Staffing shortages of registered nurses have been reported in
all regions of the country since 19881 . Nurses who once staffed hospital beds have
responded unfavorable working conditions by moving to outpatient care, managed
care services, home care, and even into business roles. In less than ten years, 78 million baby
boomers are going to become eligible for Medicare and greatly increase the
demand for healthcare. At the same time, the remaining RN workforce will be
shrinking in size as nurses retire. The average age of nurses will continue to
rise, with nearly half of all practicing RNs over age 502 . Already
challenged to do more with less, senior nurses, working 16-20 hour shifts
caring for larger loads of sicker patients, are reporting declining patient
care conditions. In fact, 75% of nurses
in a recent survey feel that the quality of nursing care has declined in the
last two years and 42% said they would not feel comfortable having a loved one
receive care in the facility in which they work.3
In recent years, healthcare has come to understand that while
individuals make errors that lead to injury, it is our systems that make those
errors possible or fail to intercept them.
Research has shown that system failures that lead to medication error,
the leading cause of adverse events in inpatient care, include factors directly
attributable to the nursing shortage: frequent interruptions in preparation of
medications, lack of education, overworked or overtired staff, insufficient
staffing and faulty organization of patient care as well as illegible orders,
faulty labeling, reliance on floor stock.4 And yet, according to the American Nursing
Association, nurses who refuse to work overtime can be threatened with losing
their jobs or licenses under an alleged patient abandonment charge.5 Insufficient
staffing can also results in unchecked pain and poor patient monitoring. In a survey of 600 hospital nurses conducted
by the California Service Employees International Union, nearly one in four
nurses said that patients "regularly" go without a routine medical assessment
because the nurses lack the time to conduct one, despite state regulation
requiring each patient to be assessed during every shift.6 In a national
nursing survey, 56 percent of respondents believe that the time they have
available for patient care has decreased.7
Traditionally, nurses have
served as a safety net at the bedside intercepting up to 70% of the errors that
occur at earlier stages in the medication use process.8 Under stress,
nurses report giving medications to the wrong patient, in the wrong dose, or
missing a dose entirely when their attention is drawn away by a more urgent
matter or in situations where their knowledge of the drug was minimal.
Complicating their already demanding workloads, nurses have seen nearly 10,000
new drugs enter the market over the past 15 years9 . They are understandably unable to learn the
pharmacology of each new drug including indications for use, drug-to-drug
interactions, therapeutic ranges and appropriate lab monitoring. As a result,
the number one causative factor for most serious adverse drug events is cited
as "lack of drug knowledge"10 . Coupled with a decrease in patient monitoring due to
time constraints, patients are put a great risk of suffering an adverse drug
event.
The U.S. Department of
Health and Human Services projects that by 2006, 1 million nurses must join the
work force to avert a nationwide shortage. But indications are that fewer than
600,000 will be ready by then.11 In the sort
term, processes and systems must be implemented to ensure patient safety and
retain current staff. For years
healthcare has rallied behind computerized physician order entry systems and
pharmacists have lobbied for more advanced information systems and distribution
technologies while the needs of nursing have been largely ignored by
information technology leaders. That
oversight will change as hospital administrators scramble to enhance recruiting
and retention efforts and nurse leaders demand the security that accessible
decision support tools and information technology at the point of care can provide. By providing nurses with a technological
safety net for medication administration, the hospital will not only improve
patient care but also gain a critical recruitment and retention tool.
Thirty-nine percent of
medication errors occur during the administration phase.12 In response to this, nursing long ago adopted the
standard practice of checking the "five rights" (right patient, right
medication, right dose, right time and right route) during medication
administration. However, medication errors can still occur when the five rights
have been verified due to basic human vulnerabilities and complex system
failures that are compounded by a manic care environment. Human errors such as
failing to detect the difference in a look-alike or sound-alike drug or
misreading a dosage by one decimal point are common. Errors involving maximum
daily dosing, allergies, and drug interactions are not prevented by merely
checking the five rights. To that end, nurses benefit from a point of care
administration system that goes beyond five rights to safeguard the nurse and
the patient from the devastating effect of a serious adverse drug event.
Ideally, a system can ensure
the five rights prior to administration by using a combination of bar-code
technology and seamless interfacing to the hospital's information systems.
Using standard barcode technology, the nurse scans her name badge and then the
patient identification band to access the patient's profile. She then scans the medication to verify that
the drug, time, route and dosage all match the order. The automated checking
process intercepts errors by alerting nurses to information inconsistent with
the pharmacy order. The system should
further guard against medication errors by incorporating clinically relevant
decision support tools beyond five rights verification. To illustrate this
point, consider the following examples of actual medication errors and how an
advanced point of care system could have prevented the error.
