practical limits of order entry

[baronzb]

I am aware of a small hospital pharmacy, about 139 beds concerning behavioral health.

How common is it for pharmacists to do all the order/entry? Some hospitals seem to have hundreds of orders a day, not just for admits but for patients on the floor, with no physician order entry. I have never heard of so much order entry in a shift for one two techs, much less one pharmacist. How does one get that much order entry (sometimes over 400 scripts per day) done in addition to the regular responsibilities?

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[TheBlaah]

I may be off base, but are you saying there's zero computer-provider order entry? So it's all paper based orders?

Never seen it before. Usually, there's a requirement by cms that hospitals must have a certain percentage of orders be computer entry by a provider to receive federal money (meaningful use).

I've seen a pharmacist verify 1000 orders a day, but that's far different from entering them.

 

[ValeRx]

That's a very primitive hospital if hand written scripts are being delivered to an inpatient/outpatient pharmacy at a hospital and them someone is physically typing them in?

 

[zelman]

That's a very primitive hospital if hand written scripts are being delivered to an inpatient/outpatient pharmacy at a hospital and them someone is physically typing them in?

I’m sure that’s not how it works. They are written into the chart and then that chart page is faxed to the pharmacy. This has the added bonus of the fact that the first thing on the page will get faxed to the pharmacy a dozen times as the page fills up, but you can never assume it was sent after the previous order was written so you need to enter the last thing PLUS check the next to last thing to see if that was entered or not.

 

[zelman]

I may be off base, but are you saying there's zero computer-provider order entry? So it's all paper based orders?

Never seen it before. Usually, there's a requirement by cms that hospitals must have a certain percentage of orders be computer entry by a provider to receive federal money (meaningful use).

I've seen a pharmacist verify 1000 orders a day, but that's far different from entering them.

If it’s not a profit-generating hospital, they have no incentive to get federal money. State run facilities where I used to work hadn’t switched to CPOE when I left in 2016, though a couple in the network were trialing it.

 

[zelman]

I am aware of a small hospital pharmacy, about 139 beds concerning behavioral health.

How common is it for pharmacists to do all the order/entry? Some hospitals seem to have hundreds of orders a day, not just for admits but for patients on the floor, with no physician order entry. I have never heard of so much order entry in a shift for one two techs, much less one pharmacist. How does one get that much order entry (sometimes over 400 scripts per day) done in addition to the regular responsibilities?

What are “the regular responsibilities”? Keeping the Pyxis full?

 

[PharmDBro2017]

What are “the regular responsibilities”? Keeping the Pyxis full?

Depends if the one pharmacist is also the DOP. In that case... you're staff, clinical, and DOP. A lot of smaller facilities/LTACs have one full-time pharmacist that does all of the above, and they do not have CPOE.

That would mean order entry, clinical duties (anticoag/TPN/vanc/aminoglycoside monitoring), P&T, policy and procedures, environmental monitoring, USP 795/797/800 oversight, diversion prevention, etc. That's the tip of the iceberg.

 

[zelman]

Depends if the one pharmacist is also the DOP. In that case... you're staff, clinical, and DOP. A lot of smaller facilities/LTACs have one full-time pharmacist that does all of the above, and they do not have CPOE.

That would mean order entry, clinical duties (anticoag/TPN/vanc/aminoglycoside monitoring), P&T, policy and procedures, environmental monitoring, USP 795/797/800 oversight, diversion prevention, etc. That's the tip of the iceberg.

Much of that doesn’t happen in psych hospitals. Often patients cannot have IV meds on the unit and that eliminates most PK duties.

 

[baronzb]

I’m sure that’s not how it works. They are written into the chart and then that chart page is faxed to the pharmacy. This has the added bonus of the fact that the first thing on the page will get faxed to the pharmacy a dozen times as the page fills up, but you can never assume it was sent after the previous order was written so you need to enter the last thing PLUS check the next to last thing to see if that was entered or not.

that's exactly what that is! It also gives the brown nosers a chance to treble check orders several times a week until pt. discharge. There is also a MAR check between nurse MAR and the pharmacy copy of the MD faxes.

There's the discrepancy, override, continuous narc inventory, count and pyxis load, abx stewardship (fairly basic), and other odd jobs.

The order entry load can be as high as 550 scripts per shift. That's a lot of order entry.

 

[PharmDBro2017]

Much of that doesn’t happen in psych hospitals. Often patients cannot have IV meds on the unit and that eliminates most PK duties.

Word; I'm not as familiar with the behavioral health/psych hospital.

 

[zelman]

that's exactly what that is! It also gives the brown nosers a chance to treble check orders several times a week until pt. discharge. There is also a MAR check between nurse MAR and the pharmacy copy of the MD faxes.

There's the discrepancy, override, continuous narc inventory, count and pyxis load, abx stewardship (fairly basic), and other odd jobs.

The order entry load can be as high as 550 scripts per shift. That's a lot of order entry.

Depending on the complexity of the orders and computer system, 550 could be hectic but doable. I’d guess paced like a 1000 Rx/day retail shift (i.e. not really possible for a new hire).

 

[baronzb]

I

Depending on the complexity of the orders and computer system, 550 could be hectic but doable. I’d guess paced like a 1000 Rx/day retail shift (i.e. not really possible for a new hire).

I've never worked retail outside of a tech role, but I would think 1000 scripts may be easier than 350-500 order entries. How do you guys deal with the order entry, something that is not usual in most pharmacy settings for the pharmacist?

 

[zelman]

How do you guys deal with the order entry, something that is not usual in most pharmacy settings for the pharmacist?

I’m spitballing here, but maybe, just maybe, you should enter the orders? Seems like the best way to deal with it from what I can see.

 

[Rockinacoustic]

I

I've never worked retail outside of a tech role, but I would think 1000 scripts may be easier than 350-500 order entries. How do you guys deal with the order entry, something that is not usual in most pharmacy settings for the pharmacist?

Use your clinical judgment and triage. Obviously an order for B52 or antibiotic is more urgent than a bowel regimen or a long-acting IM agent.

 

[owlegrad]

I

I've never worked retail outside of a tech role, but I would think 1000 scripts may be easier than 350-500 order entries. How do you guys deal with the order entry, something that is not usual in most pharmacy settings for the pharmacist?

Speaking as a pharmacist who does order entry, I think you are overestimating it’s difficulty. Like anything else, it takes practice. Obviously a pharmacist who does all the order entry is going to have less time for other things but as long as you know how to type I don’t think it is actually that challenging.

 

[baronzb]

I’m spitballing here, but maybe, just maybe, you should enter the orders? Seems like the best way to deal with it from what I can see.

Any practical advice on lowering errors, common medicines that may pose problems from entering, etc.?

 

[zelman]

Any practical advice on lowering errors, common medicines that may pose problems from entering, etc.?

Learn your prescribers’ habits, both good and bad. They tend to use the same treatments and make the same errors.