Contents:
BPOC
in the News
•
Bar-coding—the “quickest hit”
of patient safety tools
• JCAHO spotlight on St. Marys
• The role of bar codes in blood transfusion
safety
Providers
Leading the Way
•
Sutter Health, Northern California
• Lancaster General Hospital, Lancaster,
Pennsylvania
• Miami Children’s Hospital, Miami,
Florida
• Mercy Medical Center, Dubuque, Iowa
• Medical Center of Aurora and Rose Medical
Center, Denver, Colorado
• St. Francis Hospital, Charleston, West
Virginia
• Baptist Health South Florida
• Charleston Area Medical Center, Charleston,
West Virginia
• Partners Healthcare System, Boston, Massachusetts
• Trinity Hospital, Minot, North Dakota
Taking
Action
• HIMSS pens letter on bar-code merits
• Pennsylvania agency to monitor errors
• AHRQ awards grant to fund CPOE study
• Air Force to automate pharmacy system
• New technologies tackle drug errors
Research
•
Few studies quantify role of technology in error
reduction
• ISMP receives grant to help hospitals measure
progress
• Preventable Adverse Drug Events in Hospitals:
A Literature Review
Cause
for Concern
•
Thirty-five percent of employees’ time wasted
Legislative
& Regulatory
• SSM goes to Washington with patient safety
advice
• Congressional act to fund BPOC introduced
• Florida law cracks down on handwriting
• IT issues gain attention on Capitol Hill
• New patient safety partnership
BPOC
in the News
Bar-coding—the
“quickest hit” of patient safety tools
The
August issue of Healthcare Informatics cites BPOC systems
as the “quickest hit” of the leading innovations in
patient safety technology. Quoting Susanne E. Larrabee, BS Pharm,
of Northern Michigan Hospital, the article highlights the roughly
130 errors that are avoided each month at the medical center by
using the bar-coding system.
At
this point, however, relatively few hospitals have comprehensive
bar-coding systems, a necessary step to fully utilize the range
of bar-code technology. Healthcare “really hasn’t
leveraged the power of bar-coding,” says Debbie Murphy,
a life sciences market development manager. “The bar code
is like a license plate. When you put a number into a database,
it gives you a whole bunch of information … the bar code
becomes a pointer to the medical record.”
JCAHO
spotlight on St. Marys
The
June Briefings on Patient Safety, a Joint Commission on Accreditation
of Healthcare Organizations publication, reports on the pros and
cons of BPOC system use, based on the experiences of St. Marys
Hospital Medical Center, a Bridge Medical customer. Located in
Madison, Wisconsin, St. Marys is a 330-bed level II tertiary community
hospital that has achieved Magnet status, partly due to its use
of Bridge’s MedPoint technology to reduce medication errors.
Among the tips St. Marys proposes are:
•
Provide
the pharmacy with adequate time. Don’t underestimate
the time it will take them to develop a formulary.
•
Include
the IT department as soon as possible.
• Set aside ample training
time. Learning the BPOC system is
relatively
easy, but several hours of training per person are
required in order to become fully comfortable
with the
system.
•
Be prepared for staff reluctance. Using a new system is a
major change, and it will take some getting
used to from
some staff members.
•
Choose
hardware that is easy to adapt and upgrade, such as
laptops.
•
Keep
all staff involved in the process and encourage them to
suggest improvements.
The
role of bar codes in blood transfusion safety
A
study in the September 2003 issue of Transfusion evaluates
a bar-code patient identification system for blood sample collection
for compatibility testing and blood administration. The report
states that following the introduction of bar-code-based patient
identification, correct verbal identification of patients rose
from 11.8 to 100 percent, and the systems improved patient identification
compliance on wristband and local components. In summary, the
article concludes: “This study found significant improvements
in the performance of blood sample collection and the administration
of blood after the introduction of bar-code technology into the
clinical transfusion process.”
— C. L. Turner, A. C. Casbard, and M. F. Murphy, Transfusion
42, no. 9 (2003): 1200.
