Evaluation of STAT medication ordering process in a community hospital
Background: In most health care facilities, problems related to delays in STAT medication order processing time are of common concern.
Objective: The purpose of this study was to evaluate processing time for STAT orders at Kimball Medical Center.
Methods: All STAT orders were reviewed to determine processing time; order processing time was also stratified by physician order entry (physician entered (PE) orders vs. non-physician entered (NPE) orders). Collected data included medication ordered, indication, time ordered, time verified by pharmacist, time sent from pharmacy, and time charted as given to the patient.
Results: A total of 502 STAT orders were reviewed and 389 orders were included for analysis. Overall, median time was 29 minutes, IQR 16–63; p<0.0001.) . The time needed to process NPE orders was significantly less than that needed for PE orders (median 27 vs. 34 minutes; p=0.026). In terms of NPE orders, the median total time required to process STAT orders for medications available in the Automated Dispensing Devices (ADM) was within 30 minutes, while that required to process orders for medications not available in the ADM was significantly greater than 30 minutes. For PE orders, the median total time required to process orders for medications available in the ADM (i.e., not requiring pharmacy involvement) was significantly greater than 30 minutes. [Median time = 34 minutes (p<0.001)].
Conclusion: We conclude that STAT order processing time may be improved by increasing the availability of medications in ADM, and pharmacy involvement in the verification process.
2. Wakefield DS, Wakefield BJ. Are verbal orders a threat to patient safety? Qual Saf Health Care. 2009;18(3):165-168. doi: 10.1136/qshc.2009.034041
3. Wakefield DS, Ward MM, Groath D, Schwichtenberg T, Magdits L, Brokel J, Crandall D. Complexity of medication-related verbal orders. Am J Med Qual. 2008;23(1):7-17. doi: 10.1177/1062860607310922
4. Niazkhani Z, Pirnejad H, van der Sijs H, Aarts J. Evaluating the medication process in the context of CPOE use: the significance of working around the system. Int J Med Inform. 2011;80(7):490-506. doi: 10.1016/j.ijmedinf.2011.03.009
5. Ross J. Clarity needed on standing orders. Nurs N Z. 1998;4(5):11.
6. Ayd FJ Jr. Problems with orders for medication as needed. Am J Psychiatry. 1985;142(8):939-942.
7. Gordon DB, Dahl J, Phillips P, Frandsen J, Cowley C, Foster RL, Fine PG, Miaskowski C, Fishman S, Finley RS; American Society for Pain Management Nursing; American Pain Society. The use of 'as-needed' range orders for opioid analgesics in the management of acute pain: a consensus statement of the American Societyfor Pain Management Nursing and the American Pain Society. Home Healthc Nurse. 2005;23(6):388-396.
8. Donihi AC, DiNardo MM, DeVita MA, Korytkowski MT. Use of a standardize protocol to decrease medication errors and adverse events related to sliding scale insulin. Qual Saf Health Care. 2006;15(2):89-91.
9. Fahimi F, Sahraee Z, Amini S. Evaluation of stat orders in a teaching hospital: a chart review. Clin Drug Investig. 2011;31(4):231-5. doi: 10.2165/11540000-000000000-00000
16. Miller K, Shah M, Hitchcock L, Perry A, Englebright J, Perlin J, Burgess H. Evaluation of Medications Removed from Automated Dispensing Machines Using the Override Function Leading to Multiple System Changes. In: Henriksen K, Battles JB, Keyes MA, Grady ML, editors. Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 4: Technology and Medication Safety). Rockville (MD): AHRQ; 2008.
17. Woehlck HJ, McQueen AM, Connolly LA. Off-hours unavailability of drugs during emergency situations with automated drug dispensing machines. Can J Anaesth. 2007;54(5):403-404.
12. Ishizuka H, Horiguchi M, Waki Y, Maeda M, Ishikura C. Computerized dispensing system: reducing the time of dispensing medicines. Int J Biomed Comput. 1991;28(1-2):137-146.
10. Tiersten D. The "stat" problem. Clin Lab Med. 1983;3(3):499-507.
11. Kilgore ML, Steindel SJ, Smith JA. Evaluating stat testing options in an academic health center: therapeutic turnaround time and staff satisfaction. Clin Chem. 1998;44(8 Pt 1):1597-603.