High Risk Medications - A 2-year old was administered penicillin G
benzathine by a CRNA post surgery. In the recovery room, a nurse noticed that
the solution in the patient's IV tubing was white and thick. An investigation
found that the CRNA, in her 15th hour on the job had unknowingly administered
the medication intravenously instead of via the IM route. Fortunately, the
child did not suffer any serious side effects.13
The nursing shortage is most
severe in ICUs and ORs making these units particularly vulnerable to medication
error.14 Organizations, such as the Institute for Safe
Medication Practices (ISMP) provide safety alerts to healthcare providers
regarding high risk medications. The
ideal system incorporates these warnings and alerts the care provider when a
high-risk medication is about to be administered. In this example, an alert would have reminded the CRNA that
Penicillin G Benzathine is only to be given IM and prevented the error.
Medications with
Significant Clinical Actions - A
combative patient was ordered a neuromuscular blocking agent for sedation. The
nurse, while struggling to control the patient without assistance, administered
the medication to the man, who was not intubated or mechanically ventilated.
The patient coded and suffered serious anoxic consequences.15
The system should
automatically generate alerts to clinicians when neuromuscular blocking
medications, or other drug families that require significant clinical actions,
are selected for administration. The
warning reminds the nurse that ventilatory support is needed for the
administration of these drugs.
Look Alike / Sound Alike
Medications - A 60-year-old woman
diagnosed with atrial fibrillation suffered a myocardial infarction following
emergency surgery. The patient was ordered amiodarone, however, the assistive
nurse aid on duty did not have experience with amiodarone. Instead, amrinone,
which was stocked on her unit, was administered. Fortunately, the patient did
not suffer permanent adverse effects.16
In this instance, a point of
care system would have alerted the nurse to the potential for confusion and
informed her that amiodarone is used for arrhythmias and angina whereas
amrinone is used to treat CHF. Having
been made aware of the potential for an error, the nurse aid may opt to seek
the advice of a senior nurse or the pharmacy.
Maximum Daily Dosing - A physician ordered, "colchicine 0.6 mg orally every
2 hours until diarrhea develops" for a patient with gout. The patient was found
dead after receiving the 25th tablet, a total dose of 15 mg. The recommended
dosage per course of therapy is 4 to 8 mg.17
To provide the highest level
of safety, a point of care technology should enhance maximum dosing information
by incorporating a rolling 24-hour count of doses administered. In this case, a warning would have appeared
as the nurse was about to administer the dose exceeding the maximum daily
dosing criteria, preventing the fatal overdose.
Missed Doses - Due to an error in the medication delivery process,
a patient didn't receive his prophylactic anticoagulation until 24 hours after
his hip surgery had begun. He developed pulmonary emboli, which resulted in his
death. The jury's decision was $539,000 against the hospital.18
An advanced point of care
medication administration system provides both a "real time" medication profile
and electronic medication administration record. In the medication profile, missed or late doses are easily
discernable by use of on screen highlighting, color-coding, and/or icon
placement. Any medication ordered, but
not given at the ordered time is easily seen.
Clinical Documentation - A 2-year-old boy underwent surgery and returned to
his room with a continuous epidural infusion of hydromorphone and bupivacaine.
The orders were for the nurse to assess the patient every hour. By the next
morning, the patient had gone into cardio respiratory arrest and died. The
nurse claimed she had done the assessment, but did not have the time to
document the results. The hospital settled the claim for $1 million.19
Nurses complain about the amount
and complexity of paperwork that has resulted from a multitude of actions by
regulatory bodies and the reimbursement industry. As an extension to the
electronic medication record, a comprehensive administration system can capture
information such as pre and post dose pain scales. The system can also allow for regularly scheduled actions such as
pain assessment every shift. Utilizing
this type of clinical observation capability may have safeguarded the caregiver
from later disciplinary and legal action if not prevented the child's death
entirely.
This nation's
healthcare system is in the precarious position in which 60% of nurses today
choose not to work at the bedside in our hospitals.20 Unwilling to bear hardships of nursing
through this shortageñ grueling physical and mental demands, forced overtime,
increasing workloads, sicker patients, anemic pay raises, and ever more
devastating liability ñ nurses are jumping ship to seek safer harbors. Fifty percent of respondents to a survey of
nurses said that "reputation of employer as a healthcare institution" or
"general working conditions for nurses at the institution" was the most
influential factor in deciding to accept employment.21 Recognizing
this, hospitals that wish to survive this staffing crisis, will have to
establish themselves at premier institutions and invest in improving bedside
working conditions. According to a
recent article in Modern Healthcare, "Top recruiting hospitals use
technology in a way that supports performance.
