By Mike Schlesselman, PharmD, FASHP 

A 280-bed, not-for-profit community hospital in New London, Connecticut, Lawrence & Memorial Hospital (L&M Hospital) strives to continually improve the quality of patient care, increase efficiency, and decrease costs. The management of physician orders can be a challenge for those who have not yet achieved CPOE. To address this issue, for a number of years, L&M Hospital had been using scanning/fax technology to transmit physician orders to the pharmacy, and with the expiration of an existing contract, we had the opportunity to explore other options for managing these orders.

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System Requirements         
We wanted a solution that would decrease our operational budget, increase our control over the hardware we used, and improve our existing workflow. To decrease our operational budget, we could purchase the hardware needed to manage physician orders with capital budget dollars, versus leasing the hardware and software from the vendor. In doing so, we estimated we could achieve a full return on investment in three years, as well as a 50% decrease, related to physician order management, in our operational budget.

We also used this opportunity to look at our order sheet. We had been using a NCR triplicate form to provide backup copies for the pharmacy and a copy for nursing order verification, but the NCR copies often made scanned images hard or impossible to read. With this in mind, we wanted to make the move to a single-sheet order form.     Pharmacy also wanted an efficient means of STAT order notification, and our existing system did not have a clean method to accomplish this. Finally, L&M Hospital was looking for a vendor that would interface with our existing Meditech health care information system to positively identify and link patients to medication orders.

The Solution
L&M Hospital implemented a Web-based software program, Galactica Rx, developed by the Shams Group (TSG), to scan physician orders to the pharmacy from the nursing units. Because Galactica Rx is a Web-based application, it does not require vendor-supplied workstations or servers. We own the computers and are able to control our virus protection software and security policies to protect our network and PCs. We are also responsible for any operating system upgrades and system backup activities.

Galactica Rx uses bar codes on the scanned documents to link the order to the patient account. Admission, discharge, and transfer data retrieved via a Meditech interface allows the account number to be linked to the patient name and location for display on the Rx Worklist – a list of all of the orders requiring action in the pharmacist work queue. The pharmacist can easily view this patient information, as well as the source location of the scanned document, while reviewing medication orders in the Meditech system.    

Galactica Rx also allows us to separate STAT and routine orders. Upon sending orders to the pharmacy, nurses select a “routine” or “STAT” button. STAT orders appear in red at the top of the pharmacists’ work queue. The pharmacists’ work queue sorts orders by nursing unit, and Galactica Rx has a number of additional work queue filters, such as patient name, room number, or order type (STAT or routine).

There are also a number of ways for pharmacists to view and retrieve completed orders. While an order is being reviewed and processed by a pharmacist, the system categorizes it with “working” status. Pharmacists can place orders on hold if they require further work or clarification. “Hold” orders can then be accessed and completed when appropriate. We are also able to make notes and attach intervention data to orders using Galactica Rx. This feature provides a useful documentation tool for staff pharmacists and pharmacy management alike.

Galactica Rx also provides a number of reports, such as order process time, order time in the queue, activity by user, and clinical interactions noted, to aid in the management of the system. Some of the reports are aggregate/summary and others have drill-down ability. Many can be downloaded to Excel spreadsheets or other formats for further analysis.

The new software also provides us with a single-sheet order form. Galactica Rx automatically generates a copy of the order for nursing, so we have been able to discontinue our use of the triplicate NCR form. We have estimated this change can save the hospital up to $14,000 on an annual basis.

Conclusion
Using the TSG Galactica Rx system, L&M Hospital has found a means to decrease our operational budget and improve both pharmacy workflow and the security of the hospital network. Furthermore, the implementation of Galactica Rx has had a minimal impact on the nursing units. We are positioned to expand this technology to care areas outside of the nursing units that require pharmacist review of medication orders. 

Mike Schlesselman, PharmD, FASHP, received his doctorate from Creighton University in Omaha, Nebraska, and completed his residency at the Medical College of Georgia Hospital and Clinics, where he ultimately became assistant director of pharmacy. Currently the director of pharmacy for Lawrence & Memorial Hospital, Schlesselman is also a fellow of ASHP.