Compliance, Modernization, and Improved Workflows with EPCS


I’ve always valued spending time with older generations. I love listening to their stories and absorbing the wisdom they’ve amassed throughout their lives. I used to work in a hospital setting, but when I moved to a long-term skilled nursing facility, I felt I was where I was supposed to be.

I spent most of my nursing career in critical care, but I have long had an interest in understanding the foundations and inner workings of systems. That led me into informatics, where I could combine my interest in electronic health record (EHR) systems with my nursing expertise.

In 2019, I joined Rouse Estates, a non-profit organization that offers various services across a number of facilities that allow us to care for individuals of all generations. Making the leap to long-term care was a big change for me, but it was also a big opportunity. What I found at the Rouse was an underutilized platform that could be maximized to improve workflows and in turn, make life more comfortable for our residents. 

Understanding the Potential of PointClickCare

My role at the Rouse was a new one, and it primarily revolves around resident information systems and PointClickCare, an industry-leading cloud-based healthcare software provider. As the clinical informatics specialist, I’m the go-to person for any issue or question related to the platform.

The Rouse had PointClickCare in place for a while, but we weren’t using it to its full capabilities. We still had many paper-based processes in place. Nobody knew how to streamline those workloads and move all of it into PointClickCare. And within PointClickCare itself, there were a lot of features that staff didn’t know existed. 

I didn’t have experience with PointClickCare, so I spent a lot of time on SmartZone, PointClickCare’s online training portal. I also used the help files and relied on PointClickCare Pulse online community to help me get up to speed. Armed with my newfound knowledge, I took a much more detailed look at the system and found PointClickCare’s Electronic Prescriptions for Controlled Substances (EPCS) solution. 

An Efficient Way to Get Ahead of the Curve

EPCS is a special instance of ePrescribing that provides pharmacies, hospitals, and practitioners a mechanism to use technology for controlled substance prescriptions. This replaces the paper, fax, email, and phone processes for placing prescription orders.

Before, when our physicians came in every day, they were greeted with a huge stack of papers to address, many of them prescription requests. Prescription orders were entered into PointClickCare but we still had to wait for the physician to fill them out and sign them. Then we’d fax it to the pharmacy and follow up with a call to confirm they received the fax. We strived to get the medication back that same day, but that didn't always happen. Sometimes faxes wouldn't go through, and we’d have to resend it, which was time-consuming and inefficient.

Missing or misplaced prescription orders means that long-term care residents experience delays getting the medications they need.

Another challenge for our organization has to do with our rural location. If we don't get our orders in by 5:00 p.m., we don't make that last pharmacy run for the day, which means that our residents go another day without the medications they need. 

In addition to addressing these issues, there was another big benefit to adopting EPCS. In 2019, Pennsylvania passed a law that mandated that all Schedule II, III, IV, and V controlled substances be prescribed electronically—no more paper prescription pads or faxes. The law went into effect in October 2019, which left me just a few months to get the ball rolling. If we could adopt EPCS quickly, we could be ahead of the game.

Buy-In and Training

I pitched the idea of implementing EPCS to our leadership team. Once they saw how the solution could improve our process—and ensure we were in compliance with the new law—they were on board. Because EPCS was a part of our existing system, the decision to move forward was a no brainer. I didn’t get any pushback or objections from our medical providers, which says a lot about how antiquated our existing process was. 

As far as costs are concerned, there are no added fees for EPCS since it is included with Integrated Medication Management (IMM). There is a one-time payment for professional services, and you don’t have to worry about it again. In the long run, that adds up to significant cost savings.

Even though using EPCS wasn’t a difficult change, it still disrupted a system that had been in place for decades. Training primarily consisted of showing our nurses how to enter the right order type on these controlled substances. Implementation was surprisingly easy, and I continued to monitor the controlled substances to verify that the orders entered the previous day were done correctly. I made sure everyone was comfortable with the process and that it was second nature to them.

A Better Way to Fill Prescriptions and Comply with the Law

Moving to EPCS has saved us paper and improved workflows for doctors, nurses, and even pharmacists. Instead of having to get paper prescriptions from the physician, or the physicians calling the pharmacy with those orders, we can do everything electronically. That’s a big time saver.

We are also more confident that, once that physician signs that prescription, the pharmacist on the other end will see it without having to check a fax machine. They no longer have to hunt down faxes or try to decipher handwriting, because everything appears up in their system automatically in a standardized format to ensure clarity and accuracy. Perhaps their biggest time saver is that the system does automatic checks for medication conflicts and potential allergies that could be a problem with the prescribed medication. This provides an extra layer of safety for our patients.

A solution that automatically checks for medication conflicts and potential allergies adds an extra layer of patient safety.

In addition to implementing EPCS, the Rouse is using PointClickCare’s Discharge Orders solution for the transmission of electronic discharge orders to the resident’s pharmacy of choice. About 90% of our discharge orders are now done electronically. We have shaved about five minutes off of each order, and while this may not sound like a lot, over the course of a 12-hour shift those minutes add up for nurses and physicians. Every minute they save not having to manually fill out prescription orders is another minute that they can spend at a patient’s bedside. They also have more time to spend on their progress notes, ensuring better continuity of care.

Settling into the New Process

Thanks to EPCS, the Rouse and our providers are in compliance with the Pennsylvania state mandate, potentially saving everyone costly penalties. I expect that a similar act will eventually be implemented on a federal level, and once it is, the stakes will be a lot higher. By implementing EPCS early, we won’t be caught on the back foot later. In the meantime, we don’t have to worry about signature forgeries for prescriptions or manual mistakes that could delay the delivery of medication.

Electronic prescriptions for controlled substances is a necessary step on the path to modernization, eliminating forgeries and manual mistakes.

Making the move to EPCS and electronic Discharge Orders was necessary, not only to improve the workflow for nurses and physicians, but to move our organization forward on the path to modernization. Eliminating manual processes greatly reduces the risk of error and eliminates one more administrative task, allowing our staff to do the work they love most.

When I came to the Rouse, I felt like I’d come full circle. I know this is where I need to be, making a difference in the lives of a generation that has touched me so deeply. By adopting these PointClickCare solutions, we’ve ensured our residents are as comfortable as they can be, thereby improving their quality of life.