The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts


Rikki S. Bruinsma1, Carol A. Dorfler1

Background: Once a physician placed an order for an inhaled medication, the process to ensure the delivery of that medication involved communication of the order to the Respiratory Therapy (RT) and Pharmacy Departments. This involved a manual process where the unit secretary (US) had to fax the paper order to Pharmacy and also had to enter an order into the electronic medical record (EMR) for Respiratory. The step of entering an order into the EMR deviated from the process of ordering any other medications, which involved only faxing the order to Pharmacy. Due to this deviation in practice, the step of entering the order was often omitted by the US, resulting in RT not being notified of the order and ultimately, the therapy not being delivered. To reduce the incidence of omitted inhaled medication treatments, an automated ordering process utilizing a single physician order was created.

Methods: RT has tracked the monthly rates of omitted inhaled medications as an on-going quality initiative. Rates are calculated by dividing the total number of treatments omitted by the total number of treatments ordered. Between 12/04 and 09/06, the average monthly rate of omitted therapy was 0.29%, with the majority of omissions due to lack of notification. Results were routinely reported to various hospital committees. A directive was received from Risk Management to develop a solution to reduce the incidence of these omissions. Collaboration between Respiratory Therapy, Pharmacy, and our EMR vendor, Cerner Corporation, yielded a process within our current electronic system that utilizes a single electronic order to notify both the RT and Pharmacy Departments. In conjunction with the roll out of Clinical Provider Order Entry (CPOE), the role of the US was eliminated from the ordering process.

Results: Since implementation in October of 2006, the average rate of omitted inhaled medication treatments has decreased by eighty-six percent to 0.04% treatments per month.

Conclusion: Implementing a single-order notification process of inhaled medications has been successful in reducing the incidence of omitted inhaled medication treatments.