Computer system in hospital Pharmacy

The computer has become a very common tool in all areas of science and technology. With the
proliferation of the internet and the development in computer technology and manufacturing the ratio
of price to performance of computer continues to decrease. This has resulted in the development of
number of computer applications.

The field of pharmacy immensely benefited by the use of computer and will continue to benefit as the
pharmacist gain more familiarity with computers. The field of Pharmacy is immensely benefited by the
use of computers. Some of the important areas where computers are useful include new drug
discovery, drug design, analysis, manufacturing of drugs

Use of computers in hospital Pharmacy

 In receiving and allotment of drugs (drug management)

 Storing the details of every individual
 Professional supply
 Records of dispensed drugs to inpatient and outpatient
 Patient record information
 Patient monitoring ( BP, blood glucose, temperature)

Pattern of Computer usage in Hospital Pharmacy

Use of computers in hospital pharmacy is improving but still in nascent stage. It was suggested in
view of improving patient outcome , reduce practioners workloads so as to improve patient
contact time and also to improve the hospital pharmacy efficiency. But many barriers including
accessibility, cost, lack of knowledge and training, lack of professionalism limit the use of
computers in hospitals.

Patient record database management.

Patients recording management is an integral component in modern day healthcare management

system. If proper records are kept in secure and safe place within the hospital helps healthcare
professionals compare and contrast certain illnesses based on certain features. It can also be
used for research purposes if guaranteed of security and privacy issues. The patient’s records
kept include patient data, which helps to maintain patient’s medical records. The medical records
must be accurate, efficient and correct that reflect the patient’s medical history. Medical
professionals maintain impeccable records as it serves numerous purposes.

Strengths of Paper Patient Records

 Paper records are familiar to users who consequently do not need to acquire new skills or
behaviors to use them.
 Paper records are portable and can be carried to the point of care.
 Once in hand, paper records do not experience downtime as computer systems do.
 Paper records allow flexibility in recording data and are able to record "soft" (i.e., subjective)
data easily.
 Paper records can be browsed through and scanned (if they are not too large). This feature
allows users to organize data in various ways and to look for patterns or trends that are not
explicitly stated.

Disadvantages
  Problems with Access, Availability, and Retrieval

 Problems with Format

 Problems with Patient Record Content

 Problems with Linkages and Integration

 Increasing Demand for Data

 Maintaining Confidentiality

 An Information Explosion
 A computer-based patient record (CPR) is an electronic patient record that resides in a
system specifically designed to support users by providing accessibility to complete and
accurate data, alerts, reminders, clinical decision support systems, 3 links to medical
knowledge, and other aids.

Advantages

 Data Sharing Is Improved In The Organization

 Improvement In Data Security

 Effective Data Integration

 Database Management Systems Minimize Data Inconsistency

 Better Access to Data

 Increase in Productivity of the End User

 Quick Decision Making

Eg. Meditab

Medication order entry

Prescription processing is invariably one of the main activities going on within the pharmacy on a
day to day basis and computers are used to make this process more reliable and efficient. Both
the customer service side of the pharmacy operation and the dispensing aspect are today carried
out through the use of computing systems . Pharmacy computers also handle customer service
activites such as sales and cash handling within the retail operations.
 computerized provider order entry (CPOE) systems are designed to replace a hospital's paper-
based ordering system. They allow users to electronically write the full range of orders, maintain
an online medication administration record, and review changes made to an order by successive
personnel. They also offer safety alerts that are triggered when an unsafe order (such as for a
duplicate drug therapy) is entered, as well as clinical decision support to guide caregivers to less
expensive alternatives or to choices that better fit established hospital protocols. CPOE systems
can, when correctly configured, markedly increase efficiency and improve patient safety and
patient care. However, facilities need to recognize that currently available CPOE systems require
a tremendous amount of time and effort to be spent in customization before their safety and
clinical support features can be effectively implemented. 

The first main reason health care organizations and providers implement CPOE is to prevent,
reduce, or eliminate medical errors and adverse drug events or ADEs.