They invest in IS to eliminate manual tasks, enhance access to
information and improve patient care - such as by using electronic medical
records and patient monitoring systems."22
Few information technology solutions can be shown to provide nurses with the
security that an enhanced point of care medication administration system
can. This realization will soon have
hospital executives declaring, "If we build it, the bedside nurse will not only
come but will also stay."
_______________________
1 Health Resources and Services Administration, Bureau of Health Professions, Div. of Nursing. The Registered Nurse Population, February 14, 2001
2 Buerhaus, Peter I. Second Opinion; Nursing Shortage, Washington Post. Dec. 8 2000.
3 ANA, Analysis of American Nurses Association Staffing Survey, February 6, 2001.
4 Reducing Health Care Error: Systems-Based Approaches and Nursing Perspectives. Nursing Trends & Issues; Vol. 3, No. 8 Aug. 1998.
5 Foley, Mary. Mandatory Overtime is An Alarming Trend. AANC News, Vol. 17, No. 6, June 2000.
6 San Diego Union-Tribune. Not Enough Nurses? February 21, 2001.
7 ANA, Analysis of American Nurses Association Staffing Survey, February 6, 2001.
8 Leape, Lucian, et al. System Analysis of Adverse Drug Events. JAMA, Vol. 274, No. 1. July 5, 1995
9 ISMP - A Call to Action: Eliminate Handwritten Prescriptions Within 3 Years! April, 2000.
10 Leape, L. Bates,DW, et al. Systems Analysis of Adverse Drug Events, JAMA July 5, 1995, vol 274
11 Coming crisis spurs nurse rally - 1 million recruits are needed in U.S.; 600,000 expected Boston Herald Wednesday, March 7, 2001.
12 Leape, Lucian, et al. System Analysis of Adverse Drug Events. JAMA, Vol. 274, No. 1. July 5, 1995
13 Cohen, Michael, Medication Errors. Nursing99, October, 1999.
14 Buerhaus, Peter I. Second Opinion; Nursing Shortage, Washington Post. Dec. 8 2000.
15 Neuromuscular Blocking Agents ñ Proposed Labeling and Packaging Standards for Medication Error Prevention. USP Quality Review, February, 2000.
16 Mitka, Mike, What's in a Drug Name? Plenty! JAMA, October 22, 1999.
17 Hoffman, Richard P., Drug Death: A Danger of Hospitalization, 1989, p. 79.
19 Fiesta, Janine, Target High-Risk Areas for Medication Errors Nursing Management December, 1998.
19 Fiesta, Janine, Target High-Risk Areas for Medication Errors Nursing Management December, 1998.
20 Padron, Laura. Bedside Nurses are an Endangered Species. AACN News; Vol. 17, No. 8 Aug 2000.
21 Alspach, Factors that influence Recruitment and retention of Critical Care Nurses. Critical Care Nurse, 1992.
22 Attract and Retain RNs. Modern Healthcare, January 31, 2000.Legislation & Regulation
The Department of Health and Human Services reopened the
HIPAA privacy act regulations for a new, 30-day comment period. In his
statement, Secretary Thompson said, "Our goal is to achieve privacy protection
that works. I believe we should be open to the concerns of all those who care
strongly about health care and privacy. And after we hear those concerns, our
commitment must be to put strong and effective patient privacy protections into
effect as quickly as possible."
Thompson also confirmed that the effective date of the Health Insurance
Portability and Accountability Act privacy regulations has been extended to
April 14th.
Patients in hospitals, nursing homes and outpatient clinics
nationwide will have a new vital sign monitored beginning in January ñ their
level of pain. JCAHO has issued new standards that will require physicians to
treat pain until it is relieved. Under the requirement, pain levels will range
from zero for no pain, to 10 for unbearable pain, as described by the patient.
JCAHO's mandate will also encourage pain management through state-of-the-art
technology.
If the new pain levels and the
course of treatment are not monitored, providers risk losing accreditation by
JCAHO.
Hospitals & Health Networks Volume 75, Issue 2; ISSN: 1068-8838
California is demanding that hospitals
implement policies to reduce
medication errors or risk losing their licenses. A law signed last fall
requires acute care and specialty hospitals, ambulatory surgery centers and
urgent care facilities to implement a formal plan to eliminate or substantially
reduce medicationó related errors by Jan. 1, 2005. Democratic state senator
Jackie Speier, who introduced the bill, calls technologyóparticularly medication
ordering and administration technology-a "critical component of a total
approach" to reducing medication errors.
