Name: Standardization of Tablet Splitting Workflows at JHHS
Start: 2026-05-15T08:20:00-0400
End: 2026-05-15T08:40:00-0400

Eastern States Conference for Pharmacy Residents and Preceptors

Standardization of Tablet Splitting Workflows at JHHS

Friday May 15, 2026 8:20am - 8:40am EDT

Room 7

Title: Standardization of Tablet Splitting Workflows at JHHS
Authors: Eric Mackin, PharmD; Ian Watt, PharmD; Emily Pherson, PharmD, BCPS; Rosemary Duncan, PharmD, BCPS; Lisa Hutchins, PharmD, BCPPS; Dave Stimler, PharmD, MBA
Objective: Audience members will be able to outline the steps used to develop a standardized split tablets workflow across a health system.
Self Assessment Question: Which of the following is a benefit of standardizing split tablet practices across a health system?
1. A. Clear accountability across departments
2. B. Automatic selection of dispense code in EHR when dispensing split tablets
3. C. Reduced variability for employees who work at multiple sites
4. D. Decreased manual manipulation of orders on verification and reverification
5. E. All of the above
Background: The purpose of this project is to gain consensus among Johns Hopkins Health System hospital sites on the preferred practice for splitting tablets, i.e., when tablets should be split in the pharmacy prior to dispensing or split by a nurse on the unit.
Methods: The objective of this project is to develop a workflow for splitting tablets that aligns Johns Hopkins Health System (JHHS) and allows for the implementation of enhancements to the EHR (Epic). To accomplish this, the project team confirmed current workflows for all JHHS hospitals, surveyed other hospitals and health systems to determine common practices, and gathered data on all enteral dispenses across JHHS in October 2025 using Epic SlicerDicer. This data was then analyzed in Microsoft Excel to quantify total enteral dispenses, dispenses that require splitting a tablet, repackaged doses dispensed, number of split dispenses for which a commercially available tablet exists for the intended dose, and most frequently split medications. A summary of the data was presented to a health system-level Automation and Operations Committee, and stakeholders from each hospital collaborated to gain consensus on the newly aligned workflow.
Results: JHHS hospitals initially reported varied split tablet workflows, ranging from pharmacy staff splitting all tablets to nurses splitting all tablets. JHHS hospitals also reported differences in prepackaging practices (unit dose packaging a pre-split tablet). Surveys of other health systems revealed no standard tablet-splitting practice. In October 2025, 2.2% of all enteral dispenses required splitting a tablet, with 28.7% being dispensed from pharmacy and 71.3% dispensed from ADC. Data analysis showed that this number could be further decreased by purchasing the lowest commercially available strength of more medications and increasing prepackaging practices. After discussion, the workgroup came to consensus on option 3: pharmacy staff split all tablets dispensed from the pharmacy; nursing staff split all tablets dispensed from the ADC. Pharmacy staff will also minimize the number of dispenses that require splitting by optimizing prepackaging and purchasing practices.
Conclusion: No national standard exists for tablet splitting workflows, creating variance in practice and complicating EHR optimization. JHHS pharmacies were able to come to consensus on a new workflow that works for all hospitals by assessing the objective impact of each potential new workflow and developing solutions that emphasize safety, accuracy, and efficiency.

Moderators

Carol Luong

Clinical Pharmacist, Inova Health

Presenters

Eric Mackin

PGY1 Medication Use Safety and Policy Resident, Johns Hopkins Hospital

Dr. Eric Mackin is the PGY1 Medication Use Safety and Policy pharmacy resident at The Johns Hopkins Hospital. He is originally from Louisville, Kentucky and completed pharmacy school at the University of Kentucky College of Pharmacy. After completion of PGY1, he will complete specialized... Read More →

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