Building a safety net: by leveraging huge amounts of data and applying it to a wide array of projects and purposes, hospitals stay focused on patient safety and make headway.It's not the threat of lawsuits as much as a desire to deliver better healthcare that is driving much of today's efforts to improve patient safety.
Whether it's reducing medication errors medication error Malpractice An error in the type of medication administered or dosage. See Adverse effect, Error. or monitoring the onset of symptoms to facilitate treatment protocols, clinicians are tapping into huge databases for their answers. But, to achieve the desired results, hospitals need to invest in newer clinical systems that feature medication reference databases or find new uses for existing databases, like those that are integral parts of electronic medical records.
When it comes to reducing medication errors, a number of vendors have automated the entire medication administration process--from the transmission of orders to the pharmacy to the dispensing dispensing
provision of drugs or medicines as set out properly on a lawful prescription. A prescription can only be filled, the drugs supplied, by a registered pharmacist, veterinarian, dentist or member of the medical profession. of drugs at the bedside.
For Opelousas General Health System (OGHS OGHS One Great Hour of Sharing
OGHS Oak Grove High School (Oak Grove, Mississippi)
OGHS Oak Glen High School (West Virginia) ) in Opelousas, La., the solution came from Mountain View, Calif-based Omnicell Inc. "We were looking for Looking for
In the context of general equities, this describing a buy interest in which a dealer is asked to offer stock, often involving a capital commitment. Antithesis of in touch with. a product to improve patient safety and reduce medication errors in our facility," says Jared Lormand, OGHS's chief information officer. "We needed a product that would simplify the process and automate our medication administration by using bar codes."
Interestingly, poor communication problems between nurses and the pharmacy were one of the issues contributing to the organization's medication error rates, Lormand says, and, the situation wasn't helped by evenings and night shifts, when typically no on-site pharmacist pharmacist /phar·ma·cist/ (fahr´mah-sist) one who is licensed to prepare and sell or dispense drugs and compounds, and to make up prescriptions.
n. is available. But Donna Copper, R.N., OGHS's chief nursing officer, says even when a pharmacist was available, there were "multiple phone calls and multiple questions." In many cases, the questions pertained to the appropriateness of specific drugs or a request to clarify an individual order. And on occasion, there was also finger pointing, according to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
By installing a system that uses an automated MAR (Medication Administration Record medication administration record Hospital practice A computer-generated schedule for administering medications to a Pt for a defined period of time, including physician's orders and time to adminster the agents ) and provides nurses with alerts as to possible drug/drug, drug/food or drug/allergy interactions, the human factor and, therefore, the possibility of human error, was taken out of the equation, Copper says.
OGHS began rolling out the bulk of Omnicell's MedGuard system between 2003 and 2005, according to Lormand. The hospital first invested in the vendor's medication dispensing cabinets, then purchased SafetyMed RN, a nursing workflow automation See workflow. solution for the bedside that uses bar coding, and then SafetyPak, a barcode medication packaging system. In addition, OGHS installed OmniLinkRx, which currently allows physician orders to be electronically faxed into the pharmacy's system. "We're considering buying a CPOE CPOE Computerized Physician Order Entry
CPOE Computerized Provider Order Entry
CPOE Computerized Prescriber Order Entry (computerized physician order entry) system, but for our size organization, price is a consideration. At 193 beds, we can't afford to buy the latest and greatest software each year. We have to alternate our capital purchases with building buildings and installing the latest diagnostic equipment." Plus, he notes, "With the best-of-breed technology we have here, finding a CPOE that plays well with other systems is hard to do."
Yet, the decision to purchase the Omnicell solution and to automate the process was driven solely by concerns over patient safety issues, which seems to remain the number one provider concern in the healthcare arena, ever since the well known Institute of Medicine study turned all eyes onto patient safety several years ago.