The Board of Commissioners of the Joint Commission on
Accreditation of Healthcare Organizations approved standards directly focused
on patient safety in hospitals. The new standards require hospital leaders to
create an environment that encourages error identification and remedial steps
to reduce the likelihood of future, recurring errors. Hospitals are to implement a program for proactive assessment of
high-risk activities related to patient safety and to undertake appropriate
improvements. To do this, hospitals
must aggregate patient safety-related data and information to identify risk to
patients; apply knowledge-based information to reduce these risks; and effectively communicate among all caregivers to
improve performance. Finally, the standards specify that hospitals are to place
appropriate emphasis on patient rights, education of patients and their
families, continuity of care, and management of human resources. The anticipated
implementation date for the standards is July 2001.
Source: Seattle Post-Intelligencer
Eliminating handwritten
prescriptions, sound-alike drug names and look-alike drug packaging could help
reduce medication errors, according to a report released by the Washington
State Health Department. The report, requested by the Legislature, describes
ways to reduce drug-related errors in response to growing national concern over
medical error rates.
Report says medication
errors are the most common type of medical errors in the United States. HCPro, a health care consulting company in Marblehead, MA,
announced the results of the survey conducted to determine the nature and
frequency of medical errors. HCPro
surveyed about 300 risk- and quality-assurance managers, senior
administrators and non-physician clinical staff members from 380 hospitals. Bob
Croce, executive editor at HCPro notes that the results of the survey are
almost identical to the 1999 IOM survey, with medication errors ranking at the
number one in both surveys.
The U.S. Pharmacopeia, or USP, released the "Summary of
1999 Information Submitted to MedMARxSM: A National
Database for Hospital Medication Error Reporting." The report summarizes the
1999 data of 6,224 medication error records from 56 facilities, including
community, government, and teaching hospitals of varied characteristics. The analysis of the 6,224 reports, which
include both potential and actual errors, indicated that most errors (97%) did
not result in patient harm. Errors resulted in harm or death just 3% of the
time. USP's data report indicates that the three most frequently reported types
of errors were: omission errors, improper dose errors, and unauthorized drug
errors. Also, the report states that of the five phases of the medication use
process, most errors were reported to have originated in two primary areas: administering
and documenting.
The Guardian
More than one patient in
every 10 admitted to hospital for treatment will suffer some sort of harm while
they are there, according to the first study of its kind in the UK. The study
by Charles Vincent, professor of psychology, and colleagues in the
clinical risk unit of University College London has never been undertaken
before in the UK. They found that the
rate of adverse events in their pilot study of 1,014 patients in two London
hospitals was 10.8%. Since some patients suffered more than one event, the
percentage of medical mishap was still higher, at 11.7%. This is considerably higher
than the 3.7% recorded by a Harvard study in the US, but lower than the
Australian figure of 16.6%.
Source: American Family Physician
The Institute for Safe
Medication Practices (ISMP) joined with the Pediatric Pharmacy Advocacy Group
to survey hospitals about medication safety practices for pediatric patients.
According to the ISMP survey results, greater precautions are necessary to
protect pediatric patients from potentially tragic medication errors. While
many safety practices are used fairly consistently, approximately 75 percent of
all survey respondents said that prescribers often or consistently failed to
include the mg per kg dose on pediatric medication orders. Thirty-three percent
of respondents from neonatal intensive care units (NICU) and pediatric
intensive care units (PICU) reported little or no involvement by clinical
pharmacists in these high-risk patient care units. While Nearly 90 percent of
NICU and PICU respondents said that specialized training was required, only 66
percent of respondents from general practice units had similar training.
Purdy BD, Raymond AM, Lesar TS. Ann Pharmacother. 2000;34(7-8):833-838
New study shows that
hospitalized patients taking antiretrovirals are at risk for adverse outcomes
due to prescribing errors and that this risk has increased with the rising
complexity of antiretroviral drug regimens.
Researchers performed a systematic evaluation of all medication
prescribing errors involving antiretroviral medications in a 631-bed tertiary
care teaching hospital between January 1, 1996, and October 31, 1998. A total
of 108 clinically significant antiretrovirals prescribing errors
were detected during the 34-month study period.
The most common errors were
dosing related. Overall, errors
occurred in 5.8% of admitted patients prescribed antiretroviral
medications. This accounts for an increase from 2% of admissions in 1996 to
12% of admissions in 1998.
