— Jayson Przybyla, Pharm.D., Informatics pharmacist

The following are topics to consider when implementing or already live with Willow pharmacy integrated within the EMR.  Always check with software technical support and preform analysis and testing before implementing any of the topics discussed.

 

Fix barcode errors before they are reported

As new medication products are received by pharmacy, consider using the pharmacy buyer or tech resource to test barcode scanning for new products before they are stocked with validate barcode tools.  In addition, consider using an excel spreadsheet for barcode error documentation on a share drive that is utilized by both pharmacy and the Willow team.  This facilitates fixing barcode errors before they are reported by nursing on med administration.

Dynamic alternative alerts

Dynamic alternative alerts are on-the-fly alerts generated by the system that suggest a list of alternative medications when a non-formulary or non-stocked medication is ordered from the Prior to Admission med-list.  These alerts provide benefit by suggesting a formulary or hospital stocked product, which may decrease pharmacy clarification calls.

Before turning on this functionality, make sure to test it out and analyze the results.  Some Non-formulary examples to test may include Calcium products, opioids, cardiac meds as well as other critical meds. Then analyze the list of suggested alternatives generated by this alert. This may help with how you decide to configure the alert settings.  If you plan to set these alerts to suggest on pharmaceutical subclass, consider excluding classes like oncological, HIV, vaccines, antidotes and others.  When system level alerts finds matching meds in these classes, they commonly do not provide appropriate alternatives.

Medication Age based context by age and location

Age based contexts can be set up to use patient location (department) in addition to age.  Sometimes this may be necessary for patients that are older than the defined age but, located in neonatal or pediatric department.  When choosing which departments that would qualify for age based contexts be sure to discuss the reasons why a department should apply the age context as well as why not.

Making Therapeutic substitution alerts easier to review

When creating Therapeutic substitution alerts, consider using the smartgroup based alternative alerts that allow for display name modification.  Consider changing the original display name with the therapeutic interchange (ordered product >>product substituted).  Displaying the therapeutic interchange in the display name may facilitate appropriate selections when the alert fires for the ordering user.

Post implementation follow-up with end users

Following up with end users after an implementation facilitates relationships between end users and the build team as well as provides necessary feedback on how the solution/build is working.  Depending on the size, importance and other characteristics of the change implemented, consider following up with end users and/or champion of the change in a few intervals post implementation.

Ask open ended questions.  Ask for feedback on what works, and what doesn’t.  How can this be better?  A majority of issues are discovered by end users.  Therefore it is important to follow up with end users and continue foster the relationship.

Fixing Barcodes at go-live

When a nurse cannot scan the medication barcode or gets and error message, consider implementing a process where the nurse can place the empty package with the non-scanable barcode into envelope with the order ID# and other useful pt data at the automated dispensing station.  The pharm tech can collect these barcode packages during ADS fills and bring down to pharmacy to return to Willow team to troubleshoot and fix.

Remind physicians of expiring meds with system lists column

Setting expirations on medications is intended automatically stop the medication along with to have physicians assess if treatment needs to be reordered.  However sometimes expiring medication are not assessed and there by expire.  If this occurs frequently, consider a reassessment of the expiration duration and discuss the pros & cons of extending the duration for different classes of meds.

In addition, consider utilizing an expiring meds column that displays an icon when a medication order is set to expire within predefined time prior to expiration.  Additional configuration may be necessary; make sure to test the build.  If expiring med column is used, consider adding it to the physician’s system list as a standard column.  This may help alert physicians of expiring meds, as they are in the process of reviewing their list of patients.  Also, training and education may be necessary in order to improve compliance and limit orders from expiring without being reviewed.