Pediatric Informatics: Computer Applications in Child Health (Health ...

27 Dispensing: Pharmacy Information Systems 347
To prevent errors in this step, pharmacists need access to clear and unambiguous
information about the prescription, the patient for whom it is intended, and the
indication for which the drug has been prescribed. The prescription must be complete,
and must include sufficient detail, clarity, and legibility, with unambiguous
use of numbers, units, and abbreviations. Pharmacists must have ready access to
patient-specific data to track/audit prescriptions and to check dosages, presence of
potential drug interactions, allergies, or contraindications. Pharmacists also need
timely access to prescribers to clarify prescriptions as necessary.
Electronic support for accurate communication of medication orders includes
the use of computerized order entry systems (covered in Chapter 26), standard conventions
and electronic formats (such as HL7) for writing and encoding prescriptions
and unique identifiers for prescribers and patients. The Joint Commission has
not yet incorporated this concept into their Medication Management model.
27.2.2.2 Order Checking/Verification, Preparation, and Dispensing
Order checking/verification of a prescription involves identification and correction
of errors and ambiguities in the transcribed order and/or determining the adequacy
of an available substitution when a desired drug or drug form is not readily available.
Pharmacists’ familiarity with the clinical domain (such as pediatrics), the
clinical condition of the patient and practical considerations (such as alternative
drug forms when oral administration is impractical) is essential.
Preparation and dispensing of a drug dose is a pharmacist’s assurance that the
correct drug for the correct patient and indication is provided at the correct dose
and form, for administration at the correct time and schedule, with the correct
directions, and checked for any contraindications. Pharmacist information needs
include: patient-specific data including age, weight, height, current medications,
allergies and diagnoses and physiologic parameters that determine drug absorption
and clearance (such as liver and renal functional test results), general medical
knowledge of the pharmacology, toxicology, and drug interactions of prescribed
drugs and practical knowledge about pharmacy availability, substitutions, contraindications,
and interactions.
Information technology resources that support this step include: electronic health
records, drug-specific information libraries for prescribers, nurses and patients, formulary
and inventory management systems (including controlled access cabinets, barcoding,
and radio-frequency identification) and disease-specific order sets. The role
of pharmacists is central in creating and maintaining systems that provide information
support about drugs and proactively provide decision support to prevent errors in the
ordering/prescribing and administration steps of the medication delivery process.
27.2.2.3 Administration and Monitoring
Administration is the direct delivery or application of a drug to a patient, and in
inpatient settings is frequently performed by a nurse. Nursing actions within the