Further Implementations
Since this system was implemented pharmacists have reported they feel more secure that schedules are appropriately set up, and they enjoy the efficiency of automated scheduling based on the rules of the link. Nurses have expressed the added sense of security in knowing that important medications, such as pre-hydration, won’t be forgotten and that alerts will appear if an attempt is made to administer chemotherapy out of sequence.
Initially, this system was implemented on the BWH clinical services that order chemotherapy: oncology, gynecology, bone marrow transplant, and rheumatology. Since last year when the project was submitted to Healthcare Informatics Innovator Awards Program, few changes have been needed for operation, other than tweaking some business rules—like being able to break a link for individual treatment plans—in the system. Physicians haven’t had to ask for additional link types.
The linking tool was designed to be scalable, so it can be used on other adult clinical services at BWH and at other Partners sites. “It’s really not so much a technical issue to open it up the entire Brigham and Women's inpatient population,” says Rogala. “It’s more of our ability to support it and that’s why we haven’t done it yet.” Massachusetts General Hospital has secured funding for fiscal year 2012 to employ the linking system for chemotherapy related medication orders.
The biggest challenge the BWH team faced was to create an effective tool, without over-engineering it. “We could still be analyzing it now, and we could have come up with 10 different links, so really trying to keep the scope to the must-haves and where the risks were to patients,” says Rogala.
One of the elements that led to the success of the project, Rogala says, was having clinical champions working alongside IT leadership. “Having the clinician and IT working hand and hand was really the key to success, and we didn’t create a system that created a new process, we created a system that mimicked the already existing process,” she adds. “One of the benefits we had was we already automated our closed-loop, so this was something we could build on top of. We tend to do things slowly and add value and safety.”
