Description of Event or Problem · 0
A HEALTH SYSTEM SPECIALTY PHARMACY SHARED CHALLENGES AND SUCCESSES AROUND THEIR TRANSPLANT PROGRAM. WHEN A PATIENT RECEIVES A TRANSPLANT AT THE TRANSPLANT CENTER, THE SPECIALTY PHARMACY RECEIVES THE TRANSPLANT IMMUNOSUPPRESSANT PRESCRIPTIONS TO FILL BEFORE THE PATIENT IS DISCHARGED. A FEW CHALLENGES ARE DESCRIBED BELOW: THE DAY OF DISCHARGE, THE PATIENT'S LAB RESULTS MAY NOT YET BE AVAILABLE, SO THE PROVIDER DOES NOT KNOW THE EXACT DOSE OF IMMUNOSUPPRESSANTS THE PATIENT SHOULD BE ON. FOR THIS REASON, THEY WRITE A PRESCRIPTION FOR THE MAXIMUM DOSE. THE PATIENT'S LABS TYPICALLY COME BACK JUST BEFORE THEY ARE DISCHARGED, SO THE PROVIDER COUNSELS THE PATIENT TO TAKE THE CORRECT DOSE BASED ON THE LABS. THERE HAVE BEEN OCCASIONAL CASES WHERE THE PATIENT WAS CLOSE TO RUNNING OUT OF TRANSPLANT MEDICATION AND THE PHARMACY HAD TO SEND A REFILL VIA THE STAT PROCESS, BY SAME DAY DELIVERY WITH THE COURIER OR BY USP NEXT DAY IF THE PATIENT LIVES OUT OF TOWN. A COMMON CHALLENGE OCCURS WHEN THE EHR NOTES ARE NOT CONSISTENT WITH THE MEDICATION LIST. FOR EXAMPLE, IF THE DOCTOR COPIES AND PASTES CLINICAL NOTES AND FORGETS TO UPDATE KEY INFORMATION SUCH AS A DOSE CHANGE. FURTHERMORE, CHALLENGES ALSO OCCUR WHEN THE PATIENT FILLS PRESCRIPTIONS AT MULTIPLE PHARMACIES. FOR EXAMPLE, IF THEY FILLED AN ANTIBIOTIC LAST WEEK, IT MAY BE SENT TO A LOCAL RETAIL PHARMACY. EPIC AUTOMATICALLY DEFAULTS TO THE LAST PHARMACY USED THEREFORE, WHEN THE TRANSPLANT REFILL IS PLACED, THE PRESCRIPTION IS SENT AUTOMATICALLY TO THE RETAIL PHARMACY, INSTEAD OF THE HEALTH SYSTEM SPECIALTY PHARMACY WHO IS MANAGING THEIR TRANSPLANT MEDICATIONS. EPIC AUTOMATICALLY SENDS A CANCELLATION/DISCONTINUATION NOTICE TO THE SPECIALTY PHARMACY IF A NEW PRESCRIPTION IS SENT. THIS CAN BE CONFUSING BECAUSE THE PATIENT IS STILL ON THE MEDICATION, IT MAY JUST BE A DIFFERENT DOSE, OR IT WAS SENT TO ANOTHER PHARMACY. WHEN THE PRESCRIPTION IS RE-SENT TO THE SPECIALTY PHARMACY, IT SHOULD CANCEL AT THE RETAIL PHARMACY. UNFORTUNATELY, EPIC DOES NOT CANCEL PRESCRIPTIONS CONSISTENTLY, AND THE NOTIFICATION IS NOT ALWAYS CLEAR ON WHETHER IT WAS CANCELLED OR NOT. (B)(6) IS A FEDERALLY CERTIFIED PATIENT SAFETY ORGANIZATION AND AN FDA MEDWATCH PARTNER. (B)(6)SUBMISSION ID (B)(4).