The case for change: digitising the pharmacy ordering process
- 21 August 2024
Pharmacy services tend to dislike change, preferring to apply ‘band-aids’ to traditional systems. But the advantages of digitising are now too great to ignore, writes NHS trust ePMA technician Daniel Pugh
Many hospital pharmacies still rely on traditional methods to manage their ordering processes, such as sending paper requests for medications to pharmacies via porters or pneumatic tubes. These methods originated decades ago. While the traditional ordering process may still function, it doesn’t meet the expectations of accountability, safety, or traceability in a modern system, such as real-time progress updates.
Over time, we’ve addressed this by putting ‘band-aids’ in place, such as separate order tracking systems. However, the manual burden of accurately tracking everything often leads to incomplete records, with only certain types of items being monitored. As a result, frequent inquiries about the status of medication orders further strain both pharmacy and ward resources. There is also a disconnect once the medicines leave the pharmacy with the porter, as their whereabouts or who receives them cannot be easily tracked.
More and more hospitals are transitioning from paper-based processes to digital solutions. However, there are some common misconceptions and barriers that need to be overcome.
A general misconception is that workflows will become much more complicated or that a new system won’t let people work in the way they want to. The concern about complicating workflows is sometimes justified – most healthcare apps aren’t known for their fantastic user experience. But things are improving, especially when we think of newer entrants into the market who don’t have 40 years of technical debt. Accessibility is a serious consideration, whereas once it was just a buzzword.
People being encouraged to rationalise and streamline processes (instead of work the way they want to) is actually one of the main benefits of digitised systems. Pharmacy often works on tradition rather than looking at potential improvements; as a service, pharmacy tends to dislike change. Gradually we accumulate dozens of small exceptions, changes, one-offs, and various other accommodations that all had a valid purpose at the point of conception but combine to create a very complex and difficult-to-navigate system.
Streamlined and simplified
Electronic prescribing with stock control integration provides the opportunity to fully digitalise this process, reducing transcribing, saving paper, getting rid of lost or illegible scripts, and providing full electronic status updates. Almost every aspect of ordering can be streamlined and simplified, becoming just another part of a greater system that fits in with recognised standards such as GS1 barcoding. Systems to track medicine bags with the porters (e.g., RFID tags) already exist and can be readily integrated.
Suddenly, the ePMA system becomes the hub for pharmacy activity – you can see the patients’ prescriptions and doses, amend their treatment, view their medicine reconciliation, pull in summary care record data, send prescriptions electronically and order and track medicines in one view from anywhere with network access. When used with the Electronic Prescription Service (EPS), this can allow fully remote consultations and prescribing and prevent patients from having to come into the hospital. This is ideal in cases where trusts cover vast and remote areas. When combined with GP Connect, seamless data sharing around all hospital episodes becomes possible – a true patient care record rather than an organisational patient care record.
Eventually, every dose, every prescription, every order and every dispense will be centralised and combined with primary care data, forming a comprehensive care record that provides invaluable insights for prescribers, patients, and pharmacies. At this point, the benefits for patients and ownership of their own data become clear.
Stock control in action
At South Tees we’ve partnered with Better on integration between their ePMA solution Better Meds and the Helix Stock Control system.
Valuable time is being saved that would have been spent transcribing, orders are fully traceable, and errors during transcribing are being avoided. The stock control system doesn’t have to take into consideration clinical decision support as it’s already validated in Better Meds and users can only dispense medication that has been ordered by authorised staff. The integration is also enabling a real-time update of everything that’s changed with the prescription which is helping pharmacists prioritise workload.
Following our go-live, we prioritised getting effective reporting out of the ePMA system as early as possible. It’s a fundamental factor in leveraging our system to improve efficiency. Real-time visibility of critical or time-sensitive medicines immediately gives a safety net from which pharmacies can act to improve patient care and review where issues are occurring. When combined with ward stock list data, reports like missed doses can provide far more insight than just a ‘gut feeling’ into where things are being missed and why. Using the data available can allow for a very sensitive fine-tuning of stock availability.
Look beyond medications
South Tees plans to extend the system’s scope beyond inpatient supply requests and feeding back quantities and dispensed items, as well as utilising other data such as ward stock lists and integrating with further systems, i.e., bag tracking.
As a service, we should strive to advance the ongoing progress of closed-loop prescribing – including deeper integration of various GS1-compliant standards such as Global Local Numbers (GLNs) for locations and Global Service Relation Numbers (GSRNs) for staff. The implementation and adoption of the Dictionary of Medicines and Devices (dm+d), Fast Healthcare Interoperability Resources (FHIR), and structured dosages have facilitated some progress in making data transferrable.
However, we should extend our focus beyond just medications and start looking at how every entity and action in the system can be made traceable and identifiable across the system and organisational boundaries. The standards to enable this already exist – we just need to start using them.
