Medication Orders

Medication ordering is common in all clinical contexts. Developing medication order skills can speed workflows, improve patient safety and simplify medication reconciliation at care transitions. Inpatient medication orders are constrained by Alberta Health Services (AHS) formulary considerations, and possibly facility availability. Outpatient orders have fewer limitations, although it remains important to consider regulatory and insurance constraints.

Medication Order Search Lists

A medication order is initiated by performing a search for the desired item, form and dose. Order search results default to present any matching personalizations ("favourites" organized in a "Browse" tab in order search) first. The next "Preference List" tab gathers search results commonly ordered by one's specialty. Finally, a "Facility List" shows results matching those available at one's local facility.

It is important to appreciate the difference between Preference and Facility lists:

It is possible for a medication appearing in the Preference tab to not be locally available, and so not listed in the Facility tab. It is also possible for an item to be available via the Facility tab when that item is not included in the Preference tab listing of search results. This can be easy to forget, especially for prescribers who work infrequently at a particular facility. Resulting delays, and re-checks with the ordering physician, could affect care.

Effective mitigations include:

Medication Order Challenges

Prescribers moving from a paper to a digital health record may find certain types of medication orders challenging. These are easy to write when one can rely solely upon pharmacist interpretation of prose instructions. It can take a bit more effort, and skill, to enter complex medication orders using CPOE. The benefits are worth the effort (decision supports, safety checks, interaction checks, etc.) and the effort is dramatically reduced if personalizations are used to save the initial work of order-entry so that it is automated at next need.

Dose Range Orders

Dose Range Size

Non-Standard Medications

When patients are admitted to Connect Care facilities, prescribers may want to continue home medications. On occasion, a specific medication or formulation cannot be found in the list of items orderable within an inpatient encounter, even after checking spelling, generic names and facility lists. It is likely that the medication is not on the AHS drug formulary, and so is "Non Standard" for inpatient use. Clinically equivalent formulary medications are usually available for substitution.

There may be strong clinical reasons for continuing a home medication that is non-formulary. The ordering prescriber needs to place a "Non Standard Medication" order (search for "non-standard"). This facilitates entry of the generic name of the requested medication, together with details about dose, route, formulation and duration. Such orders are routed to a pharmacist who checks if the medication can be provided. If not, the ordering prescriber is contacted to explore alternatives (such as facilitating use of patient-provided medications).

Placing a Non Standard Medication order is a safer than trying to modify a formulary medication by adding comments to its order composer. These medication modification requests could be missed by pharmacy or nursing, or the request may neglect key details.

Note: A medication name beginning with the prefix "INV" is an investigational medication. If a study drug is not wanted and the same medication without the INV prefix cannot be found, use the Non Standard Medication order.

Tracked Prescriptions for Controlled Substances

The Alberta Tracked Prescription Program (TPP,, formerly known the "triplicate prescription program") monitors use of prescription drugs prone to abuse. It does this by ensuring that such prescriptions are recorded using prescription pads with security features and copies. Normally, prescribers are required to keep a (paper) copy of the prescription. Please note that the new Connect Care eFax workflow cannot be used for prescriptions for drugs classified as Type 1 under the TPP; these prescriptions still require the use of a paper TPP secure prescription form.

Permission from TPP is obtained for Connect Care prescribers to order the controlled substance in Connect Care, produce a handwritten prescription on official TPP prescription pads, add the TPP identification number to the Connect Care record (comments section of Connect Care order), provide the primary handwritten prescription to the patient or pharmacist, and destroy any remaining paper copies of the prescription.

Investigational Medications

Patients may present for care while participating in one or more research studies. The study may involve use of an investigational treatment (usually medication) that is not on the AHS inpatient formulary, or on listings of medications available in the community. 

When studies are registered in Connect Care, it is likely that the investigational agent is added to the facility list of orderable medications. In such cases, prescribers can search for the medication and will find its name prefixed with "INV" (e.g., "INV bamlanivimab IV solution..."). If the study drug is not wanted and the same medication without the "INV" prefix cannot be found, then a Non Standard Medication order should be used.

Medication Order Personalization

Personalizing medication orders with a well-organized list of favourites is one of the best ways to speed Connect Care order workflows. 

Direct eFax of Prescriptions to Community Pharmacies

AHS and AHS partner facilities using the Connect Care clinical information system can send medication prescriptions directly to community pharmacies via an electronic fax (“eFax”) process, without the need for a printed prescription or handwritten signature. This avoids the prior need to print, hand-sign, then fax a prescription. Community pharmacists receive these prescriptions via fax, following their usual procedures. 

The new Connect Care eFax workflow cannot be used for prescriptions for drugs classified as Type 1 under the Tracked Prescription Program (TPP); these prescriptions still require the use of a paper TPP secure prescription form. Furthermore, the eFax option is available for medications only, not supplies such as diabetic supplies. 

For security and safety, electronically faxed Connect Care prescriptions include an electronic signature linked to the unique username, password and professional registration number of each prescriber (such as a physician's College of Physicians & Surgeons of Alberta registration number). The electronic signature replaces a handwritten (“wet”) signature; consequently, graphic signatures are not required and do not appear on direct-faxed prescriptions. Additionally, each prescription has a unique order number that is specific to that prescription. Community pharmacists have access to an online real-time validation tool that can verify the authenticity of Connect Care electronic prescriptions.

To send a prescription via direct electronic fax to a community pharmacy, there are two steps for the ordering prescriber:

A tip sheet further explains these steps. (Note: This workflow should not be used for treatment [therapy] plan medications, as these have specific settings that should not be changed.) 

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