1. Clinical Pharmacist’s Build and Quality Assurance of Medication Orders
Justin Tenney ● Kelly Horton● Matthew Maughan
Study Background
Results
Pharmacists from various countries and educational backgrounds building medication order sentences for a new electronic medical record system in a soon to be opened women and children’s hospital in the Middle East based on a North American model.
Objectives
Evaluate which therapeutic classes may have more complicated dosing regimens.
Identify which components of a medication order have the least uniformity and variable guidelines on appropriate usage.
Ensure safety and best practice standards of the highest level by utilizing pharmacists from different practice backgrounds and education.
Methods
Medication orders were built into the Computerized Physician Order Entry (CPOE) system and evaluated individually by multinational team of pharmacists.
The medications were arranged into therapeutic categories. The therapeutic categories with greater than 30 medications were included in the study.
For a medication order to be considered complete, it had to be reviewed by two consecutive pharmacists who did not see any further necessary changes to the previous pharmacist’s medication order.
The medication orders included all items listed in the chart below.
Therapeutic Classes Included
Number of Drugs
Cardiovascular
116
Hormonals 42
Antimicrobials
113
Antidotes 41
Psychiatry/Neurology
Diabetes 40
Topicals 90
Hematology 33
Gastrointestinal 79
Cough and Cold 32
Opthalmic, Otic, Nasal Agents 78
Respiratory 31
Biologicals, Vaccines 75
Human Immunodeficiency Virus
Analgesics 73
Anesthesia, Paralytics 25
Vitamins, Minerals, & Electrolytes 66
Drug Class
Age or Weight Filters
% of Incomplete after 6th Pharmacist Review
Antimicrobials 14
48.3%
Analgesics 2
50%
Antidotes
28.6%
Cough and Cold 1
100%
Biologicals, Vaccines
Cardiovascular 3
Diabetes
N/A
Gastrointestinal 6
54.5%
Hematology
HIV
Hormonals
Opthalmic, Otic, Nasal 5
83.3%
Psychiatry, Neurology 15
62.5%
Respiratory
Topicals 4
57.1%
Vitamins, Minerals, Electrolytes
33.3%
Therapeutic Classes Excluded
Number of Drugs
Anti-gout 4
Osteoporosis 5
Contrast 9
Urological/anticholinergic 11
IVF/TPN 24
Oncology (For other reasons) 76
Medication Order Items Evaluated
Strength or volume of dose
Route of administration
Strength or volume of dose unit
Frequency
Infusion duration
PRN option chosen
Age filters
Appropriate PRN reasoning
Weight filters
Need for additional order sentences
Drug form
Indication (if unique)
Infusion duration unit
Special instructions
Conclusions
Greater attention to detail should be given to categories in which pharmacist agreement was shown to involve more pharmacists. These were generally categories that also would be impacted by age and weight. Pharmaceutical references also vary greatly on what defines an age category so implementation of a hospital standard could potentially be of great clinical impact.
Antimicrobials, antidotes, psychology/neurology, vitamins, minerals, and electrolytes appear to have less uniform dosing schemes, so reaching a consensus on common dosing practices in these drug classes may be more difficult in comparison to agents from other therapeutic classes.
Study Limitations
The grouping of therapeutic categories has variable interpretation.
We were unable to document the quantity of changes in each round of review completed by the pharmacists.
The difference in educational backgrounds and experience of the pharmacists could have impacted the number of reviews needed between therapeutic categories.
Acknowledgements: Kyle Gunter, Amr Soliman, Anish Patel