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Development & Maintenance of Medication Related Aspects of Electronic Health Records

2016 ANNUAL MEETING

Christina Robinson, Pharm.D., BCPS Pharmacy Clinical Informatics Coordinator

DisclosuresI do not have (nor does any immediate family member have) a vested interest in or affiliation with any corporate organization offering financial support or grant monies for this continuing education activity, or any affiliation with an organization whose philosophy could potentially bias my presentation

2016 ANNUAL MEETING

Disclosures• I have no disclosures

2016 ANNUAL MEETING

EXCEPT…

I Being in Pharmacy Clinical Informatics!!!

Objectives

• Describe the process for development and implementation of evidence based electronic order sets

• Illustrate the process for development and implementation of rules based alerts and clinical decision support (CDS) tools

• Construct examples of a process for maintaining and evaluating the effectiveness of these tools in the electronic medical record

2016 ANNUAL MEETING

Swiss Cheese Theory

2016 ANNUAL MEETING

What Defenses Can We Use to Prevent the Holes from Lining Up?

a) Optimizing the Configuration of the Clinical Informatics System (CIS)

b) Loose pieces of paper with handwritten notes passed from one shift to another

c) Effective electronic communication tools that are retained within the CIS

2016 ANNUAL MEETING

Answer: a & c

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Who’s Needs Should be Considered When Developing the CIS?a) Prescribers:CPOE, Alerts, Medication Reconciliation

b) Pharmacists: Verification, Alerts, Reminders

c) Nurses: Order & Task Summaries, Barcoding

d) Patients: Safety, Education, Accurate Documentation

e) Revenue Integrity/Finance: Accurate Charging, Meaningful Use Measures

f) Medication Safety Coordinators & Risk Management

g) All of the above

2016 ANNUAL MEETING

Answer: g

Evidence Based Order Sets –Optimization of System Configuration

• Bupivacaine Liposomal (Exparel®)

• Acetylcysteine IV Therapy

• Alteplase for Stroke and Acute Myocardial Infarction (MI)

• Pneumonia

• Enoxaparin and Fondaparinux

• Heparin Protocols

2016 ANNUAL MEETING

2016 ANNUAL MEETING

Bupivacaine 1.3% Liposomal (Exparel®)

2016 ANNUAL MEETING

Bupivacaine 1.3% Liposomal (Exparel®)

2016 ANNUAL MEETING

Bupivacaine 1.3% Liposomal (Exparel®)

Bupivacaine Liposomal Label & Kit

2016 ANNUAL MEETING

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2016 ANNUAL MEETING

Bupivacaine 1.3% Liposomal (Exparel®)

2016 ANNUAL MEETING

Bupivacaine Liposomal- Utilization of Allergy Screening

2016 ANNUAL MEETING

Bupivacaine Liposomal- Utilization of Allergy Screening

2016 ANNUAL MEETING

Bupivacaine Liposomal- Utilization of Allergy Screening

2016 ANNUAL MEETING

Bupivacaine

Liposomal -

Utilization of

Allergy

Screening

2016 ANNUAL MEETING

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2016 ANNUAL MEETING

Bupivacaine Liposomal – Education by RN

2016 ANNUAL MEETING

Bupivacaine Liposomal –RN Charting x96 hrs post-op

2016 ANNUAL MEETING

2016 ANNUAL MEETING

Pharmacy SBAR – Build a Patient List

SBAR: Situation, Background, Assessment, Recommendation

2016 ANNUAL MEETING

PharmacySBARGoes to the Pharmacy Worklist

2016 ANNUAL MEETING

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2016 ANNUAL MEETING

Acetylcysteine IV Therapy v1.2

2016 ANNUAL MEETING

2016 ANNUAL MEETING

Weight-Based Medications

And Dose Caps

2016 ANNUAL MEETING

2016 ANNUAL MEETING

2016 ANNUAL MEETING

A Wise Man Once Said: ‘It always comes down to the labels.’

