island health – implementation of a fully automated electronic health record and closed loop...
TRANSCRIPT
Island Health – Implementation of a fully automated Electronic
Health Record and Closed Loop Medication System – lessons
learnedJan WalkerRegional Leader, Medication Safety
Clinical Lead UDMD ProjectQuality & Patient Safety
Russ SwagaManager Pharmacy Informatics
Pharmacy Lead, IHealth
The right drug, the right dose, given to the right patient, at the right time…..
OHC Services the Oceanside geographic area consisting of approximately 50,000 residents.
Provides urgent care, medical day care, medical imaging, outpatient laboratory, primary care and integrated community care services (mental health, seniors health, home and community care, diabetes and home support)
Center is open from 0730-1030 daily. Seriously ill clients needing continuing care are
referred to one of 3 hospitals close by: Westcoast General, St. Joseph’s General or Nanaimo Regional General hospitals.
Oceanside Health Center
Medication Errors - Preventable Categories
22million medications are mixed annually 14 million are mixed by nurses 8 million are mixed by pharmacy
WHY?
Systems and Processes to support Medication Error Reduction
CPOE – Computerized Provider Order EntryeMAR – Electronic Medication Administration RecordADC – Automated Dispensing CabinetsPPID- Positive Patient Identification (bar code scanning)BBVM – Bedside Barcode Verification of Medications (bar code scanning)
Evidence Based Order Sets
Dose Range Checking
Adverse Drug Event Rules
Med Reconciliation
Prescribing
Transcribing
Ordering and Dispensing
Administration
Documentation
Closed Loop Medication System (CLMS)
BPMH and PharmaNet Integration
BPMH and Prescription Documentation at OHC - 2014
Urgent Care Primary Care0
2000
4000
6000
8000
10000
12000
14000
16000
15906
1325
49574159
BPMH's DocumentedPrescriptions Documented
BPMH Compliance in UC- 2014
61.3%
# of Patient Encounters with No BPMH # of Patient Encounters with BPMH Performed
Prescription Writer
Sep-
13
Oct-1
3
Nov-1
3
Dec-1
3
Jan-
14
Feb-
14
Mar-1
4
Apr-1
4
May-1
4
Jun-
14
Jul-1
4
Aug-1
4
Sep-
14
Oct-1
4
Nov-1
4
Dec-1
40.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Barcode Scanning in Oceanside Health Centre Urgent Care
% of Positive Medication Identification
% of Positive Patient Identi-fication
OHC Compliance Report
Good Catches
:
Nurse retrieved correct medication, scanned and administered
Order for Gravol inj:
Nurse scanned diphenhydrAMINE 50 mg/mL Vial – 1 mL (Benadryl) and received a warning
Good Catches (cont)
:
Nurse scanned tetanus imm.glob.hum. 250 unit syr -1 mL for the order below and received an alert, prompting her to realize it was the wrong vaccine..
Education is key Physician engagement is key Timely order entry is key All professionals working within scope is key Appropriate staffing levels is key Understanding workload and workflow is key Computer login lag is a determinant Non Scannable Medications is a determinant Leadership turnovers early in adoption phase
is a determinant
Lessons Learned
Engage end users as early in the design process as possible
Ensure all stakeholders are involved◦ Nursing, Pharmacy, Quality and Safety
(MedSafety), Informatics, and I.T. Factor in ongoing support and maintenance
into Project Plan After stabilization, have an auditing and
metrics plan in place that is tied to a Continuous Quality Improvement (CQI) strategy
Takeaways
Implementation of a fully electronic health record, throughout acute and residential services within Island Health◦ One patient – One record wherever possible within
the organization A fully functional closed loop medication
administration system throughout acute and residential services within Island Health◦ Safer medication practices to enhance safe
patient care and reduced medication error incidents
Island Health future plan
A vision needs people – the right people!