Improving patient care by using medical records to transmit medication orders

In this retrospective report, the development, implementation, and outcomes of the first 2 years of a novel method for transmitting medical orders for outpatients at the US Public Health Service (PHS) Indian Hospital in Tuba City, Arizona are explored. During this time, pharmacy services within the Indian Health Service were eliminating the use of individual prescription order forms. Medication orders and pharmacists' notations relating to those orders were being written directly into patients' medical records. Pharmacists screened the charts for completeness of patient history information and for drug interactions or other contraindications before filling medication orders. Resulting improvements in pharmacists' communication with physicians and nurses are described and specific cases in which patient care was improved as a result of this program are documented. This program allowed greatly expanded clinical roles for pharmacists and may be used as a model for providing comprehensive pharmacy services to ambulatory patients in small hospitals, clinics, and managed health care facilities.