Pharmacy Informatics

Pharmacy Informatics

field focusing on medication-related data and knowledge within the continuum of healthcare systems

• acquisition, storage, analysis, use, and dissemination of knowledge and data

• delivery of optimal medication-related patient care and health outcomes

• dedicated to improving health and ensuring the value of the medication use process through health information technology

• interface information technology and medication use to improve safety, efficiency, and patient care

Role of Informatics Pharmacist

• build and maintain databases with accuracy, precision, and attention to detail while respecting standard conventions for naming and formatting 

• be a strong advocate for patient safety and encourage use of technology 

• fluency in data analytics and reporting 

• educate and train staff and clinicians for new deployments or updates + help w troubleshooting 

• be a leader and provide guidance; serve as liaison between pharmacy, clinicians, and vendors; know how to talk to people and translate what you know; collaborate with other disciplines to support use of technology for safety

formulary

set list of medication offered by hospital or insurance company

• insurance: determine what medications are covered by pt’s insurance plan

• hospital: medications approved for use in hospital setting as determined by the Pharmacy + Therapeutics Committee

• all other drugs considered non-formulary

FSV

Formulary Service Vendor - company that provides services and technology to manage formulary (e.g. FDB - First Data Bank, Medispan, etc)

ADS (or ADC, ADM)

Automated Dispensing System (Automated Dispensing Cabinet, Automated Dispensing Machine - e.g. Pyxis, Omnicell)

• safe + efficient vending of medication outside of pharmacy

• interface w EHR (displays pt profile so RN can select only required medications ordered)

• RN or clinical may override system for emergency circumstances if Rx not ordered yet

• equipped with scanner so meds refilled by pharmacy or returned by RN must be scanned 

• user access to system regulated - areas + permissions assigned based on user’s role

• interfaces with pharmacy inventory management software + controlled substances inventory software to send refill messaging 

Carousel

vertical storage device commonly used in hospital pharmacies, esp. w/ limited space 

• saves space/time + takes advantage of vertical height

• non-controlled medication storage adopted from manufacturing industry design

• vendors develop software to manage contents + control hardware

Smart Pumps

infusion devices that have dose-error prevention software to deliver intermittent or continuous infusions in bag or syringe form for IV medications, fluids, and epidural use

EHR (or EMR)

Electronic Health (Medical) Record (e.g. Epic)

CPOE

Computerized Provider (Physician) Order Entry

• drug information

• clear + concise display names for medications to reduce confusion + builds medication entries using ISMP’s recommendations (ie. Tall Man lettering)

• build order sets and panels that are evidence-based so providers don’t need to enter one-off orders (EHR must be updated when new therapies emerge/evolve)

• give providers order entry guidance by providing clinical decision support (CDS) such as dose recommendations

• ensure up to date formulary in EHR!

MAR/eMAR

Medication Administration Record/electronic Medication Administration Record

• populated automatically

• allows RN to see which meds are due and when

• uses BCMA to ensure pt and drug barcodes match EHR for Rx and dose prescribed

BCMA

Barcode-assisted medication administration

• promotes pt safety and reduces medication errors at the bedside (correct Rx to correct pt)

Interface

a point where two or more independent systems connect and communicate

HL7

Health Level Seven - standard for the exchange of health data between applications

• RXE segment has details about pharmacy-specific orders

Interoperability

the ability of different applications, devices, and information systems to be integrated and exchange information

Types of systems used in order entry and dispensing in hospital setting 

• CPOE - ensures ordering of correct Rx

• EHR - designs workflow + dispense logic to increase efficiency (+interface!!)

• Interface/integrated messaging (nurse → pharmacy for dispensing OR → ADM for vending

• ADM - dispenses RPh verified Rx

• RPh verification + barcode scanning - correct Rx is dispensed

• BCMA - correct Rx is given to patient

• Pump Integration - uses barcode scanning to scan pt + Rx barcodes and infusion pump channel barcode to administer infusion

• MAR - uses BCMA to ensure pt barcode and obtained drug barcode matches prescribed drug barcode in EHR (Rx/dose/dose form/etc) before administration

safety benefits of cleanroom workflow management systems 

allow for systematic compounding of sterile products

• interfaces with hospital’s EHR

• equipment needed

  • touchscreen computer

  • scanner

  • camera

  • printer 

  • scale for gravimetrics

• medication build

  • drug name + strength 

  • reconstitution volume + diluent 

  • concentration after dilution 

  • compatible diluents 

  • storage requirements and BUDs

  • special considerations (ie. inline check, filter requirements, etc.)

features of smart infusion pump

• database of syringe manufacturers for correct syringe size for admin (source of error - too fast or too slow infusion rate)

• pharmacy builds drug library and each medication entry has ranges and/or limits on doses, rates, and concentrations - reduced risk of pump error (notifications/alert if input value is out of range)

• allows for alternative programming for medications with multiple uses + requiring different Rx ranges

• reports can be generated to review/document number of alarms/alerts 

goals of interoperability

• improve quality of care 

• reduce errors and improve efficiency

• reduce healthcare costs

• protect patient privacy and data

• simplify medication order process

ISMP

Institute for Safe Medication Practices

• nonprofit organization that educates healthcare community and consumers about medication safety

• empowers healthcare community to prevent medication errors + advance patient safety

• conducts research to provide evidence-based safe medication practices