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2016 ANNUAL MEETING

Nursing Worklist

2016 ANNUAL MEETING

Alteplase Bolus and Infusion for Stroke

2016 ANNUAL MEETING

Alteplase Bolus for Ischemic Stroke

2016 ANNUAL MEETING

AlteplaseInfusion for Ischemic Stroke

2016 ANNUAL MEETING

NS Order to run post

Alteplase

2016 ANNUAL MEETING

Alteplase Bolus and Infusion for Stroke: Room for Improvement

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2016 ANNUAL MEETING

New NS Plain Order

for post-Alteplase

2016 ANNUAL MEETING

NS Rate to be

Added by

RPh

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Frien

dly R

emin

der

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Safety Issue: Development of

Smart ‘No ____’ orders

2016 ANNUAL MEETING

No Antiplatelets x 24 Hrs Post Alteplase

2016 ANNUAL MEETING

No Anticoagulants x 24 Hrs Post Alteplase

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2016 ANNUAL MEETING

“No ____” Orders Actively Screen for Contraindicated Meds x24hrs Post Alteplase

2016 ANNUAL MEETING

New Additions to Alteplase Order Set

2016 ANNUAL MEETING

Alteplase Configuration in Acute MI Set

Evidence Based Order Sets –Optimization of System Configuration PLUSMLM’s (Medical Logic Modules)

• Antibiotic Selection in Pneumonia • Recommendations Based on Risk Factors

• Enoxaparin and Fondaparinux • Automation of Lab Monitoring Based on Indication

• Heparin Protocols• Weight based Automation of Protocols

2016 ANNUAL MEETING

2016 ANNUAL MEETING

Web Link

Select Risk

Factors

2016 ANNUAL MEETING

Antibiotic Recommendations

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2016 ANNUAL MEETING

Enoxaparin Order Set

2016 ANNUAL MEETING

Enoxaparin – Labs Based on Indication

VTE ProphylaxisTherapeutic

Anticoagulation

2016 ANNUAL MEETING

Enoxaparin – Labs Selection

MLM edits needed for system to

recognize that a SCr is included in

a BMP & CMP

2016 ANNUAL MEETING

New Oral Anticoagulants

2016 ANNUAL MEETING

Rivaroxaban – Taper Dose Orders

2016 ANNUAL MEETING

Rivaroxaban – Taper Dose Orders

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2016 ANNUAL MEETING

Rivaroxaban – Taper Dose Orders

2016 ANNUAL MEETING

Rivaroxaban – Taper Dose Orders

2016 ANNUAL MEETING

Rivaroxaban – Taper Dose Orders

2016 ANNUAL MEETING

New Oral Anticoagulants: Home Medication Reconciliation

HEPARIN PROTOCOLS

2016 ANNUAL MEETING

Heparin Weight Based Protocols

2016 ANNUAL MEETING

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2016 ANNUAL MEETING

Heparin Weight Based Protocols

2016 ANNUAL MEETING

Heparin Protocols – RN Worklist

2016 ANNUAL MEETING

Heparin Protocols – Task Form

2016 ANNUAL MEETING

Heparin Bolus q6h PRN – Max Dose

2016 ANNUAL MEETING

CDS Based on Specialty Areas

2016 ANNUAL MEETING

CDS Based on Specialty Areas

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2016 ANNUAL MEETING

Insulin Soft Stop MLM

2016 ANNUAL MEETING

Additional CDS Based on Reported Med Errors

Hypoglycemia

2016 ANNUAL MEETING

Insulin Hard Stop MLM

2016 ANNUAL MEETING

Insulin Hard Stop MLM

SYSTEM MAINTENANCE

2016 ANNUAL MEETING

• Maintain integrity of hyperlinks

• Each site must add allergy codes to new items built for ADM’s

• Update automation (MLM’s) when guidelines are updated

• Order set configuration and MLM updates when lab monitoring changes are needed

• Clinical Informatics Order Set Team!!! • Mandatory Order Set Review by Pharmacy – on any order set with

medications

• Alert fatigue – use configuration options as much as possible to utilize alerts to help avoid medication errors but also be proactive in reducing unnecessary ‘nuisance’ alerts

• Pharmacy Clinical Workgroup (CW)

Reducing Alert Fatigue

2016 ANNUAL MEETING

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