In working with many pharmacists over the past 18 years I have found that when it comes to discussing the foundation of their Drug database that the conversation has changed.  We have gone from “tell me what you want to see for you and your staff” to “tell me what you need to see for you, your staff and the rest of the hospital staff”.  You would think these conversations would be the same, and for the most part they are the same.  But, times have changed; and as CPOE becomes more of a reality for your facility, it will continue to change.

I remember meeting with pharmacists during the mid 1990’s.  We were planning out how to create their Drug database so that the trade and generic name text would be easy to search, but also visually appealing to the rest of the hospital when printing out labels or MARs.  We needed to be clear, but made changes for the drug selection process so that the right medication was easily detectable when the pharmacists were entering orders.  Everything was about how it would appear when printed.  Safety was focused around the same premise.

After we hit Y2K focuses were changing toward how nurses were viewing the information.  Hospitals were changing from paper MAR to eMAR processes.  Becoming electronic meant a review of how the Drug databases were built.  Paper MARs reports could easily be edited and altered, but the early stages of an eMAR sometimes were not as flexible.  Too much information is not always the best case scenario.  Most hospitals began to optimize their Drug databases for everyone’s needs.  Unfortunately some did not, which became problematic for the nurses and an issue when trying to train and educate properly.  Since this was a path to inefficiency and a potential patient safety issue, everyone realized what was needed to be done and that the Drug database was no longer a one department database.

Now we throw into the mix CPOE.  Bringing full circle the decentralization of the pharmacy database hospitals are struggling with the needs of the physicians.  Building the Drug databases need to be optimized again because now the structure has to work for three user groups.   Physicians view the drug information from a different point of view.  Fewer clicks!  Fewer key strokes!  Streamline the process.  Now you’re building ordering strings and defaults that apply for the physicians.  You’re building reminders and comments so that the physicians order will cross to the pharmacy database cleanly.  Taking the time to do this correctly will lead to the success of the CPOE buy-in and implementation.  Failing to do this correctly will lead to the implementation’s demise.

So as you proceed with any and all of these projects there are simple steps that can be followed to help with your planning and understanding the resources that will be needed to build and optimize your Pharmacy databases.

1. Know who your audience is with whom you are building the system - It seems simple enough, but when you start to build order strings for the physicians if you build them in the manner that a pharmacist would want to view them, you’ll be doing them twice.
2. Keep things consistent – Attempt to keep the same format for each drug type.  Select a format that you will use before you begin so that no matter how many hands you have building the system, everyone is doing it the same.  The last thing you want to do is have inconsistencies where the physician has uncertainty where to find a medication when placing an order.
3. Understand the process and flow – If you do not understand who, when and where a user is going to do a particular function, you will not fully understand how to build it.  Building it the way you would like to see it is not always the correct way.

Following these steps will lead to a successful optimization of your Drug database.  This will be a long process that will take many resources from different areas.  Remember, this is no longer a database for just your pharmacy department.  This is no longer the database that you began with many years ago.  It’s a changing mechanism, vital to your future projects.