MK Chapko, Northwest Health Services Research and Development Center of Excellence; S Amott, Northwest Health Services Research and Development Center of Excellence; AN Hedeen, Northwest Health Services Research and Development Center of Excellence

Objectives: The VA's Computerized Patient Record System (CPRS) has the potential for helping to deliver high quality care more efficiently. We assessed the impact of CPRS on inpatient medication delivery time and the need for editing inpatient medication orders by pharmacists.

Methods: Electronic and paper medical records were examined for patients admitted with a diagnosis of pneumonia and requiring IV antibiotics at the VA Puget Sound Health Care System. 127 records were obtained for patients admitted during the 16 months (August 1997 through November 1998) just prior to the implementation of CPRS. 150 records were obtained for patients admitted during the 14 months (December 1998 through February 2000) just after the implementation of CPRS. The following information was obtained from the record: patient demographics, diagnosis, antibiotic, time of admission, time the physician entered the medication order, time the pharmacy started to process the order, time the medication was scheduled to be delivered, time the order was delivered, and change in the order made by the pharmacy.

Results: We found a significant decrease in the interval between the time that the physician entered the order and the time the pharmacist received the order: 1.89 hours before and 1.11 hours after the implementation of CPRS. We found a marginally significant decrease in the interval between the time that the physician entered the order and the time the patient was scheduled to receive the order: 2.39 hours before and 1.16 hours after the implementation of CPRS. We did not find a significant decrease in the interval between the time that the physician entered the order and the time the patient actually receive the order: 5.38 hours before and 4.19 hours after the implementation of CPRS. We found no significant difference from before to after the implementation of CPRS in the percent of medication orders for which the pharmacy had to recommend a therapeutic change. We found a large increase in the percent of orders that the pharmacy had to edit for data processing reasons from before (1.0%) to after (41.3%) the implementation of CPRS.

Conclusions: We observed some significant time savings in the processing but only a non-significant trend in the actual delivery of inpatient IV antibiotic medications for patients with pneumonia from before to after the implementation of CPRS. CPRS resulted in a significant increase in the percent of these medication orders that needed to be edited by pharmacy.

Impact: These data should help to identify methods for making the delivery of medications to VA patients more efficient and timely.