Thomas EJ, Brennan TA. BMJ. 2000;320(7237):741-4
The study looked at 15,000
hospitalized patients discharged in 1992 from hospitals in Utah and Colorado,
excluding psychiatric and Veterans Administration hospitals.
Non-elderly patients
experienced adverse events at a rate of 2.80% compared with a 5.29% incidence
among elderly patients. Preventable adverse events were more common among
elderly patients, probably because of the clinical complexity of their care
rather than age based discrimination.
Drs. Kenneth Barker, Betsy Flynn, and colleagues presented
information from a recent study on various medication error detection methods
in 24 hospitals and 12 skilled nursing facilities. Direct observation of
medication administration detected a
19% error rate whereas only a 1% error rate was detected by chart review,
and a single error was reported (0.03% error rate) on an incident report.
With direct observation a sampling of nurses are observed as they prepare and
give their medications. The observer's notes are then compared with the
original orders on the patients' charts to identify the percent of doses that
were given (or not given) in error. Although the observation methodology will
not identify prescribing errors, hospitals are able to monitor a weekly error
detection rate for drug administration, which also captures drug dispensing
errors. Thus, it is particularly valuable for evaluating the impact of system
changes.
Thomas P. Lombardi, BS, PharmD, FASHP, and Jeffrey D. Kennicutt, BS, PharmD
The risk of hospitalization
secondary to adverse medication outcomes in elderly patients is estimated at
17%, almost 6 times greater than that for the general population. The objective
of this review is to characterize drug related problems in the elderly,
particularly as they apply to nursing home residents, and to describe the
approach that St. Peter's Healthcare Services of Albany, New York, has
taken to improve medication safety in its long-term care residents.
The study asserts that
up-to-date technology must be used to maximize efficiency and effectiveness of
the medication management systems. Implementation of technology that uses
computer based alert systems, bar-coded medications, and handheld wireless
point-of-care devices should be assessed because in the acute care arena
these technologies have demonstrated the prevention of ADEs and medication
related errors. However, regardless of the technology used, the electronic
infrastructure must be organized to support the new technology used in
medication usage. Development and implementation of these types of advances
in technology will be more difficult in the nursing home setting secondary
to the logistics, such as location of off-site contract services provided.
Nurses at the ISMP were asked to share their thoughts about
the changes that they would make if they returned to practice. Here's what they
said:
* Enlist the help of patients to safeguard
against errors.
* Take the Medication Administration Record
(MAR) to the bedside.
* Minimize the need for error-prone
calculations.
* Ask for an independent double check of
high-alert drugs before administration.
* Take time to report errors.
* Make pharmacists a valuable member of the team. As a backup, carry a palm-held device
downloaded with up-to-date drug information.
* Communicate important information to the
pharmacy.
* Do not sacrifice safety for timeliness.
* Review the literature for reports of errors
that have occurred in other organizations.
A statewide coalition of health care, consumer, and business
groups in Wisconsin has endorsed a set of recommendations for improving the
safety of medication use and reducing errors. The patient safety coalition made
medication errors in organized health care settings its first priority, but it
noted that steps are needed to reduce errors in outpatient settings like
physician offices and community pharmacies as well. The coalition said its 10
recommendations "warrant immediate attention by providers, purchasers, and
consumers of health care in Wisconsin."
1. Provide 24-hour pharmacy coverage
either on-site or on-call.
2. Utilize available computer software to
provide clinical screening to maximize patient safety in the dispensing of
all prescription medications.
3. Conduct an evaluation of an integrated computerized
prescriber order-entry (CPOE) system with clinical decision support for
medications and other ordered services by January 1, 2002, with implementation
by January 1, 2004.
4. Implement an oral and inhalant unit dose
distribution system for all nonemergency medications administered within
the facility by January 1, 2002.
5. Utilize a pharmacy-based and pharmacist-managed
process for the preparation of intravenous admixture solutions.
6. Pharmacies and physicians should include
the generic name on the label of prescription medications dispensed to
patients.
7. Investigate and evaluate the use of
bar-coding systems for the packaging and administration of medications by
January 1, 2002.
8. Prepare and maintain written policies and
procedures for the use of select high-risk medications within the facility.
9. Prescribers should institute actions to eliminate
the use of symbols and phrases that are commonly misinterpreted by
pharmacists and other health care providers.
10. Prescribers and pharmacists should include
the intended use on all prescription orders and prescription drug labels
and packages for consumers.
