By Vern Johnson, RPh

FOR OSF SAINT FRANCIS MEDICAL CENTER, A 616-BED, MAJOR REGIONAL
health care provider, the manual delivery of physician medication orders to the pharmacy eventually became too labor-intensive, time-consuming, and error-prone to overlook. We embarked on a mission to overhaul the physician order transmission process with the goals of improving patient safety, communication with nursing, and pharmacy efficiency.

We had been using a pneumatic tube system to transfer copies of physician orders from the patient floors to the pharmacy—an effective but slow process. As an initial, low-tech process improvement, we used our existing, nursing unit-based Lexmark multifunction printers (MFPs) to fax orders to pharmacy. The output facsimile was received in pharmacy on one of two desktop fax machines. While this removed some workload from the pneumatic tube system, other impediments emerged.

The Drawbacks of a Fax-Based System
Faxes were not always legible; any stray mark or imperfection had the possibility of causing a misinterpretation of the order and presenting a potential safety issue. If a pharmacist had difficulty reading an order, it became necessary to locate the ordering physician for clarification, leading to delays. Furthermore, with 30 nursing stations relaying more than 1,500 order sheets daily, dialing the pharmacy fax machines often resulted in a busy signal.

As faxes piled up in the pharmacies, segregating STAT orders required sifting through the entire stack of orders. If pharmacists were not alerted by phone to expect one, a STAT order could go unnoticed, resulting in delayed therapy. And because pharmacy personnel manually time-stamped each order sheet for QA data, nursing personnel had no way to gauge turnaround time. Follow-up phone calls to pharmacy led to frustration and additional workload for both nursing and pharmacy.

The shortcomings of our fax-based system motivated us to look for a better, more high-tech order-management solution. We wanted a solution that could help us balance the workloads placed on each pharmacy, prioritize STAT orders, watermark pediatric orders for immediate visual recognition, and create a definitive audit trail.

Implementing a New Medication Order Management System
We decided to work with representatives from Lexmark’s health care consulting division, who conducted an end-to-end analysis of our physician order process, and subsequently recommended a multi-phased approach to eliminate fax machines and eventually do away with printing altogether. We understood the key to success was including those involved in handling orders — unit clerks, nurses, and pharmacists — in the process from the beginning. Since they would live with the system every day, it had to meet their needs for speed, simplicity, accuracy, ease of use, and reliability.

In the first phase of the implementation, Lexmark suggested programming our MFPs to send digital images of medication orders to pharmacy. Nurses scanned physician orders on the Lexmark MFP, which then sent a high-resolution image through the hospital network directly to a pharmacy Lexmark printer. This significant process improvement over the fax-based system eliminated busy signals, greatly improved legibility, and created an audit trail.

Next, we tackled the challenge of identifying and prioritizing STAT and pediatric orders. With the Lexmark software’s scripting capability, the operator panel on each MFP device was updated to create a short cut for differentiating routine from STAT medication orders. Our pharmacy printers were programmed to print STAT orders from drawers loaded with colored paper to differentiate from routine orders, which print on white paper.

Because of dosing concerns, we also wanted to be able to readily identify pediatric orders. Our nurses attach bar coded patient labels to each order sheet before scanning them. Scans from our Lexmark MFPs are passed to a server running Lexmark Document Distributor, which reads the patient-specific bar codes to determine a patient’s age. Orders for patients younger than 16 are marked “Pediatric Patient” by the software.

In the third phase of our implementation of the new order management system, we decided to display medication orders on pharmacy workstation PCs, rather than output them to a pharmacy printer. STAT orders are displayed in red and are automatically placed in a separate queue at the top of the page for immediate processing. In addition, the system can route orders to remote pharmacies in the ICU and surgery departments, allowing pharmacists in those areas to step in when the central pharmacy is operating at capacity.

Workflow Improvements
Nurses can now view the order queue on their own workstations to check the status of specific patient orders. Pharmacy is also able to send printed memos to the nursing unit. As a result, we are spending less time on the phone and are more efficiently using pharmacy resources. Our nurses support our use of the system, as decreased turnaround times contribute to improved patient care. And although cost savings were not a primary goal of this project, we are printing 500,000 fewer pages annually, thereby reducing our costs associated with paper, toner, and other supplies.

Another benefit of the system is its physician order archival and retrieval capabilities. We can pull up a clear, electronic image of any physician order by patient account number or the first five letters of a patient’s last name. We no longer have to pour through boxes of order sheets to find past orders.

Based on the success and broad adoption of the solution, two of our sister hospitals have chosen to implement the Lexmark Pharmacy Orders Routing System, and we are currently examining our processes for additional uses of the technology. One possibility is to use the data stored in our electronic document management system to generate aggregated patient IV profiles.

Our medication order management solution has exceeded our goals. Our productivity gains have further assured patient safety and helped our pharmacists and nurses get back to their core jobs of serving patients, instead of chasing paper.

Vern Johnson, RPh, currently serves as the pharmacy operations manager at OSF Saint Francis Medical Center, where he has been employed for more than 20 years.