Back
to the top
Providers
Leading the Way
Sutter
Health, Northern California
Last
year, Sutter Health, based in Sacramento, California, embarked
on a system-wide installation of the MedPoint BPOC system. Five
Sutter hospitals, most recently the Sutter Tracy Community Hospital,
are now using MedPoint to ensure medication safety, with another
two installations expected by the end of the year.
Lancaster
General Hospital, Lancaster, Pennsylvania
Lancaster
General is rolling out MedPoint-MedAdmin software on tablet PCs.
MedPoint uses bar-code technology to increase patient safety with
a bedside medication verification application that communicates
with Lancaster General’s pharmacy, registration, and administration
systems.
With this application, doctors, nurses, patients, and prescribed
drugs at Lancaster General are assigned unique bar codes. During
medication administration, a nurse scans his or her own bar-coded
identification badge to log onto the system and then scans the
patient’s bar code and medication package to verify through
the tablet PC that the right patient is receiving the right dose
of the right medication.
MedPoint also electronically documents the medication administered
to the patient, eliminating a paper-based process.
Miami
Children’s Hospital, Miami, Florida
Miami
Children’s, one of the nation’s first children’s
hospitals to deploy a BPOC system hospital-wide, has recently
been awarded Magnet status, the highest honor in the nursing profession.
Magnet designation recognizes the MCH nursing staff for meeting
the rigorous quality indicators and standards of nursing practice
as defined by the American Nurses Association’s Scope and
Standards for Nurse Administrators. MCH is the first freestanding
pediatric facility in both Florida and the Southeast to achieve
this designation. Nationwide, it is only the fifth pediatric hospital
to receive Magnet certification.
Mercy
Medical Center, Dubuque, Iowa
Mercy
Medical Center has installed a $500,000 bar-code scanning system.
Combined with a drug-dispensing robot and a CPOE system, Mercy
is aggressively combating medication administration errors. The
bar-code system was initially deployed in the surgical services
unit and had spread hospital-wide by the end of July. Installation
of the CPOE system should be completed by March 2004.
— Associated Press, July 17, 2003.
Medical
Center of Aurora and Rose Medical Center, Denver, Colorado
Two
Denver-area hospitals have implemented electronic medication administration
records, or eMARs, as part of a 16-hospital pilot program for
patient safety sponsored by the HCA healthcare system. Medical
Center of Aurora and Rose Medical Center in Denver now use bar-coded
patient bracelets and account numbers to monitor patients and
ensure the proper care.
St.
Francis Hospital, Charleston, West Virginia
St.
Francis Hospital is using a pharmacy robot to scan bar codes and
pick medications for patients as part of an initiative to improve
safety. In December, the hospital plans to begin using laptops
and bar-code scanners at the bedside. St. Francis, which is affiliated
with not-for-profit HCA, is the only hospital in the area to use
a pharmacy robot.
— Associated Press, August 10, 2003.
Baptist
Health South Florida
Baptist
Health in Miami, Florida, is using a new bedside technology designed
to make many medication errors a thing of the past. A computer
checks—then double-checks—that the right patient is
receiving the right dose of the right drug at the right time.
In the $35 million pilot project for the new bedside technology,
medicine is stored and dispensed at a “mini-med” station
in 50 rooms at Miami Cardiac and Vascular Institute at Baptist
Hospital. Each patient’s ID bracelet features a bar code.
When the nurse scans it, the patient’s medication orders
pop up on a computer screen that hangs from a mobile arm. After
the nurse chooses the medicine by touching the screen, the locked
medication drawer opens. The nurse then scans the bar code on
the medication, which crosschecks the information on the patient’s
bracelet.
Eventually, all Baptist Health hospital rooms will be equipped
with the Pyxis PatientStation SN.
— Resource, a publication of Baptist Health South
Florida, fall 2003.
Charleston
Area Medical Center, Charleston, West Virginia
Upgrades
to Charleston Area Medical Center will increase patient safety
by enabling nurses to use bar-code scanners when giving drugs
to ensure the “five rights” (right patient, right
medication, right dose, right time, and right route of administration).
