Use of medication orders for monitoring prescribing and documenting consultations

A study of the consultations performed by pharmacists under a documentation system that avoids extra paperwork is described. Pharmacists at a tertiary-care teaching hospital developed a system under which the medication order itself is used to capture the information needed for documenting pharmacist consultations. Orders requiring consultation are flagged, and the consulting pharmacist makes a note on the prescription detailing the problem and the outcome of communication with the prescriber. These orders are collected daily and photocopied. To evaluate the system, data on the consultations and the drug orders they represented were collected from July 1990 through June 1991. The potential of the flagged order, if implemented, to adversely affect patient outcome was used to classify the consultations. During the 12-month period, 1031 clinically significant consultations were documented. The rate of acceptance by prescribers was 83%. Orders with potentially fatal or severe consequences accounted for 18.4% of the consultations. The medical service had the largest percentage of consultations, followed by the psychiatric, surgical, and obstetrics and gynecology services. The data were used to show the positive impact that the pharmacy department has on patient outcomes. A system for documenting pharmacist consultations that avoided the use of forms was simple to use and showed a high rate of acceptance of recommendations.