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Jennifer D'Onofrio



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  • OS30 - What's New in Medication Management (ID 51)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical and Executive
    • Presentations: 1
    • Coordinates: 5/29/2019, 10:30 AM - 12:00 PM, Room 200 C
    • OS30.01 - Old Becomes New: Revitalizing Medication Ordering Practices After 15 Years (ID 181)

      Jennifer D'Onofrio, University Health Network; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives:
      University Health Network (UHN) first implemented electronic medication order entry and administration in 2004. Since then, clinical best practices and system technologies have notably evolved. However, the organization had not established formal processes to periodically evaluate 1) existing medication screens from a UHN-wide clinical perspective and 2) opportunities to implement system upgrades that optimize medication order entry. Today, medication screens have accumulated long lists of order options, inconsistent layout standards, and non-customized dosing intervals. These contribute to prescriber confusion and frustration, risking prescribing errors. In June 2017, a project focused on updating medication screens became a UHN priority. The project?s purpose is twofold: 1) to simplify existing order entry screens to support easier, clearer, and consistent prescribing of medications and 2) to implement a formal process that sustains and carries forward the benefits of this work. This abstract highlights the development of electronic medication build standards, its application and associated interim benefits, and describes the emergence of the EPR Medication Order Request for Additions & Revisions (EMORAR) Subcommittee.


      Methodology/Approach:
      Analysis of the implemented EPR system was conducted by UHN?s Data and Implementation Science senior analysts and Pharmacy Informatics specialists. Multidisciplinary stakeholder consultations informed the project?s guiding principles for improving electronic medication ordering, and new layout and display standards. These were evaluated by UHN Healthcare Human Factors team and approved by Safe Medication Practice (SMP) and Pharmacy & Therapeutics (P&T) committees. Applying the standards, prototypes are developed by project?s clinical pharmacist. UHN references (ex. policies, department specific handbooks, nursing manuals), UHN clinical tools, and UHN-wide data are used to justify modifications. The prototypes are reviewed by a therapeutic-specific Clinical Working Group (CWG) consisting of pharmacists and nurse practitioners. Subsequent iterations are reviewed by physician expert representatives. Additional stakeholders are engaged as needed. Microsoft Excel is used to document 20 metrics describing pre and post screen changes. Regular interim reporting is completed for 3 key clinical metrics from a user-perspective which includes the difference in means and percent change.


      Finding/Results:
      As of October 2018, 79 medications have been updated. The table below defines the 3 metrics and summarizes the most current results.table. percent change in order options visible to front-line prescribers.jpg


      Conclusion/Implications/Recommendations:
      UHN recognized the need to establish proper committee infrastructure to maintain electronic order entry practice in a well-kept state. A new P&T Subcommittee (EMORAR) led by clinical pharmacy and pharmacy informatics co-chairs was established. This subcommittee maintains integrity of electronic medication screens standards by reviewing change requests and overseeing initiatives involving enhanced system capabilities. New today becomes old tomorrow, hence formal processes are necessary to ensure evolving clinical best practice is supported by existing technology effectively.


      140 Character Summary:
      Old becomes new: Revitalization of medication ordering practices to meet new build standards at University Health Network?s acute care hospitals.

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