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