E-prescribing Helps ED Avoid Fraud and Ensure Safety

Dr. Steenburn is a pharmacist withColumbia Memorial Hospital inHudson, NY.

At Columbia Memorial Hospital,we recently invested $20 millionin new facilities andequipment, including a state-of-the-artemergency department (ED). In an ED,patient safety is the ultimate priority,but managing time and informationsimultaneously can be a formidabletask. Although our new ED now hadmore room and could handle morepatients every day, everything hadbecome more spread out. Our staffmembers found it harder to communicatewith each other and get an accurateoverview of the patients? medicaland prescription histories. In addition,we faced an ?information vacuum? becausethe staff did not have easyaccess to data about what happened toa patient in the ED before being admitted.Gathering this information is one ofthe most important steps in treating apatient and is critical for determiningthe safest and most appropriate courseof treatment and medication.

Our physicians and staff needed tofind a way to work more efficiently,especially when it came to data, inorder to ensure patient safety and managethe many and often powerful drugsprescribed in the ED. To address theseissues and streamline patient data,Columbia Memorial adopted a newautomated ED information system(EDIS), HealthMatics ED by Allscripts.The automated system providespatient-information management for avariety of ED procedures, includingpatient tracking, order entry, prescribing,data retrieval, charting, and nursingfunctions. These features dramaticallyimprove response time, help preventunnecessary treatments or medications,and can even save lives. In addition,the system-wide documentationpromotes patient safety outside of theED by helping the staff identify peoplewho are dishonestly going from hospitalto hospital seeking prescriptions.

Ensuring Quality, One Prescriptionat a Time

In an ED, patient safety is the ultimatepriority, but many obstacles must beovercome before that can be realized.With the new EDIS system, we canrecord and access information in realtime, and our caregivers and communitypharmacists can work togetherquickly to ensure the safest treatments.

The automated system helps ourhospital?s pharmacists in their effortsto meet the Joint Commission onAccreditation of Healthcare Organizations?quality standards. For instance,the hospital recently adopted a routeof-administration change for promethazineto intramuscular-only. A Pyxisreport was run on the medication, andHealthMatics ED was used to reviewthe record of each patient receivingthe drug to verify the correct dose androute of administration and to monitoradherence. Because Pyxis is interfacedwith Meditech, when a medication isremoved from Pyxis that is recorded inMeditech, the hospital pharmacist canlook in HealthMatics ED to verify thatthe dose ordered in the ED matchesthe dose that was removed. Random24-hour reports pulled from Pyxis arechecked against all patients in the EDthrough HealthMatics ED to verify thatthere is an order for every medicationremoved.

The new system also creates quick,legible prescriptions, many of which areavailable with a single click. This toolhas significantly improved the accuracyof documentation, providing pharmacistswith complete, detailed notesabout treatment on a patient?s chart.Until recently, caregivers relied onhandwritten records to determineimportant patient facts such as allergiesor previous treatments. Now theycan set alerts for reminders to reassessorders and medications. We can delivercurrent and past patient informationfaster with complete mobile access topatient charts, including real-timeviews of order details. Comprehensiveorder sets prevent sending conflictingorders, and our staff can even viewmultiple orders on a single patient, aswell as flexible order sets. The technicalaspects of the new system are producingbenefits beyond the ED walls; itssimple interface ensures that the laboratory,health information services, andother systems using various vendorscan send and receive orders using standardor customized protocol interfaces.

The built-in prescription writer andautomatic prescription printout are alsoboosting our efficiency, substantiallyreducing the stress and time that areusually involved with prescribing medications.Now, we do not have to lookaround for people to get somethingdone?it just happens.

Because of this system, patients arealso receiving prescriptions at theircommunity pharmacies more quickly.Oftentimes, delays occur when a pharmacistcalls the doctor to find out justwhat drug the patient has been prescribed.Before the new system wasimplemented, filling out a prescriptionat the hospital could take hours?nowit takes just a few minutes. Implementingthis new automated systemhas truly streamlined the work flow forall of our ED caregivers and is reducingthe inefficiencies and safety hazards ofoperating in a paper-based environment.It also solves the age-old problemof trying to read doctors? illegiblehandwriting.

Preventing Fraud and Abuse

Implementing an EDIS function hasimproved more than just efficiency andorganization at the hospital and localpharmacies; it is also helping us savemore lives. In the ED, health care professionalsplay a critical role in preventingerrors and the misuse of prescriptionmedications. Thousands ofpatients die each year because of medicalerrors at hospitals, many of whichoccur because of mistakes and misusein the delivery of prescription drugs.Information on patients? health historiesand medications can now beshared more quickly among physicians,staff, and administrators, enhancingthe speed and overall qualityof patient care.

Now that we have electronic prescribing(e-prescribing) in the ED, staffmembers also do not have to worryabout security concerns associatedwith conventional prescription-drugpads and order processes. Drugabusers often use EDs as a source forpowerful prescription drugs and addictivepainkillers such as oxycodone,meperidine, and opiate-based medications.It is often difficult in a busy ED tothoroughly track patient histories forsigns of drug abuse and to monitor drugdispensing and prescription pads.Common prescription diversions inhospitals include ?doctor shopping,?patient deception of doctors, alteredprescriptions, and stolen prescriptionpads. With so many patients comingthrough the ED doors and a maze ofpaperwork to sort through, it is often achallenge for hospital staff memberssuch as ED pharmacists to detect diversiontactics or suspicious activity. Withthe convenience and precision of the eprescribingsystem, our ED physiciansand pharmacists do not have to worryabout the security concerns associatedwith conventional prescription padsand filling patient prescriptions.

Managing Prescriptions Beyond the ED

The influence of the new automatedsystem extends far beyond the ED?sdoors. The system prints out comprehensivedischarge notes that patientscan take with them when leaving thehospital, giving patients, families, andcaregivers directions to refer to andensuring the safe and appropriate useof prescriptions. After the patientleaves the hospital, the primary carephysician can continue with an appropriatetreatment course, while alsohaving access to the ED care information.In addition, our financial andadministrative staff can access thenew system and use it to check patientacuity and volume.

Our experience is a great example ofhow EDs are using health informationtechnology to ensure a safer prescriptionenvironment, manage more patienttraffic, and promote better communicationbetween the ED and thepharmacy. With this innovative yet simplenew tool, Columbia Memorial?scaregivers and community pharmacistsare safeguarding some of themost critical steps in the patient careexperience.