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Moving Forward on Medication Administration Safety at Billings Clinic

April 26, 2014
by Mark Hagland
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At the Billings Clinic, interoperability is improving patient safety

The Billings Clinic, a pioneering integrated health system based in Billings, Montana, encompasses a multispecialty physician group with 275 physicians and 80 mid-level health professionals, and a 272-bed hospital, and encompasses a total of 3,500 employees. The organization, the largest patient care organization in Montana, has long been a pioneer in care management and other innovations.

Leaders at Billings Clinic continue to innovate along numerous dimensions. Among them is an ongoing initiative to improve medication administration. Jacob Thiesse, PharmD, a clinical pharmacist who also carries the title of informatics pharmacist, has been helping to lead that initiative in the organization. Indeed, Thiesse delivered a presentation in Orlando, Fla., in February during HIMSS14, the annual conference of the Chicago-based Healthcare Information and Management Systems Society. In that presentation, he spoke about ongoing integration and interoperability work encompassing the Cerner Millennium electronic health record (EHR), with PharmNet (an integrated EHR with pharmacy suite), as and the Omnicell ACD system, from the Mountainview, Calif.-based Omnicell. Thiesse met with HCI Editor-in-Chief Mark Hagland at HIMSS14 and spoke with him again shortly afterwards in greater detail regarding his organization’s initiative in this area. Below are excerpts from that interview.

Could you explain a bit of the background regarding the current initiative to improve patient safety through IT interoperability?

Certainly. We had already moved some way along our journey before the recent enhancements. We had already been live for some time with Omnicell medication-dispensing cabinets. But even though the Omnicell cabinets were indicating to users when medications were removed, there were still some problems, so we approached Omnicell about it. We traced the source of the problem back to the context of the eMAR [electronic medication administration record]. The problem was that everything that’s on the eMAR was missing at the time when the meds were taken. There was an interface, and it sends patient ADT and ordering information; but it didn’t know when a patient had gotten a particular med, when a nurse dispensed it. There’s a readout on the cabinet that says, this is the particular order, and the last time it was pulled was at this time. But there’s no more context than that; it could have been pulled from different cabinets or from the pharmacy. And so even though it’s helpful to have that on the cabinet, it’s not as good as having that information in the eMAR.

Jacob Thiesse, PharmD

When a nurse dispenses, the nurse keys in the information?

Let me walk you through it. Before, typically what would happen is that the nurse would somehow know it was time for a patient to get a medication. Usually, the nurse is at the bedside and the patient is complaining of pain, or perhaps the nurse is just at the nurses’ station and knows it’s time to check vital signs, etc. So the nurse would head to the Omnicell cabinet, and it would have a list of active orders there. So everything was available that the patient could receive at any particular time; but it doesn’t have a list of things that are appropriate to receive at that particular moment. So the nurse would select from the cabinet the items they remembered they were supposed to give, or had written down to give at that time. And anything not in the Omnicell cabinet, they’d grab from a different bin. And at the bedside, they’d scan the patient’s wristband and the med, and then would type that dispensing into the eMAR; we’ve had an eMAR for six or seven years.

So essentially, the nurse would have to scan the medication and click the scan button, and then it would enter it into the eMAR. So there’s that. That was our only fail-safe for making sure a patient was getting the right meds and it wasn’t a duplicate and that someone hadn’t come by before and done so. So we were pretty much reliant on the bedside barcoding and scanning system.

So to contrast that with what we’ve got now, we’ve recently implemented mPage, Cerner’s latest way to display data that’s interactive. It runs on HTML and Java, so it’s a familiar interface. This was put together to support interoperability between Omnicell and Cerner. So what it does is that it displays each of the items scheduled for the patient to receive at one particular time; and it also displays “PRN meds,” or as-needed meds.

So information is being populated directly into the eMAR from the EHR?