The second main reason health care organizations and providers implement CPOE is to improve
patient safety.

The third main reason health care organizations and providers implement CPOE is to reduce
unnecessary variation in health care. 

The fourth main reason health care organizations and providers implement CPOE is to improve
the efficiency of health care delivery.

CPOE also is far-reaching from the sense of where it is used, and the order types involved. CPOE
use is not limited to the inpatient environment. It is useful to any health care setting where clinical
processes, tests, procedures, and medications are ordered, performed, or administered. The
most common settings are inpatient or ambulatory settings.

Medication Order Management System- is a electronic-based, automated order management and

robust clinical intervention tracking tool that enables hospital pharmacies to identify key safety, quality,
productivity and clinical improvements. For hospitals implementing Computerized Medication Order
Management Systems, Medication Order Management System is designed to Supplement Systems
environment, so that your hospital truly benefits from a complete affordable order entry solution.
 Improve productivity, quality and nursing satisfaction With advanced, real-time productivity,
clinical and quality reporting metrics
 Complement Medication Order Management Systems technology, utilizing flexible contract
and billing terms to shift.
  Improve operational efficiency and patient safety

The process of prescribing and administering a medication involves several steps, each of which
has vulnerabilities that are addressed-to greater or lesser degrees by Medication Order
Management Systems:

1. Ordering: the clinician must select the medication and the dose and frequency at which it is to be
administered.

2. Transcribing: if handwritten, the prescription must be read and understood by the recipient (usually
a pharmacy technician or pharmacist)

3. Dispensing: the pharmacist must check for drug-drug interactions and allergies, then release the
appropriate quantity of the medication in the correct form.

4. Administration: the medication must be received by the correct person and supplied to the correct
patient at the right time in the right dosage. In hospitalized patients, nurses are generally responsible
for this step, but in the outpatient setting, this step is the patient's or caregiver's responsibility.

Medication Order Management Systems are generally paired with some form of clinical decision
support system (CDSS), which can help prevent errors at the medication ordering and dispensing
stages and can improve safety of other types of orders as well. A typical CDSS suggests default
values for drug doses, routes of administration, and frequency and may offer more sophisticated drug
safety features, Such as checking for drug allergies or drug - drug or even drug-laboratory (e.g.
warning a clinician before ordering a nephrotoxic medication in a patient with elevated creatinine)
interactions.

Entering information into computer system:

a. Information required is prompted.

b. Quantities are expressed in metric units.

G Input the correct dispense as written (DAW) code (e.g., DAW would indicate the prescriber wants
the brand name drug dispensed)

d. Calculate a day's supply of medication.

e. Third-party adjudication: Submitting prescription for payment by third -party drug insurance
provider. If the prescription drug insurance company denies payment the patient is responsible for full
payment of the prescription unless the rejected claim is corrected and resubmitted to the third-party
prescription drug provider

f. Drug utilization evaluation (review Process of verifying that the prescription being processed does
not interact adversely with the other medications on a patient's profile. lf a warning is observed the
pharmacist is to be notified immediately to determine the proper course of action in filling the
prescription such as contacting the physician or to continue fling the prescription. he pharmacist
makes a decision based on the information on hand.

Drug labels (Prescription Product Labelling )

roper labeling is one of the most important aspects of dispensing a prescription. The label must comply with
state and federal regulations and should correctly and clearly convey all necessary information regarding
dosage, mode of administration, and proper storage of the product. The quality of the labeling is extremely
important to the patient's perception of the quality of the product and may have profound implications for his
or her safe use of the medication and compliance with the prescribed regimen.

