Background During the implementation of an integral pharmacotherapy management system with an electronic prescription system (Silicon) connected to a nursing module for the electronic management of medication and nursing care (Gacela), we found that we needed to identify all of the non-pharmacological prescriptions that were traditionally prescribed on a manual prescription sheet, and to find an alternative channel -having eliminated paper from the prescription process - so that they could reach the nursing staff.
Purpose To eliminate paper from the communication process between physician-pharmacist-nurse. To identify all non-pharmacological prescriptions and adapt them to the new electronic prescription system.
Materials and methods An observational study of 100% of the treatment sheets received by the pharmacy service at a tertiary hospital (1419 beds) over 7 consecutive days in order to identify the non-pharmacological prescriptions. A non-pharmacological prescription was considered to be any prescription that did not refer to drugs, medicinal gas, IV hydration therapy, or enteral/parenteral nutrition. The review was carried out by the pharmacists responsible for each inpatient care unit.
Results A total of 2,048 single dose treatment sheets were reviewed (average: 186 sheets/pharmacist). 279 different non-pharmacological prescriptions were identified, which were grouped in categories: 111 (39.8%) general measures (e.g. contact isolation, walking with frame); 72 (25.8%) diet (e.g. try oral tolerance, remove tube); 41 (14.7%) ventilation (e.g. nocturnal BIPAP); 41 (14.7%) laboratory test (e.g. blood test, urine culture); 14 (5%) water balance (e.g. hourly urine output, fluid restriction). Due to the heterogeneity of non-pharmacological prescriptions within each of these categories and the limited versatility of connectivity between Silicon and Gacela, we created a fictitious specialty in the electronic prescribing program, called ‘Nursing care’. This fictitious specialty allows transcription of non-pharmacological prescriptions as if they were drugs, so they can subsequently be dumped to the drug diaries or included in the specific nursing care schedules of the Gacela application. The specifications of nursing prescriptions could be incorporated to the line through the open field ‘Remarks’. By default, it was configured with a frequency without fixed hours so that it could be viewed by all of the nursing shifts.
Conclusions The incorporation of ‘Nursing Care’ as another prescription line was a quick and easy solution to a problem arising with the implementation of an electronic prescribing system, allowing communication of non-pharmacological orders between doctors and nurses and the withdrawal of paper from the process. More appropriate tools are needed, because the modification made shows the pharmacists’ ability to solve problems, but does not replace an adequate tool.
No conflict of interest.
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