(TL/DR: what workflow do you all use for prescribing to an on-site dispensary?)
Hello all! I just got OpenEMR up and running for a field medical clinic in Central America. We saw >100 patients this week, and we hope to staff it with teams coming every 2 weeks or so. This forum has been extremely helpful in getting things off the ground–I never thought that we could get the system up and running so quickly!
If I could, I’d love to get your thoughts our workflow–patients are seen by the MD who is inside an upfitted RV, and then are directed to our “pharmacy” in a storage building about 100 feet away. There have some bulk meds, and many common meds pre-packaged and pre-labeled in baggies (ibuprofen 2 tabs q6h prn, #20; multivitamins #30, etc). My goals are to 1) make the process relatively “paperless”, and 2) (ideally) utilize the built-in inventory system.
Right now, when the doc is ready to write meds, they use the “select from inventory” drop-down in the prescription module (that I have populated with our templates for our current meds on hand). They save/print the templated Rx (modifying as needed), though we don’t have a printer in the RV, so we cancel the print screen. Then the Doc changes the patient status to a status I created called “Rx Sent - Pharmacy” and the doc directs the patient toward the pharmacy on site.
Meanwhile, the pharmacy volunteer is monitoring the flow board, and when she sees a status change to “Rx Sent”, she opens the chart, clicks on the edit/pencil button on the “prescription” section of the Dashboard (so the rx plus any additional instructions/comments entered by MD in the prescription module can be viewed), and fills the prescription. This has greatly sped up the prescription process, particularly in groups (one mom + several children), as the pharmacist can be working on each prescription as the MD finishes each patient–often all meds are done by the time the whole group gets to the pharmacy!
- The problem I am running into is that I now realize that meds seem to stay on the prescription list even in subsequent encounters for the same patient. I incorrectly presumed that things in the “prescriptions” module would only be tied to that encounter, while if added to “medications” they would carry over visit-to-visit. So now if the same patient returns next week–and our workflow remains the same–the pharmacist will pull up a screen showing the new prescriptions AND the old prescriptions. This raises the possibility for error.
Possible solutions/questions:
- I could have the pharmacist delete the meds from the prescription list as they fill them, but this does not seem to function as I expected (clicking box next to prescription and then clicking red “delete” button does nothing). Is there a different way to delete these? Or perhaps these automatically drop off after the prescription duration has elapsed?
- I could stop using the prescription module and just use CAMOS prescriptions to make an entry in the encounter note and direct the pharmacist to look there. But then I lose the inventory functionality.
Thanks for making it through the long question–I’d certainly appreciate if anyone has any thoughts for our use case!