivered, packaged so that there is minimal package opening, and most importantly, the packaging should be barcoded to the resident, drug, dosage, route, time, and time of administration. The system should also have a feature for timely drug reordering. Some systems also have resources for nursing staff such as drug information, printable drug fact sheets for resident education, and online images and description of the medication.

The electronic medication administration record and electronic treatment administration record have multiple functions aside from the obvious as a site to document drug and treatment administration. This system should assist the end user to organize his or her workflow by showing the tasks that need to be accomplished in measurable units. In other words, showing the nurse what medications and treatments are due within a specific time frame to promote compliance in the medication pass time frame. The eMAR/eTAR should also have a logical sequence for the nurse to use in pouring, administering, and documenting medication or treatment administration. This should be linked to a barcode scan on the medication packaging-thus promoting safe administration practices. The program should also be able to link tasks such as vital signs, pain scores, administration, and treatment sites to a medication and/or treatment. Many programs have the ability to “remind” nurses of the tasks that are overdue and/or that have not been signed off. The system should have the ability to print a legal MAR that contains all resident demographics, medications, administration times, and nurse identifiers and nurse signatures.

Valuable tools

Reporting, communication, and dashboard features are valuable tools in providing quality care. The ability to run all types of customized reports for quality monitoring without having to request them from the pharmacy provider or have to wait until the end of the month enhances the facility quality program. Some systems have the ability to electronically communicate with the pharmacy provider so that the telephone becomes obsolete. Enhancements such as the ability to electronically request a medication review by a pharmacist are also available. Electronic dashboards that show medication usage, practice patterns, and drug costs have been developed and assist the facility in managing its formulary and drug costs.

Determining the right electronic pharmacy solution for a facility not only takes into account the cited factors, but other concerns in this age of technology. What about the nurse who has never touched a computer? Will this cost too much? If you educate the nurse and the system is intuitive, you will not have a problem. This is the nurse that you want to use in the preliminary evaluation process to see if the program is user friendly and easily teachable. Education prior to implementation is the key to success.

Many electronic pharmacy solutions have proven to be cost-effective by enhancing formulary compliance, decreasing the amount of drugs dispensed, eliminating salary burden for order reconciliation, and most importantly, increase resident safety to decrease risk liability.

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