Post on 25-Apr-2018
Ms S C Chiang BPharm, MRPS, MHA, FACHSE, FHKCHSE, FCPP
Senior Pharmacist Chief Pharmacist’s Office
In-Patient Medication Order Entry System
- contribution of pharmacy informatics
In-Patient Medication Order Entry System (IPMOE)
• It is a “close-the-loop” medication management system for in-patient care
Pharmacy Informatics – our major roles in the process
1. Re – design workflow processes for
doctors, pharmacy and nurses to replace the traditional manual processes
2. Build common drug orders, creating drug data to support e-prescribing
3. Enhance the Drug Distribution and Administration processes
Beyond just another system implementation !
Drug Distribution & Administration System before IPMOE
Nurses drug administration
Drs prescribing
Manual Manual
MAR
Pharmacy vetting , dispensing & inventory control
PMS / CARS
Ward issue / top up
At the ward level
At the pharmacy
Manual
dispensing Pre-packing
Fax /NCR
Hand written MAR
Before IPMOE
Manual dispensing workflow in Pharmacy with Paper Medication Administration Records (MAR)
- MAR By fax from wards, first come first serve
- No work prioritization
- Transcribed from MAR to Pharmacy computer system
- No clinical checking on MAR at manual prescription process
- MAR information not synchronised with Pharmacy inactive order not captured in pharmacy system
- drugs may not be sent to the ward on time
- transcription error
- unnecessary dispensing
- ward return of unused medication… …
Issues:
IPMOE Ordering module - the design principles and
drug data support from behind
IPMOE Prescribing IPMOE Prescribing screen
1 Permissible Route
3 Permissible Diluent
2 Common Order: Dilution Method, Diluent, Volume, Infusion Duration
Drug Master Database support all drug orders in IPMOE
Common Order
ONE click orderable common orders are maintained by pharmacists - Drug specific - Age specific - With dilution volume and infusion time (if applicable)
Configurability on Common Orders by
Hospital Pharmacist
Permissible Route/ Diluents
Permissible Route
Prescribing through IPMOE – one click orderable
Permissible Diluent
Permissible Route
Common Order
Permissible Diluent
Drug Master Database support all drug orders in IPMOE
• Large Scale Data Maintenance by pharmacist informatics
• Pharmacists review the drug inserts for each injectable product to create common orders
• Maintain permissible route/diluents of administration for each drug depending on product source
Data Maintenance Process
Our pharmacist Review the product inserts of over
a thousand products
Data Maintenance Process
Verification by second Pharmacist on the common
orders maintained
Tedious but Essential process
IPMOE Pharmacy module - reengineer dispensing workflow
Workflow in pharmacy after IPMOE
• System Workflow & the Related Key Features
Pharmacy Inbox Clinical Verification
Due Order Label Generation
Drug Status Checking
Send Out
1. Collecting the drugs with Labels
2. Drug Identity Checking
1. Pharmacy Inbox – REAL TIME UPDATE of all IPMOE drug orders in pharmacy Prioritize pharmacist’s work in accordance to the urgency of the order
X
4
Clinical verification – share the same profile as doctors and nurses; with active and inactive drugs showing in the same platform
2. Due Order Label Generation
Due Order Label Generation
With Item Status Checking, to reduce “no need to dispense” items Item status : • Urgent • Stat • New • Refill
Generate the label in accordance to the drug administration due time (Prioritization of Work) Can group the label in accordance to the urgency – Urgent, Stat orders Apply status checking in label printing
Print out the Dispensing Transaction report
- To support the dispensing workflow in pharmacy
- The drug items dispensed in that batch are summarized in ward basis
Drug label
- The 2D code is used to support the IPMOE drug administration process
Drug labels for dispensing
Dispensing Transaction report by ward
To interface to Automatic Dispensing machines for oral solid dose forms
Unit Dose Pouches
Each pouch is printed with Drug Information and Barcoded. Back of pouch is transparent for visual check of the drug (manually or automated by machine).
Other dosage formulations
• For oral solids not suitable for packaging by ATDPS → manually packed into full quantities (i.e. status quo)
• Other dosage forms will continue to be dispensed with patient name, drug name & strength & bar coded
→ made available together in the drug rounds
3. Drug Status Checking
Check the order status + Update the transaction status in the system
Scan & Check – the system will alert the user when there is exception detected
3. 1 Drug Order Status Checking
- Check the drug status before it is dispensed to the ward
- Alert pharmacist, if the orders are ended, modified
- Alert pharmacist, if the patients are discharged
- Further minimise unnecessary dispensing, further minimise ward return
- Update the status of each order to “Checked”
Major objectives in the Drug Order Status Checking Function:
1. Order status checking
2. Order status update
When no exception is detected, the delivery label will be printed upon checking complete
3. 2 Drug Order Status Checking (Delivery Label Printing):
- This delivery label will be adhered on the drug parcel
- System driven printing
- Automatically retrieve the Delivery Location for the batch
- Minimise the risk of writing the wrong delivery location which may lead to possible delay of treatment
- Important information can be printed on the delivery label as visual alert for the nurses
If exception is detected, the system will alert the user for follow up
4. Send Out
4. Send Out:
- At the point of picking up the drug from pharmacy, the supporting staff shall scan the 2D code on the delivery label
- The system will update the “Sending Out” time of each drug in the batch
- The time is logged in the system
• Work prioritization in accordance to the drug administration due time
• Urgent go first, Just-in-time dispensing
• Drug order status checking, minimize unnecessary dispensing, minimize redundancy
• Time stamp throughout the process, enable the track-and-trace of each drug in the production line
• Medication Decision Support Checking at the point of care
• Auto-conversion, minimize transcription
1. Pharmacy Inbox Clinical Verification
2. Due Order Label Generation
3. Drug Order Status Checking
4. Send Out
Enhanced workflow in Pharmacy after IPMOE
Faster
Better
Safer
Nurse will prepare the drugs in accordance to the due order list in e-MAR Verify patient’s identity at bedside and give the drug to the patient
IPMOE enhanced the DDAS workflow at pharmacy & ward
Drug Order Information
eMAR
Dispensing Workflow
Vetting
Dispensing Workflow
Automated Dispensing
Dispensing Workflow
PIVAS
Dispensing Workflow
Others
Point-of-Care BCMA
Scheduled Drug Rounds
Point-of-Care BCMA
Verification & Documentation
Nurses drug administration
Pharmacy vetting & drug dispensing
Drs prescribing
Synchronised Information flow + Enhanced procedures + Bar code drug products
Leading to safer, faster and smarter patient care
Acknowledgement
• Design and development teams (CPO + HI + IT )
• Implementation & Project Management Teams
• Frontline staff
– Clinicians, Pharmacy staff and Nursing staff