Emergency department prepack implementation at Providence Portland Medical Center
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Publication Date
4-29-2026
Keywords
oregon, psvmc, psvmc gme, psvmc oaa, ppmc, ppmc gme, ppmc gme pharmacy
Disciplines
Medical Education
Abstract
Introduction: Providence Portland Medical Center (PPMC) implemented a multiphase ‑quality improvement‑ project to standardize the emergency department (ED) prepack program with the Providence Oregon region. Background/Purpose: Prior to the project, ED prepack dispensing lacked a uniform process; individual sites stored and labeled medications differently, reconciliation was paper based, and staff were unclear on regulatory limits. Oregon Board of Pharmacy rules allow prepack medications for outpatient use only when the supply does not exceed a ‑48-hour‑ course, with limited exceptions. Each prepack must also carry a unique serial number, and a label specifying the hospital’s pharmacy’s contact information, drug name and strength, manufacturer, expiration date, and other required elements. To bring PPMC into alignment with the regional standard operating procedure, the team established a structured program that encompassed formulary alignment, translation/accessibility improvements, and a reconciliation process. Methods: In Phase 1, pharmacy informatics specialists (RXI) and operations staff compared PPMC’s medication list to the approved Oregon ED prepack formulary. For each prepack, the electronic prescribing (ERX) build in Epic was reviewed and modified to ensure that the ERX identifier, the custom National Drug Code (NDC), and the automated dispensing system (Pyxis) entries matched exactly. A secure storage area was designated in the ED and prepacks were labeled with date b‑ased serial numbers as described in the policy, ensuring that documentation in the medication administration record captured the unique prepack number, drug details, and prescriber information. In Phase 2, the team discovered a knowledge gap: central pharmacy staff were unfamiliar with how to use Epic translation functions and TelRx to support patients with limited English proficiency‑ or visual impairments. Finally, because each facility had been reconciling prepack usage differently, the project created a reconciliation process from scratch. Paper reconciliation was replaced by an electronic method. Results: Phase 1 led to accurate ED prepack orders from Epic to Pyxis and a consistent formulary list with the OR region. Phase 2 improved staff knowledge in translation and TelRx. Preliminary reconciliation data show that documentation errors improved from 20-30% to less than 5%. Additional outcome measures such as staff feedback, workflow efficiency, and medication error rates will be assessed; final results will be presented at the conference. Conclusions: Standardizing the ED prepack program required aligning the local formulary and dispensing systems with regulatory expectations, addressing communication and accessibility barriers, and instituting a working reconciliation process. The project demonstrates that electronic tools, staff education, and process redesign can bring PPMC’s ED prepack practices into compliance with Oregon administrative rules and a regional standard operating procedure. Future work will evaluate long-term‑ effects on patient safety and operational efficiency. IRB status: Exempt
Specialty/Research Institute
Graduate Medical Education
Specialty/Research Institute
Pharmacy