Seventy-three hospitals in and around Philadelphia have
launched a regional effort to improve medication safety. The hospitals in the
city and Pennsylvania suburbs said they will work toward 16 safety goals
designed to reduce medication errors by influencing everything from the way
prescriptions are written to the types of machines used to dispense medicines
intravenously. The project, spearheaded by the Delaware Valley Healthcare Council,
will evaluate the systems that hospitals use to prevent errors, provide each
with individualized recommendations for improvement, and give hospitals tools
for educating employees and planning changes. They will be on their own when it
comes to implementing any of the recommendations, though, and that could slow
things down. One of the goals, for example, is to "prepare for" using a
computerized system to prescribe drugs. The Delaware Valley Healthcare Council
- a regional hospital group - hopes the program will become a model for other
parts of the country. Participation is
voluntary. Area hospitals have pledged $500,000 to support the effort. The
regional council hopes to gather another $900,000 from foundations and
corporations.
The Boston Globe
Nearly every Massachusetts
hospital has taken critical first steps to root out dangerous drug errors, and
more than two-thirds have fully implemented a 12-step error-reduction
program, according to a statewide survey. Two years ago, Massachusetts was
the first state to endorse a specific set of recommendations to reduce
medication mistakes, the most common form of hospital error. The move was a
response to a troubling rise in the number of hospital errors. The report by
the Massachusetts Hospital Association suggests that hospitals listened
to that advice and are putting much of it into practice.
The Massachusetts hospitals
have forged a Coalition for the Prevention of Medical Errors that
includes state regulators, doctors, nurses, and others. The survey offers the first on-the-ground
test of that partnership, with 61 of the state's 68 full-service hospitals
answering a questionnaire mailed last spring. On average, 97 percent of
hospitals in the state have at least partly implemented the 12 short-term steps
the coalition recommended. Seventy percent of hospitals, on average, had fully
executed the 12 steps throughout their facility. 83 percent of Massachusetts
hospitals have fully computerized all pharmacy systems so they
automatically issue warnings for problems like patient allergies and drug
interactions. Just 2 percent have fully implemented, and 13 percent
partially, systems where physicians order drugs via computer in a way that
eliminates handwriting errors and provides alerts when errors are made in
ordering.
Promina Health System,
through its eight metro Atlanta hospitals, has agreed to undertake a patient
safety initiative with a group of major local employers and health insurers.
The informal agreement between Promina and the Georgia Healthcare Leadership
Council, a coalition of employers and insurers, pledges a cooperative
effort "to make health care safer, more effective and more efficient." Promina
said that it will make sure all its hospitals follow steps that some facilities
now use, such as an identification system for patients with allergies to
medications and food. Long-range goals include having doctors in hospitals order
all medications and tests by a computer system, instead of by handwritten
instructions.
The nation's huge VA system successfully launched a system that dramatically
reduces medication errors. For example, the Tucson VA reports an error rate of
less than 1 percent and believes it can reduce it even more with this system.
The system is called "Bar Code Medication Administration," Here's how
the system works: Patients wear a bar coded identification bracelet. The nurse
waves a handheld, cordless scanner over the bar coded bracelet, which, in turn,
brings up the patient's records on a laptop computer on the nurse's medication
cart. The nurse then scans the bar code of the medication she is about to
administer. The dosage is prepackaged in the pharmacy, using the same computer
and bar coding system. Once a medication is given, the computer automatically
records it. If the patient has already received the drug, the computer tells
the nurse that the medication already has been given. As every nurse will tell you, the nurse is responsible for giving
the right drug, in the right amount, by the right route at the right time to
the right patient. This system assures that this will happen. While it lacks
many of the features of other computerized systems, it goes a long way in
reducing errors for a very reasonable price.
Crain's New York Business
In treating pneumonia, it's
axiomatic that the sooner the patient gets antibiotics, the sooner he recovers,
avoiding potentially fatal complications. But at too many hospitals in New
York, care for pneumonia doesn't meet medical standards. A study by the federal
government of care for Medicare patients ranked the state the fourth-worst
in promptly administering medication for the disease. It found that only 80% of
patients receive antibiotics within eight hours.
The Daily Express (UK)
Doctors are reacting to the
deaths of two patients in a week. A teenager who was in remission from leukemia
died when an anti-cancer drug was accidentally injected into his spine
instead of a vein. Then an elderly man died when a local anaesthetic was
injected into a vein rather than his spine. Just about every doctor have heard about these mistakes because
there have been 13 such errors over the past 15 years, many of which have
received widespread publicity. Last year, Government chief medical officer Professor
Liam Donaldson launched his vision of the NHS - An Organization With A
Memory - in which he promised action to reduce harmful medical errors. He even
specified this very error, injecting intravenous drugs into the spine, as a
target for "zero occurrences".
