Enhancing the Computerized Provider Order Entry System to Optimize Medical Supply Prescriptions in a Veterans Affairs Academic Teaching Hospital

BACKGROUND: Patient safety is a priority in healthcare systems across the country. At the Veterans Health Administration, when patients run out of their prescriptions, they present to the emergency department for a refill. Healthcare systems must prevent financial strain on the medical center by decreasing the number of patients who report to the emergency department for non-lifesaving conditions. Throughout the Veterans Affairs medical supplies including ostomy supply products and are supplied by the pharmacy service for outpatient utilization. Most ostomy products are available through the Consolidated Mail Outpatient Pharmacy (CMOP). In the event a product is not available the prescription may need to be specially ordered and filled at the local medical center. Due to a lack of resources, procuring these specialty orderable items can be challenging on short notice.

METHODS: An interdisciplinary Ostomy Supply Task Force was established to eliminate all non-value-added time when ordering ostomy supplies in the electronic medical record. A fishbone diagram was created to determine root causes to eliminate waste and improve patient care. A retrospective usage report identified dispensing habits for 113 orderable ostomy pouches at the Michael E. DeBakey Veterans Affairs Medical Center from March to July 2017. Each supply item was analyzed for quantity dispensed, price per unit, and whether the prescription was filled locally or at the CMOP. The pharmacy inventory was surveyed and unused supplies was removed from stock. Data was recorded without patient identifiers and confidentially was maintained. Additionally, due to the rise of new ostomy supply innovations, the VA electronic health record medical supply order set is obsolete. A new updated order set in the electronic health record to assist providers when ordering ostomy supplies needs to be developed. Furthermore, pharmacists and medical providers’ confidence levels when ordering non-formulary ostomy supplies will be assessed by survey both pre- and post-order set implementation.

RESULTS: The survey questionnaire was adapted from nursing confidence in their skills and knowledge to care for patients with ostomies publication. The survey was distributed to medical providers, nurses, pharmacists, physician assistants, and pharmacy residents. Numeric categorized variables were summarized using mean and standard deviation. Frequencies on a 6-point Likert Scale was computed for all categorical variables. A priori of alpha was set at 0.05. The data was analyzed by t-tests to assess the association between provider confidence levels when working with patients with ostomies pre- and post-order set implementation. Additionally, Pearson’s x² was used to assess the association between the healthcare team’s awareness on the availability of an enterostomal consult service pre- and post-order set implementation.

CONCLUSION: Findings from this study suggest that confidence of healthcare providers is higher with training in ostomy care and experience with caring for patients with stomas. After assessing providers confidence levels 1 month pre- and post-order set implementation we found their confidence level increased by over 75% in their ability to confidently know the difference between a colostomy, ileostomy, and urostomy, ordering the correct medical supplies, and ability to identify an alternative medical supplies/solution due to challenges caused by the supply products.