Culmination of Fall Semester 2012 research, UF&Shands Jacksonville Hospital. Presented to pharmacists and residents of the hospital in Jacksonville, FL.

1. Revealing the Relationship Between Return-to-Stock Medications
and the Implementation of E-prescribing at a Hospital Ambulatory Pharmacy
Julia Balazh, Gabrielle DeLellis, Keith Kincaid, and Gerard Woolyhand
Shands Jacksonville Medical Center
University of Florida Health Science Center/Jacksonville
Background
Purpose
Disclosures
References
Objectives
The authors of this presentation have nothing to disclose
concerning possible financial or personal relationships with
commercial entities.
Results, cont.Methods Discussion
UF & Shands Jacksonville Ambulatory Pharmacy fills around
1600 prescriptions per day. In September 2011, the
pharmacy implemented e-Prescribing. This coincided with a
drastic increase in the number of prescriptions being
returned to stock (RTS). In May 2011 the new computer
system – Enterprise - was implemented in the hospital.
The purpose of this study was to identify the reasons for the
increase in the return to stock prescriptions after the
implementation of e-Prescribing.
Primary Objective:
• To find out why the number of prescription RTS has
increased
Secondary Objectives:
• To establish whether an interactive voice response
(IVR) system would have been helpful in preventing high
RTS numbers
• To reveal the reasons for patients’ delay or decline in
picking up their medications
• To understand why patients were unaware of their
prescriptions being ready
Each day, a list of patients who had prescriptions ready for pick-
up for at least 5 days was obtained. Only those prescriptions
which were sent in electronically were utilized for the purposes of
this study. These patients were called and asked a series of
questions to determine if they were aware they had prescriptions
ready to be picked up or not. If patients were unaware of their
medications being ready, they were put in two different
categories:
• Saw provider, but provider did not tell the patient prescriptions
will be sent
• Called provider for refill request, but no one informed patient to
pick up their prescriptions
If patients were aware, they were asked if they wanted the
prescription or not. Patients who declined were placed in the
following categories:
• Cannot afford medications
• Provider stopped medications
• Patient stopped medications
• Transportation issues
If patients did not decline the medications, the reason for the
delay was further investigated. The following reasons were
identified:
• Tried to pick up but the line was too long at pick-up
• Forgot about the order
• Health
• Convenience
• Transportation issues
• Still had medications from previous fill
After each call the data was recorded into the Excel spreadsheet.
Once all the data was collected, analysis was completed.
• Of the patients who answered the phone, 48.9% of them were
not aware that they had prescriptions ready at the pharmacy.
• The most common reason for unawareness was seeing their
provider but not knowing the provider was sending a
prescription.
• Of the patients who answered the phone, 51.1% were aware
that they had prescriptions ready. Overall, miscommunication
accounted for 87% of patients delaying their medication pick
up.
• The two main reasons “aware” patients delayed picking up their
medications were: transportation and convenience. This meant
that patients wanted to wait for their next appointment at the
hospital or until other medications were due to be filled.
• When asked about whether an IVR system would’ve helped
remind them, a majority (93.2%) said that yes, it would have.
Due to this overwhelming positive result, the pharmacy may
want to consider implementing such a system.
Results
• Hogan, Thanh. “Summary of Strength and Opportunities”,
November 2012. 3rd
Quarterly Report, Shands
Jacksonville Ambulatory Pharmacy.
• Bogdan, Michael. Interview by Julia Balazh, Gabrielle
DeLellis,
Keith Kincaid, Gerard Woolyhand. "Return to Stock
Project.” Return to Stock Data Sheets. 14 Nov 2012.
Michael Bogdan, Jacksonville. 13 Nov 2012. 7. Web.
Conclusion
Patients who were aware of their prescriptions, delayed in
picking them up primarily because of transportation-related
reasons. As well, people prefer to pick up their prescriptions at
once and to make less trips to the pharmacy, as shown by the
patients who delayed due to ‘convenience’. The overwhelming
reason for patients to be unaware of their prescriptions is due
to miscommunication with the physician. The results also
greatly favored the use of an IVR system to help patients be
aware of their prescriptions.