The Impact: Pharmacy
Electronic access to patients’ health record to review clinical appropriateness of the order supported
with a more holistic view of the patient’s record. e.g., medication administration records, results of
investigations, progress notes, etc.
The status of a medication order once reviewed by pharmacy is readily available to the care team.
- Accept: everything is fine with the order
- Reject: the order is under review pending further clarification with the Prescriber
- Modify: 1 or more of the order details is not correct; pharmacist can modify details pursuant to a
clarification with the prescriber or within their own scope of practice - Cancel / Discontinue (or Void): order is inappropriate for the patient
Electronic Best Possible Medication History (BPMH) and Medication Reconciliation: Ideally will be prepopulated with medication history from previous admission or from Drug Information System (DIS) to
facilitate efficient review of home medications with patient/family or designated caregiver.
- Ability to directly relate home medication to inpatient medication
- Ease of reconciling BPMH into desired inpatient medications without transcription errors or omissions
- Ability to see home medications for decision making at all transitions in the inpatient journey
- eMAR available to view usage of PRNs and determine appropriateness of prescribing at discharge
- Easier to produce a Start, Stop Continue list for the patient on discharge
- Ideally, integration with DIS will facilitate electronic prescriptions to community pharmacies for NS
patients.
Computerized Prescriber Order Entry (CPOE): Electronic order entry will replace paper orders. Orders entered electronically, will be verified by pharmacists to ensure appropriate therapy and the appropriate product is available for administration.
Formulary and Inventory management: Electronic order entry processes will present Formulary medications to prescribers at the time of order entry, saving questioning calls from pharmacy. Perpetual inventory will be available to provide pharmacy (and hopefully prescribers) with stock availability/quantities.
Documentation: Pharmacy team members will document pharmaceutical care plans in the patient’s electronic health record. Ideally, there will be an electronic process for handover of clinical responsibility to another pharmacy team member for ongoing clinical services and an electronic process for communicating urgent issues to the pharmacy dispensary team for evening/overnight/weekend coverage.
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Consults: Providers can initiate a ‘Consult to Pharmacy’ electronically, indicating the reason (e.g., Warfarin monitoring). Pharmacists receive the consult electronically, complete the assessment, notify the originating provider via electronic messaging. The results of the consult are displayed in real time for all clinicians to view.