So why, less than a year on,
has the very same mistake been allowed to occur? The answer, according to Donald
Berwick, President and CEO of Institute for Healthcare improvement (IHI),
is that doctors are human, and humans err. Berwick believes the answer lies in
changing systems of work in the NHS, and cites the small number of patients who
used to die under anaesthetic each year because the anaesthetist mistakenly
connected the nitrous oxide tank to the oxygen line and vice versa. This can
never happen now because the fittings on the tanks have been made unique and
can't be mixed up. What's needed is clearly a simple failsafe mechanism to stop
wrongful injection.
Even in the best hospitals, patients and their families are
turning to private nursing help to supplement care from staffs that are often
short-handed and over-worked. As hospital nurses focus their efforts on
patients in crisis, private "sitters" are there to tend to the more personal
needs of patients, and provide some of the TLC services of yesteryear. Hiring a private-duty nurse or nurse's aide
brings peace of mind to patients and their families, say its proponents. It can
also be a hedge against substandard care, adding an
extra pair of eyes and ears to prevent errors and injuries.
Sitters or certified
nursing assistants do not give medications or insert IVs. A sitter will help a patient to the bathroom, and
deliver a meal. If a patient is frightened, a sitter holds his hand. At night,
a sitter watches that a patient doesn't fall out of bed or become wedged
between the bed railings and the mattress, where the patient might suffocate.
There is general consensus
among medical leaders that when you go to the hospital, you need an advocate -
a family member or friend who can follow your care and watch out for errors.
The private nurse or nurse's aide can serve as a stand-in who is not going to
be intimidated by the place. That will be necessary until we put in more systematic
approaches that build in safety.
The Agency for Healthcare
Research and Quality (AHRQ) announces
the availability of approximately 13-14 Cooperative Agreements for up to three years to support large
demonstrations in states, health care systems, and/or networks of providers to
test reporting strategies and patient safety interventions. AHRQ is interested in sponsoring
research that will improve the safety of patients being cared for in a wide
variety of medical settings. These projects should use technology, staff
training, and other methods to reduce such errors; develop replicable
models that minimize the frequency and severity of medical errors; develop
mechanisms that encourage reporting, prompt review, and corrective action with
respect to medical errors; and develop methods to minimize any additional
paperwork burden on health care professionals.
AHRQ is interested in
providing resources to evaluate the effectiveness of existing systems or
systems that will be functional within a few months of receipt of funds, rather
than in supporting their development.
Letter of
Intent Receipt Date:
April 2, 2001
Application
Receipt Date:
April 27, 2001
The Agency for Healthcare Research and Quality (AHRQ) announces the availability of Research Projects on
the use of clinical informatics and information technology (IT) to reduce
medical errors and improve patient safety.
AHRQ seeks projects to develop and test the use of innovative
technologies, such as hand-held electronic medication and specimen
management systems, training simulators for medical education, computerized
bar-coding, patient bracelets, smart cards, and automated medication
dispensing systems in clinical settings.
In responding to this RFA, applicants should address the following
central research topics: (1) the role of informatics in improving
clinical decision-making, reducing errors, and advancing patient safety;
(2) barriers to acceptance and adoption
of health information technology for improved patient safety and quality; (3) utilization of effective strategies to
improve patient safety while maintaining patient confidentiality.
Letter of
Intent Receipt Date: April 6, 2001
Application
Receipt Date: April 23, 2001
The IHI has become the National Program Office for a major
initiative of The Robert Wood Johnson Foundation, "Pursuing Perfection:
Raising the Bar for Health Care Performance." This initiative is a $20.9
million, three-year project, whose aim is to help a small number of health
care organizations achieve unprecedented performance in an array of core
processes at a system level. Successful participants will provide examples
of improvement not generally thought possible in the world of health care.
The Call for Proposals invites
hospitals and physician groups throughout the United States to apply for
selection. A National Advisory Committee (NAC) of 14 members will review all
applications and select approximately 20 organizations for site visits during
the spring of 2001. In July 2001, 12 of the 20 will be chosen as finalists, who
will then receive small grants for approximately six months to prepare final
applications. In the winter of 2001-2002, six of the 12 finalists will be
chosen by the NAC as Pursuing Perfection grantees, who will receive over the
subsequent 24 months awards of between $1.5 million and $3 million to help
support their improvement work.
