In-Patient Medication Order Entry System - contribution of pharmacy informatics

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1 In-Patient Medication Order Entry System - contribution of pharmacy informatics Ms S C Chiang BPharm, MRPS, MHA, FACHSE, FHKCHSE, FCPP Senior Pharmacist Chief Pharmacist s Office

2 In-Patient Medication Order Entry System (IPMOE) It is a close-the-loop medication management system for in-patient care

3 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!

4 Drug Distribution & Administration System Drs prescribing Manual MAR before IPMOE At the ward level Nurses drug administration Manual Fax /NCR At the pharmacy Pharmacy vetting, dispensing & inventory control PMS / CARS Manual dispensing Pre-packing Ward issue / top up

5 Hand written MAR Before IPMOE

6 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 Issues: - drugs may not be sent to the ward on time - transcription error - unnecessary dispensing - ward return of unused medication

7 IPMOE Ordering module - the design principles and drug data support from behind

8 IPMOE IPMOE Prescribing screen 1 Permissible Route 3 Permissible Diluent 2 Common Order: Dilution Method, Diluent, Volume, Infusion Duration

9 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)

10 Configurability on Common Orders by Hospital Pharmacist

11 Prescribing through IPMOE one click orderable Permissible Route/ Diluents Permissible Route Permissible Diluent

12 Drug Master Database support all drug orders in IPMOE Common Order Permissible Route Permissible Diluent 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

13 Data Maintenance Process Our pharmacist Review the product inserts of over a thousand products

14 Data Maintenance Process Verification by second Pharmacist on the common orders maintained Tedious but Essential process

15 IPMOE Pharmacy module - reengineer dispensing workflow

16 Workflow in pharmacy after IPMOE System Workflow & the Related Key Features 1. Collecting the drugs with Labels 2. Drug Identity Checking Pharmacy Inbox Clinical Verification Due Order Label Generation Drug Status Checking Send Out

17 X 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

18 4 Clinical verification share the same profile as doctors and nurses; with active and inactive drugs showing in the same platform

19 2. Due Order Label Generation

20 Due Order Label Generation 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 With Item Status Checking, to reduce no need to dispense items Item status : Urgent Stat New Refill

21 Dispensing Transaction report by ward Drug labels for dispensing 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

22 To interface to Automatic Dispensing machines for oral solid dose forms

23 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). Unit Dose Pouches

24 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

25 3. Drug Status Checking Check the order status + Update the transaction status in the system

26 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 Scan & Check the system will alert the user when there is exception detected

27 When no exception is detected, the delivery label will be printed upon checking complete

28 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

29 If exception is detected, the system will alert the user for follow up

30 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

31 Enhanced workflow in Pharmacy after IPMOE 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 Faster Better Safer 1. Pharmacy Inbox Clinical Verification 2. Due Order Label Generation 3. Drug Order Status Checking 4. Send Out

32 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

33 IPMOE enhanced the DDAS workflow at pharmacy & ward Drs prescribing Pharmacy vetting & drug dispensing Nurses drug administration emar Vetting Automated Dispensing PIVAS Others Scheduled Drug Rounds Verification & Documentation Drug Order Information Dispensing Workflow Dispensing Workflow Dispensing Workflow Dispensing Workflow Point-of- Care BCMA Point-of- Care BCMA Synchronised Information flow + Enhanced procedures + Bar code drug products Leading to safer, faster and smarter patient care

34 Acknowledgement Design and development teams (CPO + HI + IT ) Implementation & Project Management Teams Frontline staff Clinicians, Pharmacy staff and Nursing staff