In-house pharmacy workflow

(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:

  1. 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?
  2. 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!

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See if this works -

  1. Continue to keep list of medication with appropriate status (active/inactive) to record clinical picture.
  2. If required med will be obtained from outside, use Rx.
  3. If required med will be obtained in-house, add the “product” in fee sheet. These entries are in-house equivalent of external Rx. There is no need for separate Rx to be printed.
  4. Staff in pharmacy will issue the meds per entries in fee sheet and complete the checkout. System will adjust the inventory accordingly.

Alternatively you can also have detailed fee sheet printed during checkout in clinic and patient carries it to pharmacy for getting the meds. You will need manual checks in this case as system performs inventory adjustments when check out is completed.

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Thanks for your suggestions! I didn’t realize that the “product” button on the fee sheet linked to my in-house inventory–I actually hadn’t done much with the fee sheet since it is a free clinic.

We often have to modify the medication order template (as originally created in the inventory module) with comments–adjusting dispensed quantity, frequency, etc. When I enter comments in the prescription module, these comments are viewable when the pharmacy tech pulls up the prescription list view with the “pencil” icon.

It looks like if I order something via “products” on the fee sheet, I am limited to as-is templates from the inventory module–if they are truly unmodifiable, this flow may not work.

Also, I have also gotten stuck with my inventory on another issue related to inventory adjustment–in v7.0.2, it seems that lot adjustment when pressing the “transaction” button for a particular lot is greyed out and not selectable—only “purchase/receipt” and “transfer” are active. If I can’t adjust lots periodically after a manual inventory, there will be no way for me to keep an accurate count of things. Htuck helped look at things for me on another thread on this topic, and he got stuck in the same place–so it may be that I need to give up on the inventory function in its current incarnation.

Check this.