State regulators have approved a request to spend about $30 million
to upgrade CAMC’s computer system. The upgrade will also
make it easier for doctors and nurses to track patients and view
laboratory test results. The new system is expected to save CAMC
$15 million over the next 10 years.
— John Heys, Charleston Gazette, August 30, 2003.
Partners
Healthcare System, Boston, Massachusetts
Partners
Healthcare System in Boston has introduced several patient and
clinical information systems across its network of care facilities
and affiliates, such as Harvard Medical School. Its intranet,
for example, includes patient charts, lab results, and information
on patients’ medication, allergies, and procedures, as well
as a computerized physician order entry (CPOE) system. Partners’
Brigham and Women’s Hospital will begin using a wireless
bar-code medication system this fall.
Steve Flammini, chief technology officer for Partners, reports
that clinical decision support and error-prevention technology
have “an excellent return on investment.”
Trinity Hospital, Minot, North Dakota
Trinity
Hospital has implemented an automated pharmacy system that should
help prevent handwriting problems, states Jeffrey Verhey, chief
of Trinity’s medical staff. The system sends an alert if
a patient’s prescription does not correspond to his or her
diagnosis. The hospital might also expand the system to include
electronic prescription orders.
Rural hospitals that previously couldn’t afford these electronic
systems will receive a total of $26 million in federal grants
this fall to purchase patient safety technology, such as computerized
physician order entry systems, says Mary Wakefield, director of
the University of North Dakota Center for Rural Health.
Back
to the top
Taking
Action
HIMSS
pens letter on bar-code merits
Below
are excerpts from a letter sent by the Healthcare Information
and Management Systems Society on August 8 to Secretary of Health
and Human Services Tommy G. Thompson.
“A major reason that mature information technology isn’t
commonplace in healthcare organizations is the lack of economic
incentive. Since the government funds close to 50 percent of healthcare
costs, we are writing to ask your leadership in addressing this
fundamental obstacle to high-quality, error-free healthcare in
this country.…
Economics of the FDA-Proposed Bar-Code Rule
“In and of itself, the provisions of the FDA’s proposed
rule will not avoid a single medication error, will not avoid
a single adverse drug event (ADE), and certainly will not save
a single one of the estimated 44,000 lives lost each year due
to medication errors. As stated in the proposed rule, the benefits
are achieved only when hospitals purchase and install BMAR capability.
Other than early adopters, the hospital community has not responded
by implementing BMAR systems. The FDA’s economic analysis
contains the data to understand this slow adoption. In short,
hospitals would spend real and scarce dollars, without commensurate
financial benefit.”
Pennsylvania
agency to monitor errors
The
Patient Safety Authority, a new state agency in Pennsylvania,
will work with ECRI, a health services research firm, to track
medical errors and near misses in the state’s hospitals
and outpatient facilities. The state created the agency as part
of an effort to address the malpractice insurance problem by reducing
medical errors. The agency planned to begin operations by the
end of September.
More than 350 hospitals, outpatient facilities, and birthing centers
will have to report serious events involving patients that occurred
before staff detected the error, as well as incidents in which
patients were almost harmed. Organizations must report all occurrences
within 24 hours and face $1,000 per day fines if they do not release
the information. Each facility will also have to create a patient
safety committee and appoint a patient safety officer. All reports
to the agency are confidential.
AHRQ
awards grant to fund CPOE study
The
Agency for Healthcare Quality and Research has awarded the University
of Arizona College of Nursing a $1.3 million grant for a three-year
study to determine the effect of hospital computerized order entry
systems on adverse drug events. Adverse drug events (ADEs) are
widely recognized as the most common type of iatrogenic injury
occurring in hospitalized patients. The university will participate
in the study with San Diego-based Sharp HealthCare.
The study is the first of its kind in non-teaching community hospitals
and will coincide with the implementation of a commercial CPOE
system in three Sharp HealthCare community hospitals.
