Digital prescriptions speed medication to patients while boosting safety

At a team meeting to discuss medication in the Cardiovascular Intensive Care Unit, Nurse Kamylle Martin (right) works at her medication cart, while conferring with (from right) Pharmacist Helen Mantzanis and medical student Ellen Dunbar-Lavoie (each using a work-station on wheels), and Dr. Judith Therrien.
At a team meeting to discuss medication in the Cardiovascular Intensive Care Unit, Nurse Kamylle Martin (right) works at her medication cart, while conferring with (from right) Pharmacist Helen Mantzanis and medical student Ellen Dunbar-Lavoie (each using a work-station on wheels), and Dr. Judith Therrien.

Prescription medication is reaching hospitalized patients at the JGH more quickly than ever, thanks to a digital ordering system that has been implemented more extensively than in any Quebec healthcare facility with a comparable patient population.

While pharmacy departments in many hospitals (including the JGH) went digital a number of years ago, the JGH has now distinguished itself by introducing paperless prescriptions that doctors, nurses, pharmacists and nutritionists can complete on computer terminals—and sometimes on hand-held devices—throughout the hospital.

The system was introduced in November 2015, and as of May 2019, it was deployed in 96 per cent of the JGH’s in-patient units. In the planning stages is implementation in the outpatient units, and plans call for eventual implementation throughout the CIUSSS. 

Before a prescription is written, prescribers can review a patient’s full medication profile to be certain that the intended drug and dosage are appropriate and safe for that particular patient. Thanks to the digital technology, this can be done in a healthcare unit or elsewhere inside or outside the hospital.

As a result, a great deal of time is saved, since a doctor no longer needs to physically return to the care unit, look through the patient’s file, and then hand-write a paper prescription, which itself has considerable potential for error.

In addition, when a rolling, computer-equipped work-station is taken on rounds, doctors can save precious time by prescribing at the bedside.

“This is where we’ve really become innovative, and now we’re spear-heading it for the province,” says Eva Cohen, Chief of the Pharmacy Department for CIUSSS West-Central Montreal.

According to Ms. Cohen, the digital system, known as GESPHARxLite, has been implemented by a team that includes representatives from the Departments of Professional Services, Pharmacy, Nursing and IT, and physicians.

Its components (the Computerized Physician Order Entry and the Electronic Medication Administration Record) allow medication to be prescribed electronically, as well as providing fast and easy access to the patients’ medication records.

“We have a turnaround time under two hours from the time the prescription is entered to the time of validation,” says Ms. Cohen. “Suggestions, recommendations or other medication-related adjustments are also communicated back to the prescriber electronically.”

Nurses, who used to manually transcribe all prescriptions into a paper Medication Administration Record (a log of when and to whom medication must be administered), now have instant access to the electronic record at the moment when the medication is prescribed.

Among other advantages cited by Ms. Cohen:

  • Allergies, which are are flagged to prescribers at the time of prescribing, are now identified in 99 per cent of the electronic charts, as opposed to 36 per cent in the paper system.
  • The absence of hand-written prescriptions greatly reduces the possibility that instructions will be misread.
  • Dangerous abbreviations, previously used in prescribing medication, have been eliminated.
  • Professionals have quick access to prescription information, as well to as medication administration information (i.e., whether the drug was administered and, if so, when, where and by whom).

Medication reconciliation, the process of ensuring the patient’s smooth transition through a trajectory of care, will soon be digital, too. This will allow medication to be prescribed when the patient is discharged, with the assurance that the next healthcare professional will be aware of all of the changes that were made to the patient’s therapy during hospitalization.

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