Procedures to improve prescribing and dispensing of oral contraceptives at an academic medical center

Abstract

An initiative to improve procedures and safeguards for inpatient oral contraceptive use at an academic medical center is described. A retrospective chart review was conducted to determine patterns of oral contraceptive use and potential areas for quality improvement. During the six-month period covered by the chart review, a total of 95 oral contraceptive orders were placed for 55 patients, mainly for continuation of home contraception (24% of cases) and other indications unrelated to the patients' primary diagnoses, such as menorrhagia (23% of cases); more than 1 in 5 (22%) of those orders were for non-formulary products, and about 35% of the prescribed regimens called for multiple daily dosages. The evaluation also focused on pharmacy procedures for stocking and dispensing oral contraceptives, as well as procedures for processing oral contraceptive orders through the computerized prescriber-order-entry (CPOE) system. In addition to discrepancies in the numbers and types of oral contraceptive products on the formulary and in pharmacy inventories, the review identified suboptimal CPOE controls and dispensing practices that posed an undue risk of nurse confusion and administration errors. Pursuant to the evaluation, a number of system and procedural changes were recommended, approved by the medical center's pharmacy and therapeutics committee, and implemented. A review of existing processes for the use of oral contraceptives led to the identification of several strategies to improve prescribing and dispensing practices. Strategies to improve medication safety included reducing the number of oral contraceptive products on the formulary, modifying the CPOE system to restrict ordering to formulary products, dispensing only tablets that contain active drug, and repackaging oral contraceptives in unit dose form.