Ordering, dispensing and administration in Tasy: who does what
The physician orders, the pharmacy dispenses and nursing administers and charts. When the three steps do not close, the hospital bills what it did not give or gives what it does not bill.
In Tasy, the medication path has three steps with different owners: the physician orders, the pharmacy dispenses and nursing administers and charts. Each step is recorded separately, and all three must close. When they do not, the effect shows up in two places: patient safety (a missed dose, a stopped drug given anyway) and the result (an item billed and not given, or given and not billed, and stock that does not match).
The three steps
| Step | Who | What is recorded in Tasy | Closes with |
|---|---|---|---|
| Order | Physician (and other prescribers, within scope) | Drug, dose, route, frequency, time, duration | Dispensing |
| Dispensing | Pharmacy | Item, presentation, quantity, lot, for which patient | Order and administration |
| Administration | Nursing | Time given, or the reason it was not given | Order |
Between the order and administration there is also dose scheduling: nursing spreads the order's times across the day, following the unit's routine.
The order
- Made on the right encounter, by an authorized prescriber, with their own user.
- A formulary drug, with clear dose and route; non-formulary items follow the special request workflow.
- Stopping a drug is recorded on the order, not just said out loud.
- The day's order renewed on time; an expired order leaves pharmacy and nursing without a reference.
Dispensing
The pharmacy reviews the order, picks and releases the items for the patient. Pharmacist review (dose, interaction, duplication, route) is part of medication safety. Recording the dispense draws down pharmacy stock and creates the item on the patient account, depending on the setup.
An item dispensed and not used comes back through a return, which reverses it from the account and puts it back in stock. Without the return, the patient is billed for what they did not use and the pharmacy shows less stock than it physically has. The pharmacy workflow is in hospital pharmacy in Tasy.
Administration and charting
Charting is the record that the dose was given, on time, to the right patient. When it was not (the patient was fasting, refused, was away for a test), the chart records the reason. An uncharted dose is, for the payer's auditor, a dose not given.
At administration, safe patient identification applies to the person and to the drug: right patient, right drug, right dose, right route, right time.
The most common gaps
| Gap | What it usually is | Effect |
|---|---|---|
| Dispensed and not charted | Dose not given and not returned, or given and not charted | Disputed charge, wrong stock |
| Charted without dispensing | Drug taken from unit stock without a record | Consumption off the account |
| Stopped order still dispensed | Stop not passed to the pharmacy in time | Drug wasted |
| Charted above the order | An extra dose, or double charting | Patient risk |
| Expired order | Drug given without a current order | Denial and legal risk |
A daily reconciliation, by unit, between what was ordered, dispensed and charted catches these gaps while the patient is still admitted, when they can still be fixed.
The effect on the account
Supplies and drugs are usually a large part of an inpatient account. The payer's audit compares what was billed with the order and the administration record. An item with no order or no administration record is a clinical denial. See the electronic medical record in Tasy and how the encounter becomes an account.
The effect on stock and cost
Each dispense draws down pharmacy stock and enters the cost of the unit or patient. Unrecorded returns and unrecorded use of unit stock distort cost by unit and create inventory differences. See stock and inventory in Tasy.
KPIs
- Uncharted doses by unit and shift.
- Returns relative to dispenses, by unit.
- Items dispensed from stopped orders.
- Supply and drug denials for missing orders or charting, by payer.
- Supplies and drugs per patient-day, by unit.
Who writes this
Domínio has worked for more than 20 years with hospitals that run Tasy and sees, in cost and denials, the effect of every dose that does not close. To talk about your hospital's medication circuit, reach us on WhatsApp or at comercial@dominiocontabil.com.br.
Related questions
Can nursing adjust an ordered dose?
Not on its own. When in doubt about the order, nursing talks to the prescriber, who corrects the order in Tasy.
Does a dose not given need a record?
Yes, with the reason. Without a record, nobody knows whether it was forgotten or there was a reason.
Who makes the return to the pharmacy?
The unit returns the item physically and records it through the hospital's workflow; the pharmacy checks and confirms receipt.
Does dispensing already create the account item?
It depends on the setup. In many hospitals, yes; in others, the item enters the account at charting. Billing needs to know the rule.
Written by the Domínio team behind Clic Health: accountants, controllers and developers with more than 20 years of work with hospitals that run Tasy. Have a question about Tasy? Talk to us on WhatsApp.