Training Understanding The Medical Staff Perspective:

Making an Impact as Pharmacy ADPAC Grant A. McElwee, Pharm.D, NCPS, BCPS

LCDR, U.S. Public Health Service Anticoagulation Clinic Manager/Pharmacy Billing Specialist

Pawnee Indian Health Center

Why Should I Work Close with Medical Staff?

• Ultimately, providers order medications, not pharmacists, nurses, lab, etc. • Building orders to fit a pharmacist’s preference (for example)

doesn’t help the provider to be more efficient.

• EHR is very Pharmacy-Heavy! • Unless your site doesn’t have medication ordering, the bulk of

order management happens in the Drug file and with medication orders. • New drugs, prices, NDC’s, etc. change constantly. • Must stay current to avoid fraudulent billing, manage budgets,

clinical guidelines, etc.

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“You Catch More Flies With Honey Than With Vinegar!”

• “It is an old and a true maxim, that a ‘drop of honey catches more flies than a gallon of gall.’ So with men. If you would win a man to your cause, first convince him that you are his sincere friend. Therein is a drop of honey that catches his heart, which, say what he will, is the great highroad to his reason,…” • Abraham Lincoln, Address on Temperance, February, 1842

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Look to Catch Those Flies!

• For example: • Building orders or menus with provider input that fit

the providers’ workflow makes them ‘happy’ and much easier to work with on future needs or projects.

• On the other hand, if you build them without a providers’ input, it just causes separation and division. • “They are telling us how to practice.”

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Guidance on Specific Prescription & Menu Needs: Type 1 User v. Type 2 User

• The “Type 1” user • Open to change and adapts more easily • More proficient in using computer technology (can type, use a

mouse, iPad, etc.). They have a basic understanding of Windows® based programs.

• Need less training and one-on-one time • New graduates are trained on EHRs now and may have never

used paper documentation

• We may be be able to allow these more ‘liberties’ in ordering menus, customizations, etc.

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Guidance on Specific Prescription & Menu Needs: Type 1 User v. Type 2 User

• The “Type 2” user • May struggle with the EHR system as a whole • May struggle with computer skills such as typing • May not like the transition from paper to electronic charting • May require more training • Patience is important! • This provider will often seek you out as a pharmacist that can

help with ordering a prescription. (ie. Trust!) • Encouraged to engage this type of user to help improve

workflows and efficiency and reduce problems

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How To Be A Good Resource For Providers

• Know EHR order Menus for Medications! • If you’re not familiar with the GUI side (EHR order menus) then you

won’t be able to communicate as to what they are seeing or what they need to do.

Providers work here..

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Not Here…

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Protocol for Specialists

• Working with a specialty provider (Podiatry, ENT, Cardiology, etc.) on building medication orders or managing drugs is a necessity. • Their varying orders will be limited, especially with

an already limited formulary. Each specialist will have their ‘favorite’ medications and how they want to order them.

• K.I.S.S. (Keep It Simple & Streamlined). Make their orders and menus fit the specialty.

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Protocol for Specialists

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Protocol for Specialists

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Understanding Prescribing Habits

• “To each his own…” • Large Medical Staff

• Pros: Must stay as general as possible on orders and menus (less complicated)

• Cons: Can’t please everyone…

• Small Medical Staff • Pros: You can become more familiar with the providers

individually with regard to prescribing habits. • Cons: They could all want things ‘their way’ since there aren’t

as many.

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Advisement and Correction (Subtly, of Course)

• If you see incorrect prescribing habits, you can impact them with Quick Orders • For example, common dosing errors can be

‘influenced’ if that dose is not available. • You will, occasionally, be contacted by other

staff about the prescribing actions of a provider • Most don’t want to appear to correct or ‘attack’ a

provider, so you can be liaison between Med staff and other staff (again, Trust)

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Pharmacy ADPAC Involvement: Be Visible!

• Pharmacy & Therapeutics (P&T) Committee! • This is Vital! • Attending or closely following the P&T committee

enables the Pharmacy ADPAC to: • Keep up with Formulary changes • Hear the changes that the providers or pharmacists are

needing (New prescribing guidelines, new packaging, etc.) • Be involved in P&T decision making (at least being

influential).

• If possible, make regular “rounds” in clinic to check in face to face with providers

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COMMON PROBLEMS, FYI’S, AND TRAINING TIPS

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May Only Have up to 60 Characters in Sig Section

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Notes to Pharmacist Section, Careful with Information Placed There

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Drug Text Field in Drug File

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Set up through PDM

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Tie to the Orderable Item

Display to the Provider

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Messages to Providers from Drug File

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Controlling Formulary

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Dose not Available from Possible Dosages

Error potential using the notes to pharmacist field. Recommend free text in dosage field

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Building a Taper or Other Complex Dose

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Medications Tab • Sorting - check default setting (don’t change without discussion

with your EHR team/Med staff) • EHR – BEH – MED – ORD Default Collation Order

Setting Medication List Collation Order for System: PORWORD1EHR.D1.NA.IHS.GOV

Controls the default collation order for the medication list. May be One or more of the following values:

C = Chronic med status

E = Expiration date

F = Last fill date

I = Issue date

M = Medication name

N = Rx#

P = Provider name

R = Refills remaining

S = Status

To reverse the collation order, use the lowercase equivalent.

Collation Order: fms// 26

Medications Tab

• Training Points with providers: • Columns are sortable

• Can hide columns that are not useful to them (Ex: Rx#1)

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Medications Tab

• Training Points with Providers: • Can select multiple orders at a time using Shift or

Ctrl

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“Process Symbols”

In- house Rx Electronically transmitted (E-Rx) Auto-finished, ready to print (not printed yet) Auto-finish, printed prescription 29

Medications Tab

• Use of Process button • Once a medication is highlighted, click the ‘Process’

button

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Medications Tab

Training points with providers: • Understand Chronic Only, Active Only, and Calendar

Buttons

• Understand What each Status means at your facility

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Medications Tab

Training Points with providers: *Confusion with D/C sometimes if order is Renewed *Understand Outpatient Medications vs. Outside Medications *When to use Outside Medication Print or e-prescribing

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Questions?

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