Not only does the system eliminate those parts of the process where human error can cause problems, but it greatly simplifies the entire process. Prior to rolling out this automated system, physicians would write their orders and nurses would fax the orders to the pharmacist, who would then enter each order into the McKesson pharmacy information system, and then file away the paper fax, Lormand says. After medication labels were printed and the medication cart filled, the nurses would use a paper MAR to verify which drugs were to be given to which patient.
Now, after the physician signs an order, it's electronically faxed directly into the pharmacy's dual monitor workstation, Lormand explains. Then, while viewing the electronic physician order on one monitor, the pharmacist enters the order into the pharmacy system on the other. A message is automatically sent to the SafetyPak system, which prints out and affixes bar-code labels onto each patient's individually wrapped medication.
When it's time It's Time was a successful political campaign run by the Australian Labor Party (ALP) under Gough Whitlam at the 1972 election in Australia. Campaigning on the perceived need for change after 23 years of conservative (Liberal Party of Australia) government, Labor put forward a to dispense these medications, the nurse logs into the system and scans her badge, which brings up her list of patients. Then, she scans the bar code on the patient's wrist band, which brings up a list of all reeds to be administered to that patient. Once the nurse scans the bar code on the medication package, the system automatically checks the "five rights" (right patient, right medication, right dose, right time and right route). "If there's an error or an alert, she calls the pharmacy immediately," Lormand says.
Overcoming Hesitancy hes·i·tan·cy
An involuntary delay or inability in starting the urinary stream.
Not unlike other hospitals that have installed similar bar code-based medication systems, OGHS did experience some early resistance from the nursing staff. "Most nurses had not had to use computers before," Lormand says, "so we had to teach them how to use Windows and how to use a mouse, then train them on the software."
Switching from a paper MAR to an electronic one also presented a challenge. "That was traumatic for a lot of nurses," he admits. "Some of them held on to the paper MAR for three weeks to make sure the computer was right." The additional time it takes to bar code at the bedside became another challenge. "The process is slightly longer, but they've begun to trust the system," says Lormand. "And if there's any issue about patient care or safety, they can use the system to prove their actions. Now, they're dependent on the system."
Taking extra time at the bedside and automating the entire medication-use process by using an end-to-end system with built-in alerts has definitely paid off for OGHS. Because most common errors involved drugs that look alike or sound alike, Lormand says, "We have seen a 66 percent reduction in medication errors housewide." In addition, the Omnicell solution has reduced by one-half the amount of time required for a pharmacist to fill orders, which now allows the pharmacist to spend more time on the floor as an integral part of the healthcare delivery team.
The ability to perform data mining tasks has been a key factor in the patient safety efforts at Kapiolani Medical Center for Women and Children in Honolulu. Melinda Ashton, M.D., medical director for patient safety and quality services at Hawaii Pacific Health Hawaii Pacific Health is a non-profit healthcare organization formed with the merger of three longtime Hawaii health systems, Wilcox Health, Kapi'olani Health, and Straub Clinic & Hospital. , the health system that owns and operates the 200-bed Kapiolani Medical Center, says being able to tap into clinical databases associated with the hospital's EMR (ElectroMagnetic Radiation) The emanation of energy from everything in the universe. Although the EMR from electrical and electronic devices is typically measured for practical, every-day situations, every object, including humans, emanates energy. has allowed physicians to monitor specific symptoms that often show up in newborns and their mothers.
Relying on an early DOS-based EMR from San Diego San Diego (săn dēā`gō), city (1990 pop. 1,110,549), seat of San Diego co., S Calif., on San Diego Bay; inc. 1850. San Diego includes the unincorporated communities of La Jolla and Spring Valley. Coronado is across the bay. , Calif-based CliniComp International, Kapiolani Medical Center, which delivers about 5,000 babies per year, initiated a program called the Center for Health Outcomes, designed to promote and support physician-directed quality improvement. "It's to answer questions about the care being provided," says Ashton, "and it's the physicians who are asking the questions." Between 30 and 40 physicians have been involved in this project since it was launched in early 2004.
By combining CliniComp's clinical documentation and EMR solutions with ICD-9 codes The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. These codes are in the public domain.
