01-16-2012 04:23 PM
01-23-2012 12:36 PM
If you're situation described is relative to medicatinos available to ED staff via an ADC, I'd have to agree with yuor nursing management. There's little difference in the process in an ED on paper versus electronic orders. We launched CPOE in 6/11 with our ED orders "auto-verifying" so the neds can be pulled from the ADC without waiting for pharmacy review. However, we made a great push for the docs to enter the orders and verbal orders are acceptable only in very few situations.
Beyond this, I share your angst over ED medication use without pharmacy review. Literature supports the premise that it is an error-prone area of care and would benefit from pharmacist order review. Hence, the growing wave of support for ED-based pharmacists.
01-24-2012 11:03 AM
Thanks. I spoke with staff at ISMP and their assessment is that many facilities are trying to figure out the best approach. After talking with them and our ER staff, we are planning to define the meds/ circumstances when verbal orders and RN med entry are acceptable. We already have restrictions on high risk meds- they need to be verified by second RN before administration. I just need to figure out the best process for reviewing the RN entry and making sure it's appropriate.
01-24-2012 04:14 PM
01-24-2012 06:24 PM
This was going to be an issue for our site as well. What computer system are us using? We are using MEDITECH 5.64 and Pyxis 3500 (soon to be 4000).
An idea that was brought up was to allow nursing staff access to put in orders, but only for a specific order set that was built for a few "emergency" medications. Ultimately this was decided against. Nursing staff will be able to override the medication in pyxis and then the override order will cross over to the physicians sign queue.
Hope this info helps!