Documenting E-Prescribing Medication Therapy Interventions

1. Documenting E-Prescribing Medication Therapy Interventions Training Tutorial

2. The Project • Your employer is collaborating with SureScripts on a research project titled Maximizing Effectiveness of E-Prescribing Between Physicians and Community Pharmacies. • The purpose of this project is to assess the impact of e-prescribing in the community practice setting. • As part of this project, we are interested in evaluating the effect of e-prescribing on patient safety and pharmacy workflow, and for that we need your help.

3. Your Role • For this project, we are asking you to record all interventions you make on new or renewed electronic (i.e., computer-to-computer – no paper) prescriptions for two weeks (10 days) in summer 2006, and again in fall 2006. • This information will be used to inform Congress regarding the problems and best practices of e-Rx systems, and ultimately to improve patient care and pharmacy efficiency.

4. Costs and Benefits • We estimate it will take approximately 30 seconds to document an e-Rx medication therapy intervention on the standard form that has been created for this project. The time commitment on the part of the documenting pharmacist should therefore be minimal.

5. Procedure We are asking participating pharmacists to: • Familiarize yourself with the reporting form & web-portal • Prepare for data collection • Make and record interventions • Return/enter completed forms

6. The E-Rx MTI Form

7. Step 1: The reporting form • Familiarize yourself with the electronic prescription (e-Rx) Medication Therapy Intervention (MTI) reporting form and the web-portal. The web portal is optional and may not be used by some pharmacy organizations. • The e-Rx MTI form requires careful completion to ensure that useable data are collected so please print clearly. These instructions will highlight the reasons for completion of the various parts of the form. • The e-Rx MTI reporting form is designed to allow pharmacists to quickly record their medication-related interventions. • Each pharmacist should have his/her own form for each shift worked.

8. Here’s an Example:During the final check, the pharmacist recognizes the dose of a new, e-Rx for amoxicillin is too high for a pediatric patient’s weight (as listed in the patient profile). The pharmacist double checks the weight with the parent and calls the prescriber to get the dose changed. It took the pharmacist 6 minutes to make this intervention. The entry for this example is included on the training form.

9. E-prescribing refers to “the two-way exchange of completely electronic prescription data between the prescriber’s computer and the pharmacy’s computer “(i.e., no paper).

10. The circled data must be completed on each form.

11. Report the number of e-Rxsyou were personally responsible for reviewing and approving during the hours you worked on that day - NOT the total number that were dispensed in the store.

12. Record the Zip code of your pharmacy on each form.

13. Please enter a 4-digit personal identifier that is known only to you. It may be the last 4 digits of a Social Security number, an address, telephone number, or anything else that you will remember when you complete additional forms. Note: This does not apply if you will be entering your interventions via the web portal.

14. Each form should include the day and the date that data were collected.

15. Each row describes a single intervention. For each box, the options are coded (under the descriptor at the bottom of the form). Enter the code in each box.

16. Indicate whether the error was made on a New, Refill, or Transfer e-Rx.

17. The drug(s) involved in the e-Rx MTI should be recorded in these fields. This entry should include the: medication name, strength, and National Drug Code (NDC) number for at least one medication. Secondary or conflicting medications should be added in the case of drug interaction problems.

18. For this project we are interested ONLY in interventions you make on e-Rxs.

19. This column should reflect how you identified the problem. See list below for option codes. For all categories, “Other” should be used sparingly and always explained.

20. This column should be used to identify the reason the intervention was made. Please select all reasons that apply from the list below.

21. This column identifies the actions you took to resolve the problem. Select all that apply from the list of options.

22. This column identifies the results. A full listing of options appears below. Select all that apply.

23. Please report time you spent actively addressing the intervention in minutes. Do not include time that may have elapsed while awaiting a callback from a physician, for example.

24. This field is an optional free-text field. If used, this entry should be brief and include any observations about the problem or intervention that were not addressed in other fields.

25. Again…Here’s an Example:During the final check, the pharmacist recognizes the dose of a new, e-Rx for amoxicillin is too high for a pediatric patient’s weight (as listed in the patient profile). The pharmacist double checks the weight with the parent and calls the prescriber to get the dose changed. It took the pharmacist 6 minutes to make this intervention. The entry for this example is included on the training form.

26. You can also enter interventions directly into the web portal if you wish. Go to http://www.pqc.net/intervention Web-portal data entry instructions and training are available on request. Please contact Terri L. Jackson, Ph.D., R.Ph. via telephone: 520-235-5529 or e-mail: jackson@pharmacy.arizona.edu if you would like to enroll in a training session.

27. Step 2: Prepare for data collection • Please do the following: • Make copies of the e-Rx MTI form Note: you will need 1 copy for each participating pharmacist on every shift worked during the 10-day data collection period. • Discuss the study with all staff to ensure participation and increase awareness.

28. Step 3: Make & record interventions Each intervention should be recorded on a separate line of the e-Rx MTI reporting form.

29. Step 4: Return data • Daily • Fax completed forms to: Terri L. Jackson, Ph.D. at 520-626-7355 OR • Enter data into web portal at http://www.pqc.net/intervention • At the end of the study period • Mail ALL completed forms to: Terri L. Jackson, Ph.D. in the self addressed envelopes provided. • NOTE: Data should be recorded daily during the recording period regardless of whether e-Rx MTIs were made.

30. Questions? • If you have any questions, please contact Terri Jackson, Ph.D. at: jackson@pharmacy.arizona.edu, or call 520.235.5529. • OR • You may call the University of Arizona Human Subjects Protection Program office toll free at (866) 278-1455.