E-prescribing Helps ED Avoid Fraud and Ensure Safety

Author: Shanda Steenburn, PharmD


Dr. Steenburn is a pharmacist with Columbia Memorial Hospital in Hudson, NY.


At Columbia Memorial Hospital, we recently invested $20 million in new facilities and equipment, including a state-of-the-art emergency department (ED). In an ED, patient safety is the ultimate priority, but managing time and information simultaneously can be a formidable task. Although our new ED now had more room and could handle more patients every day, everything had become more spread out. Our staff members found it harder to communicate with each other and get an accurate overview of the patients? medical and prescription histories. In addition, we faced an ?information vacuum? because the staff did not have easy access to data about what happened to a patient in the ED before being admitted. Gathering this information is one of the most important steps in treating a patient and is critical for determining the safest and most appropriate course of treatment and medication.

Our physicians and staff needed to find a way to work more efficiently, especially when it came to data, in order to ensure patient safety and manage the many and often powerful drugs prescribed in the ED. To address these issues and streamline patient data, Columbia Memorial adopted a new automated ED information system (EDIS), HealthMatics ED by Allscripts. The automated system provides patient-information management for a variety of ED procedures, including patient tracking, order entry, prescribing, data retrieval, charting, and nursing functions. These features dramatically improve response time, help prevent unnecessary treatments or medications, and can even save lives. In addition, the system-wide documentation promotes patient safety outside of the ED by helping the staff identify people who are dishonestly going from hospital to hospital seeking prescriptions.

Ensuring Quality, One Prescription at a Time

In an ED, patient safety is the ultimate priority, but many obstacles must be overcome before that can be realized. With the new EDIS system, we can record and access information in real time, and our caregivers and community pharmacists can work together quickly to ensure the safest treatments.

The automated system helps our hospital?s pharmacists in their efforts to meet the Joint Commission on Accreditation of Healthcare Organizations? quality standards. For instance, the hospital recently adopted a routeof- administration change for promethazine to intramuscular-only. A Pyxis report was run on the medication, and HealthMatics ED was used to review the record of each patient receiving the drug to verify the correct dose and route of administration and to monitor adherence. Because Pyxis is interfaced with Meditech, when a medication is removed from Pyxis that is recorded in Meditech, the hospital pharmacist can look in HealthMatics ED to verify that the dose ordered in the ED matches the dose that was removed. Random 24-hour reports pulled from Pyxis are checked against all patients in the ED through HealthMatics ED to verify that there is an order for every medication removed.

The new system also creates quick, legible prescriptions, many of which are available with a single click. This tool has significantly improved the accuracy of documentation, providing pharmacists with complete, detailed notes about treatment on a patient?s chart. Until recently, caregivers relied on handwritten records to determine important patient facts such as allergies or previous treatments. Now they can set alerts for reminders to reassess orders and medications. We can deliver current and past patient information faster with complete mobile access to patient charts, including real-time views of order details. Comprehensive order sets prevent sending conflicting orders, and our staff can even view multiple orders on a single patient, as well as flexible order sets. The technical aspects of the new system are producing benefits beyond the ED walls; its simple interface ensures that the laboratory, health information services, and other systems using various vendors can send and receive orders using standard or customized protocol interfaces.

The built-in prescription writer and automatic prescription printout are also boosting our efficiency, substantially reducing the stress and time that are usually involved with prescribing medications. Now, we do not have to look around for people to get something done?it just happens.

Because of this system, patients are also receiving prescriptions at their community pharmacies more quickly. Oftentimes, delays occur when a pharmacist calls the doctor to find out just what drug the patient has been prescribed. Before the new system was implemented, filling out a prescription at the hospital could take hours?now it takes just a few minutes. Implementing this new automated system has truly streamlined the work flow for all of our ED caregivers and is reducing the inefficiencies and safety hazards of operating in a paper-based environment. It also solves the age-old problem of trying to read doctors? illegible handwriting.

Preventing Fraud and Abuse

Implementing an EDIS function has improved more than just efficiency and organization at the hospital and local pharmacies; it is also helping us save more lives. In the ED, health care professionals play a critical role in preventing errors and the misuse of prescription medications. Thousands of patients die each year because of medical errors at hospitals, many of which occur because of mistakes and misuse in the delivery of prescription drugs. Information on patients? health histories and medications can now be shared more quickly among physicians, staff, and administrators, enhancing the speed and overall quality of patient care.

Now that we have electronic prescribing (e-prescribing) in the ED, staff members also do not have to worry about security concerns associated with conventional prescription-drug pads and order processes. Drug abusers often use EDs as a source for powerful prescription drugs and addictive painkillers such as oxycodone, meperidine, and opiate-based medications. It is often difficult in a busy ED to thoroughly track patient histories for signs of drug abuse and to monitor drug dispensing and prescription pads. Common prescription diversions in hospitals include ?doctor shopping,? patient deception of doctors, altered prescriptions, and stolen prescription pads. With so many patients coming through the ED doors and a maze of paperwork to sort through, it is often a challenge for hospital staff members such as ED pharmacists to detect diversion tactics or suspicious activity. With the convenience and precision of the eprescribing system, our ED physicians and pharmacists do not have to worry about the security concerns associated with conventional prescription pads and filling patient prescriptions.

Managing Prescriptions Beyond the ED

The influence of the new automated system extends far beyond the ED?s doors. The system prints out comprehensive discharge notes that patients can take with them when leaving the hospital, giving patients, families, and caregivers directions to refer to and ensuring the safe and appropriate use of prescriptions. After the patient leaves the hospital, the primary care physician can continue with an appropriate treatment course, while also having access to the ED care information. In addition, our financial and administrative staff can access the new system and use it to check patient acuity and volume.

Our experience is a great example of how EDs are using health information technology to ensure a safer prescription environment, manage more patient traffic, and promote better communication between the ED and the pharmacy. With this innovative yet simple new tool, Columbia Memorial?s caregivers and community pharmacists are safeguarding some of the most critical steps in the patient care experience.