The Blue Cross Blue Shield of Michigan Foundation is seeking letters of interest from Michigan-based
clinicians and researchers interested in developing ways to improve patient
safety by reducing errors and accidental injuries in hospitals. The BCBSM
Foundation has dedicated $500,000 to this initiative to award grants to
applicants who will conduct research and disseminate information on best practices.
Michigan academic researchers,
physicians, hospitals, health systems and others are invited to submit letters
of interest in one of four areas:
* Determine the causes, frequency, severity
and impact of medical errors on patient outcomes.
* Develop and evaluate the impact of
strategies aimed at reducing medical errors on improving patient safety.
* Identify proven procedures that have
successfully improved patient safety and determine how they can be spread
throughout the health care industry.
* Develop approaches to disseminate
information on best practices to improve patient safety.
Letters should be mailed no
later than May 4, 2001.
St. Paul, MN, May 16-18, 2001
The third in a series of conferences to address issues vital to enhancing
patient safety and reducing errors in health care. Discussion topics include:
* The nature of patient-provider
communication,
* Professionals' and patients' disparate
understanding of risk,
* Communications at the sharp end, Intrastaff
communication,
* Effective communication as a core element in
a culture of safety,
* Communicating technological needs and human
factors,
* Health literacy and communication,
* Communications between providers and patients/families,
* Disclosing health care errors,
* Threat of litigation as a deterrent to
disclosure and communication.
Featured Speakers:
Paul Slovic, PhD, President,
Decision Science Research Institute, Eugene, OR, speaking on Emotion, Reason
and Risk: Lessons for Risk Communication from Cognitive Science
Daniel Taylor, PhD, author of
The Healing Power of Stories
Gordon Sprenger, President and
CEO of Allina Health Systems, and
Brock Nelson, President and
CEO of Children's Hospital and Clinics, Minneapolis-St. Paul, Dare To Tell It
All
Bridge Medical Inc. and Symbol
Technologies Inc. announced that they
are partnering to offer Symbol's rugged, pocketable and wireless handheld
computers for use with Bridge's MedPoint system, which helps hospitals
intercept medication errors at the point of care. The Bridge MedPoint system, first installed in hospitals in 1998,
incorporates computer networking, innovative software programs and bar-code
technology to help hospitals prevent medication errors and adverse drug events
ó and improve patient outcomes in drug therapy.
Pyxis Corporation, a
subsidiary of Cardinal Health, Inc., announced that San Diego-based Bridge
Medical, Inc. has joined the PyxisPartner Program. Under the agreement,
Pyxis will leverage the strength of its nationwide customer service
organization and the dedicated support of its Worldwide Service Center to provide
installation and service for the Bridge MedPoint medication management system.
Bridge Medical offers proprietary software to help hospitals address the
problem of medication errors.
Bridge Medical, Inc., announced that Denean Rivera has joined
the company as VP Field Operations and Service. Ms. Rivera has over 20 years
experience in healthcare software and information technology. Reporting to Sr.
Vice President and Chief Operating Officer, Rusty Lewis, Rivera will be
responsible for customer service, including implementation and support. She
will be instrumental in building the organization as Bridge continues its
widespread commercial rollout of the Bridge MedPoint system and broadens its customer
base.
Ms. Rivera comes to Bridge
from eMD, where she served as Vice President of Product Management and
Implementation. Previously with information technology vendor McKessonHBOC,
Inc., Ms. Rivera developed the product management organization and standards
across product families, working closely with strategic acquisition initiatives
and new product rollout. Rivera began
her career in the hospital clinical laboratory with a B.S. in Medical
Technology from Wayne State University and later received a degree in
information systems.
Finalists were announced in the Healthcare
Innovations in Technology Systems (HITS) partnership awards. The awards honor partnerships of healthcare
organizations and technology vendors for the creative use of new or emerging
technology to improve the quality of patient care. One winning team and one runner-up team will
be announced in each of the four categories on Thursday, April 19, during
the 3rd annual Healthcare Informatics & e.MD Expo & Conference.
St. Marys Hospital Medical
Center, Madison, WI, and Bridge
Medical, Solana Beach, Calif., have been named finalists in this awards
competition for a medication tracking system that helps to reduce and eliminate
medication errors at the point of care.
In all, fifty-eight teams entered the competition this year. They were judged by national healthcare information technology experts on 10 criteria: collaboration, uniqueness of the application, attainable implementation, improved patient care quality, improved management of clinical information, cost justification, attainable technology, improved quality of education and research, connectivity with other systems, and sophistication of the technology itself.