At the 180-bed Spaulding Hospital in Cambridge, Mass., a member of the Boston-based Partners Healthcare, Joe Sacco, R.Ph., the hospital’s director of pharmacy, has been helping to lead his colleagues forward on a multi-phase journey toward automation and improved patient safety and care quality.
The work that the clinician leaders at Spaulding Hospital have been leading has been strongly motivated by the recent changes in medication management standards coming out of the Joint Commission. In July 2010, the Joint Commission issued more rigorous standards on the management—including the labeling—of multi-dose medications, including certain types of injectibles. Because of a mandate requiring all stored medications to be labeled with an expiration date, many hospitals have ended up adopting ad hoc processes involving nurses hand-writing expiration dates on labels, ironically leading to new medication administration errors and other issues, including problems around handwriting illegibility and incompleteness of information.
Over the past several years, Spaulding Hospital’s clinician leaders have experimented with different strategies in this area, ultimately moving from a hybrid to a fully decentralized medication distribution model that allows nursing staff to print individual, patient-specific labels for medications accessed and removed from automated medication cabinets on patient care floors. Sacco and his colleagues have been working with solutions from the Mountain View, Calif.-based Omnicell. Sacco spoke recently with HCI Editor-in-Chief Mark Hagland regarding his team’s work in this area. Below are excerpts from that interview.
What led you to move forward on this initiative?
We had already had automation here since I came in. We had had Omnicell since 2002, and had expanded it in 2003. And a year ago, we embarked on expanding our use of the Omnicell product in the Windows 7 environment, including with new equipment and products. We expanded the number of medication cabinets we were using, so that we could provide an adequate number of stations for the nurses. We purchased AnywhereRN™, the company’s remote medication management solution, as well as the SinglePointe™ patient medication management system [together, the two solutions provide nurses with automated access and management of medications].
The reality, though, is that you can only get about 80 percent of your medications in a cabinet. It’s the remaining medications, including multi-dose inhalers, bulk liquids, and so forth, where the problems come in. SinglePointe allows you to create a bin for medications within the Omnicell cabinet, assign a patient to it, assign multiple medications to it, and make it a part of your regular restock system; while AnywhereRN allows nurses to remotely access medications from their cart or nurses’ station, and build their lists of meds they’re going to issue. It’s a good time-saver, because it prepares the cabinets to open.
So we started to get this equipment in, and one of the things I was concerned about was, we wanted to expand the number of medications the nurses could have on the floors in the cabinets. But some of that involved things like single-use antibiotics, and multi-dose inhalers. In the past, some of those medications would come out of the pharmacy IV room, and we [pharmacists] would label them. But the recently revised Joint Commission regulations on proper labeling, which require complete labeling, including the patient name, the room number, and the drug and dose, to be on the label, created a problem with certain medications.
Joe Sacco, R.Ph.
Do you have barcoded medication administration?
We’ve just rolled that out, but even with such a system, you still have to make sure you’ve hung an IV on the right patient, for example. And at the time when we started this, we were still a year away from barcoding. The challenge is that anything that isn’t a single unit of use like a tablet—anything that’s an IV or an ointment or a multi-use inhaler, has to have a label on it, as spelled out by the Joint Commission standards.
So what did you do?
I spoke to the director of nursing and said, we want to have these meds available as soon as possible to the nurses. But how are we going to put a label on that product? We could produce labels and have nurses hand-write on them, but that’s not a perfect system. But one of the things I noticed was, I happened to open the new cabinets one day, and noted that there’s a spot for the receipt printer, and noticed this other spot marked for a label printer, and I asked Omnicell about this, and they told me it was a future enhancement. And I said, if there’s a beta test on this, we’d love to be involved.
So that the nurse could print the label upon removing the medication from the cabinet?