Moving Ahead to Optimize Medication Administration Safety in South Alabama

Which solutions are involved?

There are a couple of different solutions involved. One is a label printer that’s directly on the Omnicell machine. So on those products that the nurse is getting out of the Omnicell, that she has to manipulate in order for the patient to take it, the Omnicell machine will generate a label that’s an exact duplicate of the barcode on the original package. So she has something that’s scan-able, to take to the patient’s room. In the past, if the nurse had to open the package and manipulate it, she had to do her best not to rip the package, and had to carry the empty package to the bedside. Because we require the nurses to do the manipulation or preparation in the meds room, not at the bedside, in order to avoid distraction. So with the label generated by the Omnicell, it will put a brand-new barcode on her new label so that when she goes to the patient’s room, she can scan the actual drug she’s just prepared.

What are a couple of typical patient care situations in which that happens?

One would be where a medication needs to be added to a bottle of formula, or breast milk, or applesauce, or juice. Another would be that the patient can’t swallow a tablet, but the medication only comes in tablet form, and there’s no stability data involved, so the nurse is having to crush the tablet or put it into a solution, because there’s no stability data to help me prepare it in advance. The label printer element is going live with our new Omnicell solution. What’s important to note is that, often, you have situations where the nurse hasn’t completely filled out all the information that might be required by the Joint Commission. And a lot of times, nurses will try to create workarounds to save time, such as taping labels to new packages, but those aren’t optimally safe solutions. This will save time and be much safer.

What do you hope overall will happen in the next year or so, once you’ve gone live?

There are a couple of things that we track that we’re hoping this will improve. One will be, we will be able to track through our bedside barcode scanning software the number times a nurse tries to scan something and the machine doesn’t read it and she overrides it.

When does something like that happen?

Typically, a couple of things might happen. One might be that the nurse has destroyed the barcode when she administers the med. Now, I’m hoping those overrides diminish, because of the availability of a new barcode. Or, the nurse might scan something, and it’s not on that patient’s profile. If there are several different sizes of something and she’s having to prepare a different dose, and that doesn’t match the patient’s profile, the dose could be made from different original dosages; and my system will be looking for a specific drug. Often, a nurse has to create a new dose through mixing two different originals. So I’m hoping that proper labeling from the machine will decrease the number of times that the machine creates an error of logic.

What should CIOs and other healthcare IT leaders understand about this topic?

I think there are a couple of things that are very important for clinicians and IT folks to understand. And one is that computerizing something doesn’t automatically make something safer: garbage in, garbage out. So for example, if a patient’s weight was inaccurately entered into the computer, you could now have an inaccurate weight in the computer. So you really have to look at processes, and is a certain person or process the correct one to enter data into the system? So you have to look at who’s going to enter information, and is a process accurate? I know that we could potentially generate reports hundreds of pages long, and trying to filter through a report that big to figure out the real problems, can just eat up time.

So, keeping reports simple and short is very important. The IT people really have to help the clinician understand, what am I looking at, and why is that important? What does this override number mean? Why am I generating so many overrides? It could be that 90 percent of a clinician’s overrides are totally appropriate, but 10 percent aren’t. And if you can give me a three or four page report that’s meaningful, that’s great. But if you generate a 100-page report, clinicians won’t have time for that. So provide information, not just data. And a lot of times, IT people don’t really know what is important in terms of the data, and what in the data clinicians are looking for. And that’s where having clinical informaticists helps. We have a pharmacist who’s dedicated full-time to IT. And we’re in the process of interviewing for a second person.

Many even large hospitals don’t have a full-time pharmacist informaticist yet.

That’s correct. But we’ve got a lot of information systems here—an EMR; and we just went live with CPOE in July, and we’ve got the bedside medication administration solution, and we’re going live with the Omnicell solution soon and are still on the Pyxis solution. So we’ve just got way too many information systems not to have this support. And a pharmacist informaticist can put things into a language that pharmacists can understand, and into a language that IT people can understand. And it’s very important to have a culture of verification of things; just being automated alone isn’t enough.