Data as a Foundation for Improvement
The first is screening for severe jaundice jaundice (jôn`dĭs, jän`–), abnormal condition in which the body fluids and tissues, particularly the skin and eyes, take on a yellowish color as a result of an excess of bilirubin. in normal newborns, implemented in March 2005. This project was set up to determine the risks for severe jaundice and to provide physicians with the results prior to discharge. The goal was to eliminate severe jaundice, an entirely preventable problem, which can cause brain damage in babies. "The American Academy of Pediatrics The American Academy of Pediatrics ("AAP") is an organization of pediatricians, physicians trained to deal with the medical care of infants, children, and adolescents. Its motto is: "Dedicated to the Health of All Children. , in 2004, came up with new guidelines for managing jaundice in newborns," Ashton says. "The CliniComp system allowed nurses to document the results of screening tests on newborns and to look up what those results meant based on the Academy standards."
Hawaii has three times the national rate of jaundice in newborns, Ashton notes.
But as a result of this screening program, the highest levels of jaundice were eliminated. There are no babies with a bilirubin Bilirubin
The predominant orange pigment of bile. It is the major metabolic breakdown product of heme, the prosthetic group of hemoglobin in red blood cells, and other chromoproteins such as myoglobin, cytochrome, and catalase. count over 24, which characterizes severe jaundice, and fewer babies with a bilirubin count over 20 compared to babies who were not part of the screening program. The results of the study even had an effect on Ashton herself. "I used to be less concerned about jaundice," she says. "But now, I find myself paying closer attention to those babies at higher risk."
The Newborn Special Care Nutrition Management Program was designed to reduce the risk of complications in babies fed intravenously for more than 14 days; the goal was to accelerate the conversion to oral feeding. Evaluation of three years worth of data pertaining per·tain
intr.v. per·tained, per·tain·ing, per·tains
1. To have reference; relate: evidence that pertains to the accident.
2. to the care of premature babies began in 2001, but the project was actually launched in 2004. Several definite patterns emerged from this study, leading to the creation of standards for the way babies are fed in the newborn special care unit (NSCU NSCU Neonatal Special Care Unit (medical)
NSCU Nursing Skilled Care Unit ). As a result, IV feedings were reduced from 20 days to 11 days, and the infection rate dropped dramatically. Ashton says that the CliniComp system allowed for "the standardization standardization
In industry, the development and application of standards that make it possible to manufacture a large volume of interchangeable parts. Standardization may focus on engineering standards, such as properties of materials, fits and tolerances, and drafting of the approach, and also allowed us to look at the results of these standards."
A project to reduce nosocomial infections Nosocomial infections
Infections that were not present before the patient came to a hospital, but were acquired by a patient while in the hospital.
Mentioned in: Enterobacterial Infections, Staphylococcal Infections in the NSCU was actually part of the hospital's contribution to the Institute for Healthcare Improvement's "100,000 Lives Campaign," this project was begun in the fall of 2005. The EMR can be mined for data to indicate when improvements in care have been successful. Better central line management and an emphasis on hand washing This article or section contains .
The purpose of Wikipedia is to present facts, not to teach subject matter. resulted in a significant reduction in hospital-acquired infections Hospital-Acquired Infections Definition
A hospital-acquired infection is usually one that first appears three days after a patient is admitted to a hospital or other health care facility. , Ashton notes.
Finally, a project to reduce infection rates in laboring patients began in early 2004 and continues today. This program's goal is to reduce infection rates among women in labor. "We tried to understand the factors involved in women developing fevers during labor," Ashton explains. "Fever likely represents an infection that needs to be treated." Infection rates during labor are about 6 percent nationwide and are usually caused by bacteria, she says. But while the mother may have the infection, her child also is at greater risk for the same infection.
