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Table 2 Workflow challenge themes

From: Understanding the dispensary workflow at the Birmingham Free Clinic: a proposed framework for an informatics intervention

Theme Definition
Labeling The labeling of medication bottles is time-consuming, redundant, incomplete, and can lead to inaccuracies.
Insufficient Process Notification The EMR has an inefficient method of alerting the pharmacist that a patient is ready for dispensary services due its reliance on the clinician’s memory.
Triple Documentation The pharmacists currently document patient prescription/dispensation information in three separate documentation forms (i.e., medication labels, Pharmacy Activity Sheet, and the EMR).
Knowledge of Patient Details During CPOE Clinicians are unaware of a patient’s financial capabilities during CPOE, that determine what type of medication and dosage to be ordered.
Clinician Ordering The destination of the patient prescription (i.e., BFC, community pharmacy) is unknown during CPOE, which often leads to incorrect CPOE.
Knowledge of Formulary Clinicians have no visibility into the available medication stock at the BFC dispensary.
Dispensing The EMR is only capable of supporting the prescribing process at the BFC and does not provide a similar structure for dispensing practices.
Patient Validation The dispensary lacks an explicit method to validate that the right medication is being dispensed to the right patient.
Inventory Maintenance The dispensary is unable to use prescription information in EMR to track medication inventory and dispensing history in real-time.
Drug-Drug Interactions (DDI) The dispensary lacks an explicit method for checking potential DDI’s at the counseling site due to the inability to readily access past dispensation records.
EMR Accessibility Pharmacists cannot readily access the EMR at relevant locations, such as the patient counseling location.
EMR Complexity Volunteer pharmacists and clinicians are not familiar with the specific protocol when ordering medications to the BFC dispensary in the EMR which leads to incorrect EMR order entries.
PAP Application Process The PAP application process is challenging and time consuming due to the large amount of paperwork involved and the wide variation in application format and patient requirements.
  1. Items in bold are the highest ranked workflow challenges as perceived by the pharmacists. CPOE = Computerized phsyician order entry