Adverse drug events can be prevented with this low-cost improvement to existing in-hospital infrastructure.

Despite the amount of focus on electronic health records (EHRs) today, manual and paper-based processes continue to play a significant role in Canadian hospital pharmacies. While the funding and IT resources required for computerized physician order entry (CPOE) projects are still years away for some health care providers, automation of medication order management processes is needed immediately to keep up with demand, ensure patient safety, and meet regulatory requirements. A recent survey conducted by Ricoh Canada involving over 220 respondents from 179 unique Canadian hospital pharmacies provides insight into the levels of automation in the critical workflow of medication ordering in Canada today. Those in the medical profession know that the hospital pharmacy is often a chaotic environment where pharmacists are processing expanding volumes of medication requests, and needing to do so with greater speed and accuracy than ever before.

Patient safety concerns

According to a study published in the Canadian Medical Association Journal, 37 percent of adverse hospital events are highly preventable, and nearly a quarter (24 percent) of these are related to medication error. According to the study, the Canadian Institute for Health Information found that Medication-associated conditions accounted for 37 percent of hospital occurrences of harm in 2014-2015 (including unintended reactions and errors in dosage or administration), and 27 percent of reported incidents involved “distractions or interruptions.” There are many reasons adverse drug events occur. Dose error, drug allergy, and wrong drug/wrong patient are the top three, but other factors such as route error, frequency error, missed dose, wrong technique, illegible order, duplicate therapy, drug-drug interaction, equipment failure, inadequate monitoring, and preparation error can also contribute to adverse outcomes.

Systemic issues

The preventable issues reported by Ricoh customers are summarized below:

Ever-present paper orders are in different workflows than CPOE (if adopted)

Regardless of source, there’s no way to prioritize orders

Inefficient communications between nursing and the pharmacy

Lack of efficient long-term archiving strategies for orders and supporting documents

Difficulties auditing/managing pharmacist activity and productivity

Lack of reporting on volumes and deficiencies makes it hard to identify improvement opportunities

Though there are a wide range of concerns in relation to medication safety, a few can realistically be implemented in any setting: better communications between caregivers and pharmacy staff, improved medication order workflow, and better record keeping.

What can be done today?

It’s clear that automating workflows in hospital pharmacies can provide many benefits. But for a great many, these projects are out of reach. High costs, competing budget priorities, IT project resources, complex implementations, and end user adoption issues continue to limit much-needed automation. The solution for many Canadian hospitals may be a hybrid paper-to-digital “bridge” that leverages existing in-hospital technologies and infrastructure, mirrors existing processes, and can continue to play a role in a future CPOE migration. End user adoption is often a concern in the health care industry, but this migration could be surprisingly easy. Hospital pharmacies could keep their current processes and improve upon them by simply scanning paper-based medication requests into a standards-based electronic workflow that was integrated with the patient record and EHR systems.

This simple approach would create a work queue that improves transparency, communication, and collaboration between caregivers and pharmacists. It would also provide an audit trail and maintain historical records to provide performance management insights. In a recent implementation at an Ontario hospital pharmacy saved 30 to 40 seconds per transaction, which, when accumulated over 1,000 daily transactions, allowed the pharmacy to save 8 hours per day, eliminating the need to hire an additional pharmacist to deal with increasing demand. Relatively low-cost, lightweight, and readily deployable, this is one project Canadian hospitals can do today to have a major impact on in-hospital pharmacy efficiency and patient safety. To learn more, please visit us at

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