As a result of this study thus far, Kapiolani Medical Center has improved the way it induces labor and the way it administers epidurals, Ashton says. Tracking both mothers and babies required tapping into huge amounts of data, but as Ashton notes, "We used the CliniComp system to gather the data and mine the data. We wanted to make sure we were not missing any infected in·fect
tr.v. in·fect·ed, in·fect·ing, in·fects
1. To contaminate with a pathogenic microorganism or agent.
2. To communicate a pathogen or disease to.
3. To invade and produce infection in. babies."
The emphasis of each of the projects was to improve patient safety, so collectively, the four projects showed physicians where improvements were needed. There was little resistance on the parts of these physicians to make the necessary changes to improve healthcare outcomes. "Once they understand the data, they can change their practices," says Ashton. "Having data on our own patients changes their minds."
Drug Databases, an Integral Clinical Management Component
The drug database that is the keystone key·stone
1. Architecture The central wedge-shaped stone of an arch that locks its parts together. Also called headstone.
2. The central supporting element of a whole. of the automated medication system at Willis-Knighton Medical Center in Shreveport, La., has been in place so long that few employees can remember a time when it wasn't.
"We have had it at least 15 years," says Alicia McPherson, R.Ph., a staff pharmacist and the pharmacy's project manager. Serving this hospital admirably through all those years has been a series of databases from Medi-Span, now part of the Clinical Tools division of Indianapolis-based Wolters Kluwer Wolters Kluwer N.V. (Euronext: WKL) is a leading global information services and publishing company. The company provides products and services for professionals in the health, tax, accounting, corporate, financial services, legal and regulatory, and education sectors. Health.
According to McPherson, all 35 pharmacists This is a list of notable pharmacists.
Drug therapy monitoring, also known as Therapeutic Drug Monitoring (TDM), is a means of monitoring drug levels in the blood. System; IV Incompatibility The inability of a Husband and Wife to cohabit in a marital relationship.
incompatibility n. the state of a marriage in which the spouses no longer have the mutual desire to live together and/or stay married, and is thus a ground for divorce Database; Allergy Database; Drug Disease Database; and Patient Education Database. All of these databases are fully integrated with MEDITECH's pharmacy information system, she adds.
McPherson says one of the greatest values in being able to access these databases is in reducing drug/drug interactions. "With all the new drugs on the market, physicians may not know all the possible interactions. Medi-Span works with Willis-Knighton to augment patient safety by educating the medical staff about new drug interactions." To avoid such errors, the clinical staff can pull up drug/drug interactions and see Medi-Span's recommendations as to how to handle those interactions, she says. At that point the pharmacist can print out the interactions for the nurses and physicians. This enables the medical staff to evaluate the interactions and clinically monitor the patients, she adds.
In further explaining how these drug databases can reduce errors, McPherson Notes, "Say the pharmacy receives an order from a physician for a Cordarone IV drip along with a Zithromax IV. The two together could cause life-threatening cardiac arrhythmias cardiac arrhythmia
See cardiac dysrhythmia.
An irregular heart rate or rhythm.
Mentioned in: Holter Monitoring, Stress Test
cardiac arrhythmia . But Medi-Span would flag that order as a problem. The pharmacist could then review the interaction information, share it with the physician and prevent any potential harm to the patient."
Willis-Knighton Health System has yet to decide on a CPOE system. However, Johnathan Lee, network administrator, information technology, says, "All medication orders are scanned to the pharmacy using Galactica RX. Both routine and stat stat
With no delay.
STAT Stat! Clinical medicine adverb Fast, quickly, immediately, schnell, vite Lab medicine noun orders are scanned into the system at the nurses station and are electronically transmitted over an Ethernet network." Once the pharmacist receives an order, he or she enters that order into the MEDITECH system "which automatically goes over to the Medi-Span page," says Pleschette Roberson, supervisor of operations, Financial Systems.
McPherson adds, "If the pharmacist notes any interaction that is considered to be significant, the physician is notified immediately."
Fore more information on Medi-Span from Wolters Kluwer Health, www.rsleads.com/608ht-207
For more information about Essentris and other patient safety solutions from CliniComp, www.rsleads.com/608ht-206
For more information about MedGuard, SafetyMed RN and other patient safety solutions from Omnicell, www.rsleads.com/608ht-205
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