Air
Force to automate pharmacy system
The
U.S. Air Force is in the first phase of developing a $25 million
pharmacy automation system that includes medication bar-coding,
automatic dispensers, and robotic systems. The program aims to
improve patient safety, standardize medication error reporting,
and increase efficiency.
Air Force bases are currently bar-coding all medications. Once
the system is complete, dispensers will administer medications
only when a bar code is scanned to verify an order. A medication
dispensing chute will identify ointments, drops, and pills.
The system will display a picture of each drug on a computer screen
and will be able to identify drug interactions. Pharmacists will
be alerted if there is a problem and will be able to research
patient information, such as prescriptions filled, prior adverse
drug interactions, and allergies. The system, which is due to
be completed by late 2004, could save an estimated $54 million
by the fiscal year 2005.
New
technologies tackle drug errors
Central
Florida Regional Hospital in Sanford has installed a mechanical
arm affectionately nicknamed Robo-D.A.N. It sorts, tracks, and
dispenses more than 400 different prescription drugs for the hospital’s
patients. But robots and drug-dispensing machines have the potential
to prevent only a tiny fraction of the nation’s medication
errors. According to a recent study by Harvard University, just
4 percent of all such mistakes occur during the dispensing phase
of a hospital’s medication system. More errors are likely
to occur during the administration phase, in which nurses or doctors
give patients their prescriptions. To prevent such errors, Central
Florida Regional was set to supplement Robo-D.A.N. with bar-code
technology beginning in September.
Back
to the top
Research
Few
studies quantify role of technology in error reduction
A
recent review in the American Journal of Health-System Pharmacy
notes that few studies highlight technology’s ability to
have a positive impact on medication error reduction. Several
of the reviewed studies documented error reduction due to computerized
physician order entry (CPOE) or barcode-enabled point-of-care
(BPOC) systems, but offered “very little or no evidence
on the appropriateness of the use of each technology.”
Of the five studies with similar endpoint measurements, one found
a “significant reduction” in errors when utilizing
a bar-code system. In general, however, it concluded that there
is a “paucity of controlled, generalizable studies confirming
the benefits of technologies intended to reduce medication errors
and ADEs.”
— E. Oren, E. R. Shaffer, and B. J. Guglielmo, “Impact
of Emerging Technologies on Medication Errors and Adverse Drug
Events,” American Journal of Health-System Pharmacy
60, no. 14 (2003): 1447–1458.
ISMP
receives grant to help hospitals measure progress
The
Institute for Safe Medication Practices has received a $285,000
grant from the Commonwealth Fund that will finance Phase II of
the ISMP Medication Safety Self-Assessment™. The program
will help hospitals measure their progress in medication safety
and will assist in the development of education tools and training
materials to further enhance safe medication administration.
Under Phase II, the ISMP Medication Safety Self-Assessment will
be amended and distributed to U.S. hospitals in 2004. Data from
a subset of these hospitals will be compared to data from the
2000 assessment to evaluate progress over the past three years.
The project will seek to determine whether new challenges in healthcare
have affected medication safety systems, and will allow hospitals
to compare their current medication safety systems and practices
to other demographically similar hospitals nationwide.
Preventable
Adverse Drug Events in Hospitals: A Literature Review
Preventable
adverse drug events (pADEs) are among the most common outcomes
of inappropriate medical care. Yet because of the vast and ever-increasing
number of drugs on the market and the multiple scenarios that
lead to pADEs, describing the problem and designing remedies present
a challenge.
The authors of an American Journal of Health-System Pharmacy
article reviewed major studies published between 1994 and 2001
that reported pADEs in hospitalized patients. The goal was to
identify the types of drugs, errors, and adverse outcomes that
constitute a substantial proportion of pADEs, thus uncovering
high-priority areas that should be addressed in patient safety
improvement efforts.
The authors found specific patterns. The most common pADEs involved
inappropriate dosing of cardiovascular drugs, followed by incorrect
combinations of psychoactive agents or opioids. Other pADEs involved
anticoagulant overdose and the use of anti-infectives despite
a history of allergic reactions. The authors note that while these
pADEs are not new, they are insufficiently described and reported.
