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DOSE RANGE CHECKING GO-LIVE
Within four months, 604 drugs-80 percent of ordered medications-were mapped in phase one and the new system went live in February 2011. Vaidya remembers the excitement in the command center watching the queries his team pre-set to analyze how frequently alerts were firing and what effect they were having. During hour three, he says, the team saw a glitch in the programming before users even reported it and made the appropriate changes, and since then hasn't really modified the system much. In the first month, Phoenix Children's had a 3-percent alerting rate for all orders, of which 2 percent were soft stops, which proved to be good balance for providers, Vaidya says. The initiative has also resulted in an 80 percent reduction in follow-up phone calls from the pharmacists back to physicians, which at five minutes per call can add up.
Since go-live, there have been no prescription overdose errors; and at the six-month mark, Phoenix Children's will do a formal review and analysis of the initiative. The next phase of the initiative will expand to include all medication orders and will continue modifying the programming logic. The next targets will be alerts for highly ineffective dosing, as well as renal, gestational, and eventually chemotherapy dosing.
GETTING CLINICIAN BUY-IN
Even though there have been significant changes in the workflow for physicians and pharmacists, Vaidya has gotten full clinician buy-in by taking a multidisciplinary approach to the project. “Everyone was seeing what we were doing, how we were building it, so there was buy-in. They knew what to expect,” Vaidya says. “Not just providing support during go-lives, but making sure the stakeholders are participants during the building phase really helped.” The clinicians also felt they were originators of the safety initiative and owned it, he says. Basfield adds that data was shared in the first 10 days, which allowed the clinical staff to “look under the hood” to see ongoing results and be proud of their success.
DEATH AND TAXES ARE THE ONLY TWO HARD STOPS IN CPOE. WE CHALLENGED THAT NOTION. WE FEEL THAT IF MISUSED, HARD STOPS CAN BRING a SYSTEM DOWN, BUT IF USED JUDICIOUSLY WITH MULTIDISCIPLINARY BUY-IN, WITH DATA TO SUPPORT, THEY CAN BE EXTREMELY POWERFUL. -VINAY VAIDYA, M.D.
Vaidya encourages fellow clinical informatics leaders to do thorough brainstorming before embarking on a patient safety initiative like this one and display to participants and stakeholders that due diligence has been done in the planning phase. Basfield recommends allowing time for creativity-like when her team came up with the reference table approach-and nurture an open atmosphere with no restrictions on innovative ideas.
Healthcare Informatics 2011 August;28(8):43-51
