Revealing the Relationship Between Return-to-Stock Medications and the Implementation of E-prescribing at a Hospital Ambulatory Pharmacy

Julia Balazh, Gabrielle DeLell is, Keith Kincaid, and Gerard WoolyhandShands Jacksonville Medical Center

University of Florida Health Science Center/Jacksonville

Background

Purpose

Disclosures

References

Objectives

The authors of this presentation have nothing to disclose concerning possible financial or personal relationships with commercial entities.

Results, cont.Methods Discussion

UF & Shands Jacksonville Ambulatory Pharmacy fills around 1600 prescriptions per day. In September 2011, the pharmacy implemented e-Prescribing. This coincided with a drastic increase in the number of prescriptions being returned to stock (RTS). In May 2011 the new computer system – Enterprise - was implemented in the hospital.

The purpose of this study was to identify the reasons for the increase in the return to stock prescriptions after the implementation of e-Prescribing.

Primary Objective: • To find out why the number of prescription RTS has increased

Secondary Objectives: • To establish whether an interactive voice response (IVR) system would have been helpful in preventing high RTS numbers• To reveal the reasons for patients’ delay or decline in picking up their medications • To understand why patients were unaware of their prescriptions being ready

Each day, a list of patients who had prescriptions ready for pick-up for at least 5 days was obtained. Only those prescriptions which were sent in electronically were utilized for the purposes of this study. These patients were called and asked a series of questions to determine if they were aware they had prescriptions ready to be picked up or not. If patients were unaware of their medications being ready, they were put in two different categories:

• Saw provider, but provider did not tell the patient prescriptions will be sent• Called provider for refill request, but no one informed patient to pick up their prescriptions

If patients were aware, they were asked if they wanted the prescription or not. Patients who declined were placed in the following categories:

• Cannot afford medications• Provider stopped medications• Patient stopped medications• Transportation issues

If patients did not decline the medications, the reason for the delay was further investigated. The following reasons were identified:

• Tried to pick up but the line was too long at pick-up• Forgot about the order• Health• Convenience• Transportation issues• Still had medications from previous fill

After each call the data was recorded into the Excel spreadsheet. Once all the data was collected, analysis was completed.

• Of the patients who answered the phone, 48.9% of them were not aware that they had prescriptions ready at the pharmacy.

• The most common reason for unawareness was seeing their provider but not knowing the provider was sending a prescription.

• Of the patients who answered the phone, 51.1% were aware that they had prescriptions ready. Overall, miscommunication accounted for 87% of patients delaying their medication pick up.

• The two main reasons “aware” patients delayed picking up their medications were: transportation and convenience. This meant that patients wanted to wait for their next appointment at the hospital or until other medications were due to be filled.

• When asked about whether an IVR system would’ve helped remind them, a majority (93.2%) said that yes, it would have. Due to this overwhelming positive result, the pharmacy may want to consider implementing such a system.

Results• Hogan, Thanh. “Summary of Strength and Opportunities”,

November 2012. 3rd Quarterly Report, Shands Jacksonville Ambulatory Pharmacy.• Bogdan, Michael. Interview by Julia Balazh, Gabrielle DeLellis, Keith Kincaid, Gerard Woolyhand. "Return to Stock Project.” Return to Stock Data Sheets. 14 Nov 2012. Michael Bogdan, Jacksonville. 13 Nov 2012. 7. Web.

Conclusion

Patients who were aware of their prescriptions, delayed in picking them up primarily because of transportation-related reasons. As well, people prefer to pick up their prescriptions at once and to make less trips to the pharmacy, as shown by the patients who delayed due to ‘convenience’. The overwhelming reason for patients to be unaware of their prescriptions is due to miscommunication with the physician. The results also greatly favored the use of an IVR system to help patients be aware of their prescriptions.