12. Novis DA, Walsh MK, Dale JC, Howanitz PJ; College of American Pathologists Q-Tracks. Continuous monitoring of stat and routine outlier turnaround times: twoCollege of American Pathologists Q-Tracks monitors in 291 hospitals. Arch Pathol Lab Med. 2004;128(6):621-626.
13. Wesp W. Using STAT properly. Radiol Manage. 2006;28(1):26-30
14. Maddock JR, Hanson LB. Application of quality improvement techniques to the reduction of turnaround time for "STAT" and "ASAP" orders. Hosp Pharm. 1993;28(7):640-644.
15. Griswold M, Whitford M, Belemjian M, Delcoure K, Lesar T. Pharmacy "STAT" line to facilitate delivery of emergency medications: implementation and experience. Hosp Pharm. 1997;32(9):1245-1250.
18. Ishizuka H, Horiguchi M, Waki Y, Maeda M, Ishikura C. Computerized dispensing system: reducing the time of dispensing medicines. Int J Biomed Comput. 1991;28(1-2):137-146.
19. Hull T, Czirr L, Wilson M. Impact of medication storage cabinets on efficient delivery of medication and employee frustration. J Nurs Care Qual. 2010;25(4):352-357.
20. Chapuis C, Roustit M, Bal G, Schwebel C, Pansu P, David-Tchouda S, Foroni L, Calop J, Timsit JF, Allenet B, Bosson JL, Bedouch P. Automated drug dispensing system reduces medication errors in an intensive care setting. Crit Care Med. 2010;38(12):2275-2281. doi: 10.1097/CCM.0b013e3181f8569b
21. Gennari FJ. Hypokalemia. N Engl J Med. 1998;339(7):451-458.
22. Janko O, Seier J, Zazgornik J. [Hypokalemia--incidence and severity in a general hospital]. Wien Med Wochenschr. 1992;142(4):78-81.
23. Hwang JC, Wang CT, Chen CA, Chen HC. Hypokalemia is associated with increased mortality rate in chronic hemodialysis patients. Blood Purif. 2011;32(4):254-261. doi: 10.1159/000325226
24. Siscovick DS, Raghunathan TE, Psaty BM, Koepsell TD, Wicklund KG, Lin X, Cobb L, Rautaharju PM, Copass MK, Wagner EH. Diuretic therapy for hypertension and the risk of primary cardiac arrest. N Engl J Med. 1994;330(26):1852-1857.
25. Cohen HW, Madhavan S, Alderman MH. High and low serum potassium associated with cardiovascular events in diuretic-treated patients. J Hypertens. 2001;19(7):1315-1323.
26. Smith SB, Geske JB, Maguire JM, Zane NA, Carter RE, Morgenthaler TI. Early anticoagulation is associated with reduced mortality for acute pulmonary embolism. Chest. 2010;137(6):1382-1390. doi: 10.1378/chest.09-0959
27. Dickinson JD, Kollef MH. Early and adequate antibiotic therapy in the treatment of severe sepsis and septic shock. Curr Infect Dis Rep. 2011;13(5):399-405. doi: 10.1007/s11908-011-0206-8
28. Menéndez R, Torres A, Reyes S, Zalacain R, Capelastegui A, Aspa J, Borderías L, Martín-Villasclaras JJ, Bello S, Alfageme I, de Castro FR, Rello J, Molinos L, Ruiz-Manzano J. Initial management of pneumonia and sepsis: factors associated with improved outcome. Eur Respir J. 2012;39(1):156-162. doi: 10.1183/09031936.00188710
29. Siddiqui S, Salahuddin N, Raza A, Razzak J. How early do antibiotics have to be to impact mortality in severe sepsis? A prospective, observational study from an emergency department. J Ayub Med Coll Abbottabad. 2009;21(4):106-110.
The authors hereby transfer, assign, or otherwise convey to Pharmacy Practice: (1) the right to grant permission to republish or reprint the stated material, in whole or in part, without a fee; (2) the right to print pr epublish copies for free distribution or sale; and (3) the right to republish the stated material in any format (electronic or printed). In addition, the undersigned affirms that the article described above has not previously been published, in whole or part, is not subject to copyright or other rights except by the author(s), and has not been submitted for publication elsewhere, except as communicated in writing to Pharmacy Practice with this document.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-ND) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.