HOSPITALS HAVE LONG FACED CHALLENGES ASSOCIATED WITH getting handwritten medication orders from the prescriber to the pharmacist. Some have installed pneumatic tube systems to transport the paper orders, but because these systems do not electronically track the movement of orders from the patient ward to the pharmacy, orders have a way of getting lost in the shuffle. Others have chosen fax machines to electronically send orders to the pharmacy, but there is always the risk of visual “noise” on the printed fax that can result in dispensing inaccuracies. Vital decimal points can be lost in translation – or even mysteriously appear in the wrong places – leading to the pharmacy dispensing an inappropriate and possibly dangerous dose. CPOE (computerized physician order entry) has often been touted as the ultimate solution to medication order management efficiency and patient safety, but implementation is costly and requires longterm planning, and doctor buy-in can be difficult to achieve, as well. Fortunately, another option exists: medication order management systems, or MOMS. These systems provide the accuracy and tracking your safety initiatives require, while being relatively easy to implement. Furthermore, relative to CPOE, these systems are not encumbered by a hefty price tag, making an investigation into their impact on your institution well worth the effort.
How Do MOMS Work?
Handwritten medication orders are fed into a scanner or fax machine, which converts the order into a digital file, such as a PDF. The electronic file is sent, via the MOMS, to a system “inbox.” Pharmacy can then view the orders on a PC and proceed with the filling process.
The electronic orders provide a few significant benefits. First, pharmacy can enlarge the PDF files to decipher a doctor’s handwriting and/or send illegible orders back to the prescriber for clarification. Pharmacists can also make timestamped annotations to orders and retrieve the electronic documents with greater ease than a paper-based system affords. In addition, browser-based MOMS also allow hospital personnel to review orders from off-site PCs. MOMS add a layer of accountability to the processes surrounding medication orders, because access to the electronic files is tracked. These systems also automatically archive the orders, eliminating the need for paper filing. Finally, nursing can use the MOMS to check on the status of an order, reducing those timeconsuming phone calls between nursing and pharmacy.
Some MOMS are server-based, and others are Web-enabled. As previously mentioned, the latter allows for access from computers outside of the hospital’s local area network. This choice can provide an added layer of efficiency for those working off-site.
The hardware required to run the MOMS should be taken into consideration. Some MOMS are software-only solutions, and others come with vendorsupplied scanners. By buying just the software, hospitals can use the scanners and computers already in place, leading to cost savings. However, because some scanners produce higher-resolution images than others, continuing to use a sub-par scanner on the nursing unit floor can result in a hospital settling for hard-to-read, low-resolution documents. Also keep in mind that if you continue to use a fax machine to send orders to the MOMS, you may run into the same visual “noise” problems that you had before implementing the system.
Some MOMS vendors also offer dual-screen viewing systems for the pharmacy workstations — one for viewing the pharmacy information system and the other for displaying the order PDF. Because the dual-screen set up eliminates the need to click back and forth from system to system, the ease of use and time saved may be worth the cost of the second screen.
Omnicell, Inc: OmniLinkRx
OmniLinkRx is a software-only system that runs on a standard hospital-provided server and workstations using Microsoft Internet Explorer. Orders may be sent via existing analog fax and scanners. Nurses simply place the handwritten physician order into the sending device at the nursing station, and the image is sent to the OmniLinkRx server. The pharmacy department is then able to access the digital image and enter it into the pharmacy information system. Nurses can view the status of orders at any Internet-enabled PC or at medication dispensing cabinets running Omnicell 10.0. The application runs on commercial Adobe Acrobat software.
McKesson Automation: MedDirect
Using MedDirect’s imaging and Web-based technology, nurses scan or fax medication orders directly into the system. Nurses select the appropriate priority STAT, ASAP, or routine by using one of the preprogrammed speed-dial buttons. MedDirect’s decision support software streamlines the order process and provides a comprehensive medication order trail.
Pharmacists, meanwhile, can simultaneously view magnified images of the order and compare it to the pharmacy information system. This allows pharmacists to zoom in on every part of the order for easy clarification. At the same time, work queues are organized to improve productivity. Each order is electronically time stamped, assigned a tracking number, and transmitted to the pharmacy viewing station.
Cardinal Health: Pyxis Connect
The Pyxis Connect system captures a digital image of the handwritten order and routes it to an electronic “inbox” in the pharmacy, eliminating the need for multiple faxing, courier, or tubing systems. In addition to the core functionality of the Pyxis Connect physician order management system, the Pyxis Connect Plus system includes a small touch-screen monitor and enhanced software that allows nurses to view physician orders and order status directly from their station. This reduces calls from nursing to the pharmacy. Pharmacists can also use the system on a remote or portable basis from the floor, remote office, or other location.
AmerisourceBergen Technology Group: InterChange
InterChange routes a medication order from the nursing unit to the pharmacy dispensing location, allowing pharmacists to direct and prioritize med orders in order to maximize the staff’s time. InterChange uses existing, reliable fax lines to receive, prioritize, sort, review, annotate, and store written patient medication orders. The pharmacist can quickly communicate a therapeutic substitution to the nurse or prescriber. Likewise, order clarifications are handled using the InterChange annotation and faxback features.
Integrated Informatics, Inc: POMS
POMS is a browser-enabled system that receives medication orders from fax machines, scanners, digital senders, printer emulation, or any combination thereof. POMS recognizes an order’s priority based upon the specific STAT or “routine” button used. Additionally, POMS uses optical character recognition (OCR) to identify STAT orders that may have been sent as “routine,” and then reroutes them accordingly. POMS recognizes bar codes to retrieve patient information and automatically populate key fields. The system stores orders in SQL Server and presents them presorted to the pharmacy for dispensing based on priority, arrival time, location origin, and other criteria.
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