Pharmacy Staff

Present situation.

The terms Clinical Pharmacy and Pharmaceutical Care seemed to be used interchangeably of late, yet the definitions are markedly different though the end-vision the same. To try and map the process is outside the scope of this page, but if you distill it down & down again you get the a cycle of enhanced supply and demand. So where does Erx come into this?

Firstly it will free time for pursuit of a consistently high level of Pharmaceutical care.

It will as with other end users contribute to an information rich environment for decision making.

It will allow the more widespread adoption of 'near patient' Clinical Pharmacy.

With a good reporting system, think of the information that could be retrieved c.f.

• Finding a list of patients who have had drugs for....
• Finding the Medical Records dept
• Finding the medical records corresponding to those patients required
• Finding anything about drug therapy and reasons behind therapeutic decision making inside

For the dispensary it will save large amounts of time:

• With medication histories becoming available 'at the touch of a button'
• Removal, in part, of transcription errors
• The facility for wards to track requests
• The facility to append messages to requests
• The facility to organise incoming work
• The facility to securely check/amend prescriptions on line
• More transparency

With this in mind the requirements from a Pharmacy view point can be constructed.

System Requirements

From a Pharmacy viewpoint any system would include the following functionality:

1. The facility to check prescribed medicines vs. known allergies from the EPR (known allergies must be a required field)
2. 'Usual dosages', and available forms & strengths for any selected (with a view to prescription) drug
3. The system must automatically highlight drug interactions that are important (this would be ?user defined) plus provide access to comprehensive, on-line interaction checking on request
4. The system must offer linked access to the Hospital formulary
5. MUST be able to restrict prescribing of non-formulary/approved non-formulary drugs as well as allowing prescription of said class of drugs under proscribed circumstances
6. It should also offer linked access to WeBNF (as developed by the CBCU at Addenbrooke's) and thus subsequently the hospital's IV drugs guide
7. The system must be able to differentiate between ward stocked drugs, non-stocked drugs (in which case generate order requests to Pharmacy) and have a facility for patients own drug (non-order - this should be reversible i.e. when patient's own drugs run-out)
8. The system must therefore recognise/allow for patient self administration of either their own drugs or those dispensed to them by the hospital as TTA packs
9. The system must be linked to the Pharmacy stock control and accounting system so as to:

• Avoid double entry of:

  • Drugs
  • Precautions in use
  • Formulary status &c.

• Electronic transfer & processing of:
  • Non-stock requests (i.e. in-patient)
  • Out-patient including day case, A&E and repeat prescriptions (e.g. clozapine)
  • Discharge prescriptions - including production of patient medication cards by the Pharmacy stock control system (if the facility is available)

10. It would be possible to prioritise prescriptions transferred to Pharmacy e.g. for urgent discharges
11. The system should take account of Pharmacy opening times i.e. there is little point transferring a prescription request to Pharmacy when it is closed. Though if it automatically alerted the on-call Pharmacist, that would be interesting...
12. It would be possible to prescribe medications that are not on the system (e.g. by using ?BNF link). There would need to be systems in place to alert Pharmacy that this had occurred so that such drugs entered in this way were included to the system ASAP.
13. MUST be able to report for example on:

• Waiting times
• Non-formulary usage
• Use of particular drugs by directorate/Teams/wards/patients
• Data protection act reports (e.g. on patient request)
• Medication histories by user defined parameters
• New drugs prescribed (e.g. on a patient set i.e. Dr Smiths patients on ward A1 over the weekend just gone)
• Unverified (by Pharmacy) prescriptions
• Patients who are self administering their own medication on a given ward

14. The system would have the facility to cost private patients therapy
15. The system must have the facility to create discharge letters (either independently of or via the EPR) which can be sent electronically to GPs
16. Any system must allow validation of prescribed medications (inc. discharge prescriptions) before processing the script/order request
17. It must allow annotations by Pharmacists (plus recording by whom & when) to prescribed medicines
18. It must allow Pharmacists to amend prescribed medicines (recording by whom & when)
19. It must allow prescription verification by Pharmacists (inc. differentiating between prescriptions verified and those which are not)
20. The system must be able to produce patient medication histories
21. The must be a facility to append recall/caution in use notices to drug files as & when they are issued by the MCA
22. There should be the potential to send discharge medication information direct to retail pharmacies in the future
23. Any system will be both secure and auditable

Please feel free to E-mail me any comments/contributions or questions

Go back to the top of the page

back to index

NEXT (Medical users)

HOME

Copyright - Will Willson 1999
designed & written using MS notepad 8]