Improving medication management in the hospital discharge setting through pharmacist intervention in the synchronisation of computer applications

• Autores: Elena Villamañán Bueno, Catalina Lara, M. Ruano Encinar, Eduardo Armada, E. Pérez David, M. Moro, Rosalía Pacheco, Alicia Herrero Ambrosio
• Localización: European journal of clinical pharmacy: atención farmacéutica, ISSN 2385-409X, Vol. 17, Nº. 5, 2015, pág. 7
• Idioma: inglés
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• Resumen

  • Background: The lack of synchronisation between hospital computer applications involved in the medication use process in hospitals often leads to an inefficient use of resources.

    Purpose: To prove that the Pharmacist Intervention (PI) in the integration between hospital computer applications involved in the drug use process improves the medication management in the discharge setting.

    Method: A longitudinal, prospective, study over ten days carried out in a tertiary hospital (1,350 beds). Patients in the discharge setting of medical specialties as well as surgical specialties were evaluated (410 beds in total). Discharges notified by physicians are registered in a Bed Management Computer Application (BMCA) (HP-HIS®). Every 20 minutes this information is transferred to the CPOE program (FarmaTools®) so that electronic prescriptions are inactivated automatically.At discharge, because of the lack of synchronisation, some Electronic Prescriptions (EP) during hospitalisation remain wrongly actives and this outdated information registered in the CPOE is transferred to the Automated Pharmacy Medication Dispensing Systems (APMDS) (Kardex®) which means that these medications are dispensed to the ward as if discharged patients remained admitted. Pharmacists daily verified the discharges and checked whether treatment of the discharged patient remained wrongly active in the CPOE, updating them as inactive if necessary. Primary endpoint was defined as the number of drug prescriptions updated in the COPE program by PI. We also analysed the number of drugs whose unnecessary dispensing and subsequent return to the pharmacy was avoided by the PI and the working time saved.

    Results: Over the study period 361 discharges were evaluated. PI updated electronic prescriptions of 132 discharged patients (36.6%) that were outdated because of the lack of synchronization between BMCA and CPOE. The remaining 229 did not require PI, in 48 cases (13.3%) because physicians had inactivated the treatments directly on the CPOE, the rest were suspended automatically as a consequence of data transmission. There were 3,327 drugs prescribed to these patients in the CPOE, of which 1,012 (30.4%) were inactivated by PI. Without PI, these prescriptions would have generated unnecessary dispensing of 3,601 medicines to the ward. PI led to save an average of 56 (SD ±6.5) minutes of work re-entering medications unnecessary dispensed to the ward.

    Conclusion: PI reduces failures in the discharge setting arising from the lack of real-time transmission between patient information applications. Greater synchronisation between the BMCA and CPOE programs would have avoided most of these problems. According to our results, the PI improves the drug treatment process in the final stage of hospitalisation, saving time and avoidable work in the pharmacy