Required Label Information

Most pharmacies have the name, address, and phone number of the pharmacy pre-printed on their
prescription labels. In addition, federal and state (NC) regulations require that the following information appear
on the label.

 prescription (serial) number

 date of initial dispensing
 patient's name
 directions for use
 name and strength of the drug product (or active ingredient(s) in a compounded prescription)
 prescriber's name
 name of dispensing pharmacist
 beyond-use date

Computerized Medication Order Management Systems allows prescribers to create a structured sig
but also offers two additional fields: Special instructions and comments. "Special Instructions are
transmitted to the pharmacy and are intended to be printed on the label, such as "do not drive while
taking" or avoid sun exposure.

Computers make the process of drug labelling easier. Advantages of computerised drug labelling

 Time saving
 Easy to prepare.
 Avoid accidental errors and omissions
 Can be easily modified based on requirement
 More aesthetic
 Storage become easy
 Reproducible.
 Automatic capture of information

Electronic Medication Administration Record (eMAR):

Intravenous solution and admixtures

The combination of bar code verification technology with an eMAR was implemented to further reduce
administration errors. The eMAR system electronically receives patient profile information from the
pharmacy system. This process eliminates the need for nurses or unit secretaries to transcribe
physician orders, therefore potentially reducing transcription errors. At the bedside, bar codeleMAR
allows for real-time confirmation of patient identification, medication, dose, and time of administration
by automatically checking the scanned medications against the patient's eMAR profile By the help of
this computerized system Intravenous solution and admixtures can be rationally prescribed and
administered.

Together, barcode scanning in the pharmacy and bar code / eMAR systems on the inpatient units
have the potential to improve medication safety by reducing post ordering medication errors.

Including smart pump in a closed loop point of care medication administration system can further
improve medication safety. The goal is to provide seamless digital pathway from computerised
medication Order Management System to the patient vein. 
Patient medication profiles:

A patient medication profile is a comprehensive summary of all regular medications taken by a

patient, including prescription Over-the-counter and complementary medicines. Current medication
profiles may vary in format and the level and type of information provided.

The aim of the Patient Medication Profiling Program is to reduce the risk of medication-related
adverse events by assisting people to understand and manage their medications, including
prescription over the-counter and complementary medicines.

The provision of a medication profile to patients is expected to improve their awareness of their
medications (.e identifying them, understanding why they have been prescribed and when and how
they should be taken). The medication profile will also give patients confidence in self medication
management, and support Communication between the patient and other health professionals,
especially on admittance to hospitals or aged care Homes

Pharmacists participating in the program will be subsidised to provide patient medication profiles to a
specified number of patients who would benefit from the provision of a profile.

Patient medication profile usually Includes:

o medication brand name;

o list of alternative brand names;

o medication generic name

o medication strength and form;

O dose and frequency,

O special directions or cautions,

O reason for use, and

O a coloured pictorial representation or product description for items not on the system (eg

Complementary medicines)

Example of Patient Medication Profile

Inventory Control

lt is extremely difficult to maintain inventory details manually especially with several thousand items
like drugs, instruments, linen and furniture, etc. in the hospital. The result is that most hospitals are
regularly throwing away large quantities of expired drugs and by the time, one is able to do the stock
checking the status gets changed entirely.

Thus, computerized systems are helpful in checking billing and accounts, obviating long line, totalling
mistakes, wrong entries and quarrelling of patients are the hallmarks of manual accounts. Bills of
patients, staff and other things are computerized and such Scenes are averted.

So in all these fields, computers are of immense help and save manual labour, time as well as money
Management of report and statistics

Computers helps hospital pharmacy to keep the record and generate report and statistics for quality
control and regulatory purpose. It is mandatory to have various report for regulatory submission with
drug control. Number of statical and other reports are necessary For quality improvement purpose.
computers helps in scheduling work and monitor it for better efficiency. It helps in improving
operational efficiency. These report and statistics usually include

Hospital data

 Number of admission
 Discharges
 Average time of stay

Aggregate drug usage

 Drug use evaluation , category of drugs etc

 Drug use per patient
 Cost .

Pharmacy quality indicators

 Average time for dispensing

 Number of errors per month.

Create reports on billing payments, prescription revenue and profit margins. Generate daily logs,
claims reports, compliance reports and so many more.