As such, the authors conclude that targeting these drugs and error
types could significantly reduce overall pADE frequency.
— P. Kanjanarat, A. G. Winterstein, T. E. Johns et al.,
“Nature of Preventable Adverse Drug Events in Hospitals:
A Literature Review,” American Journal of Health-System
Pharmacy 60, no. 17 (2003): 1750–1759.
Back
to the top
Cause
for Concern
Thirty-five
percent of employees’ time wasted
A
new study, involving 74,827 employees of 71 hospitals, by the
Murphy Leadership Institute has discovered that wasteful work
consumes 35 percent of hospital employees’ time. This wasteful
work, which affects everyone from nurses to housekeepers, can
include such activities as completing multiple forms for the same
task, filing inefficient shift-to-shift or departmental reports,
waiting for medications, and searching for misplaced records.
There is good news, however. A statistical model developed by
MLI finds that as wasteful work is eliminated, operating margin,
perceptions of quality, and employee commitment all increase.
For every percentage point of wasteful work eliminated, operating
margin increases by 0.25 points, employee ratings of the organization’s
quality of care increase by 0.9 points, and employee ratings of
the organization as a good place to work increase by 1 point.
Back
to the top
Legislative
& Regulatory
SSM
goes to Washington with patient safety advice
Tom
Langston, corporate vice president for IT at SSM Health Care,
was invited to the White House to participate in the President’s
Work Group on Health Care IT in early September. Among the items
discussed was the success of St. Marys Hospital Medical Center
in Madison, Wisconsin, and its BPOC system from Bridge Medical.
Congressional
act to fund BPOC introduced
On
September 9, Representative Amo Houghton, R–N.Y., and Representative
Earl Pomeroy, D–N.D., introduced to the House the Medication
Errors Reduction Act of 2003. H.R. 3035 states: “The Secretary
of Health and Human Services shall establish a program to make
grants to eligible entities that have submitted applications for
the purpose of assisting such entities in offsetting the costs
related to purchasing, leasing, developing, and implementing standardized
clinical health care informatics systems designed to improve patient
safety and reduce adverse events and health care complications
resulting from medication errors.”
Florida
law cracks down on handwriting
Poor
handwriting contributes to approximately 6 percent of medication
errors, harming more than 700,000 patients each year, according
to the Agency for Healthcare Research and Quality. To help combat
these errors, a new Florida law, effective July 1, requires doctors
to type or clearly print out all prescriptions and include complete
dosing information.
IT
issues gain attention on Capitol Hill
The
healthcare industry’s slowness in adopting IT solutions
is gaining attention from lawmakers on Capitol Hill. But Congress,
which is contending with record budget deficits, is not seeking
anything as ambitious as the $800 million a year that one healthcare
IT group has proposed to wire the industry.
The House authorized $50 million over two years for an electronic
medical information system as part of a patient safety bill (H.R.
663) that passed in March. Senators Christopher Dodd, D–Conn.,
and Edward Kennedy, D–Mass., both support the creation of
a health information network.
In July, the Senate Committee on Health, Education, Labor and
Pensions approved a bill (S. 720) that would establish a system
for voluntary, confidential, and legally protected reporting of
medical errors by providers. As part of that bill, Dodd proposed
and then withdrew an amendment that would have granted $50 million
for the system. He has hinted that he might reintroduce the proposal
in the Senate. Senate Majority Leader Bill Frist, R–Tenn.,
has said he would rather consider IT proposals separately.
and
New
patient safety partnership
The
Agency for Healthcare Research and Quality and the VA’s
National Center for Patient Safety have formed a partnership for
improving patient safety that will help healthcare and public-health
professionals identify the causes of medical errors. The Patient
Safety Improvement Corps will be funded by an AHRQ grant of approximately
$7 million over four years. In the first year, participants from
50 health agencies and provider organizations in 15 states will
learn about the root causes of adverse medical events and close
calls—sometimes called “near misses”—and
will be taught steps to correct and prevent such errors.
Back
to the top
©
2003 Bridge Medical, Inc. All rights reserved.
