Based in Quincy, Illinois, the 426-bed Blessing Hospital is a member of the Blessing Health System, serving nearly 400,000 people living in west-central Illinois, northeast Missouri, and southeast Iowa. Fully accredited with an average daily census of 200 patients, Blessing’s 24-hour pharmacy operates with a staff of 50 FTEs, including 12 pharmacists and 30 pharmacy technicians.

Challenges of a Paper-Based System
Blessing Pharmacy processes an average of 600 faxes with approximately 1,800 medication orders per day. Prior to March 2007, at least two pharmacy technicians monitored and maintained three fax machines around the clock. With an average of 25 incoming faxes per hour, the average time to process a medication order – from  receipt to fulfillment – was about 52 minutes. Equipment malfunctions delayed medication orders, and many orders were not received at all. Even when the fax machines were functioning properly, incoming medication orders were sometimes misplaced or lost, requiring them to be re-faxed by the nurses. Random inconsistencies in the process resulted in significant turnaround time for orders and, ultimately, nursing dissatisfaction. Far too frequently, pharmacists were interrupted to answer phone calls from nurses checking on orders, creating further delays. The paper-intensive process was creating unwarranted stress for both nursing and pharmacy.

With this paper-based workflow, when technicians received a STAT medication order, they had to drop whatever they were doing and walk the fax directly to the reviewing pharmacists. The pharmacists would re-focus and prioritize the STAT order ahead of a mounting stack of incoming medication orders. For all other medication orders, pharmacists diligently and painstakingly strived to maintain a “first in, first out” order of priority. In addition, the technicians were constantly filing the orders, rotating them through the archiving filing system and ultimately shredding them to ensure patient privacy at the end of the medication order lifecycle.

An Automated Solution
Recognizing our need for an automated, paperless workflow, in September 2006, Blessing Hospital initiated a vendor review process to evaluate the functionality of various medication order management solutions and the economics of replacing the existing fax delivery process. SNAPS, Inc.’s Snapsflow, a Web-based software application for pharmacies, rated high in functionality, had the best price, and allowed us to use elements of our existing fax-based system. The implementation was simple, and within a matter of a few weeks, we moved to a fully electronic medication order management process. The Snapsflow program is a very dependable application and has improved our ability to move medication orders through the process.

Improved Productivity
We designated three new Microsoft Windows server-class computers for the Snapsflow implementation — one for the workflow engine and its components, one for electronic archiving, and finally, one for the fax server. Utilizing our existing fax machines on the nursing units was an additional cost saver.
Using dual-monitor workstations, the pharmacy staff views Snapsflow on one screen and our pharmacy information system on the other to process orders. Nurses now fax medication orders into Snapsflow and can electronically prioritize and color code orders as STAT, ASAP, or routine. The prioritized medication orders are displayed clearly on pharmacy’s monitors.

Snapsflow provides an ADT interface with the ability to read bar codes and text on incoming medication orders. The system associates patient information from our pharmacy information system with the fax, ensuring incoming medication orders are complete and ready for review. After the technician enters the medication order, the order is electronically routed to our pharmacists according to priority. STAT orders are highlighted and routed directly to the next available pharmacist without technicians ever leaving their workstation.

Pharmacists sort and review STAT orders as they arrive, without passing and shuffling paper. They are also able to prioritize ASAP and routine medication orders by the time received, making it easier to fill orders on a “first in, first out” basis. Our pharmacists like that they are not tied to their computers in the pharmacy anymore; because Snapsflow is Web-based and accessible from any location with Internet access, our pharmacists are able to verify orders from patient care areas.  

The Snapsflow annotation and routing capabilities allow pharmacists to add notes and send problem orders back to the attention of the originating nurse’s unit. Automatic e-mail alerts can notify nursing when an order has been returned for clarification, and we are evaluating implementing this feature. Furthermore, Snapsflow can track various types of data, such as the use of unapproved abbreviations, and allows us to electronically archive our medication orders, enabling easy retrieval of completed medication orders and eliminating the need for paper shredding.

Conclusion
At this point, the pharmacy’s process is totally paperless. Technicians are free from fax machine jams and maintenance, and the pharmacy is free from its former “jungle” of paper medication orders. Our work is prioritized and better meets the needs of the patient. Overall, our quality of service has improved and both our pharmacists and technicians say they would never go back to paper. Although our average medication order review turnaround time has improved, the best measure of our improved workflow is the rare call from nursing about wayward medication orders — indicating nursing’s satisfaction with pharmacy services has greatly improved and our patients are receiving their medications in a timely manner.

Bob Miller, RPh, MA, HSA, has been the director of pharmacy at Blessing Hospital for one year, and previously served as the director of pharmacy for Hannibal Regional Hospital. He earned his pharmacy degree from the University of Missouri–Kansas City and a master of arts in health services administration from the University of Illinois at Springfield.