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Improving Medication Safety: Update on the HHS Medication Management System Project
Helena Trabulsi, Director of Pharmacy HHS Management Meeting November 11, 2011
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Why Should We Care About This?
Incidents involving medications are the second largest category reported at HHS Increasing use and complexity of drug therapies HHS Drug inventory = 2,500+ products A significant proportion of nursing time is spent on medications Current system is many years ‘out of date’ inefficient, and frustrating for staff 2
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Current State Limitations
Loose tablets, crowded drawers Packaging ‘look alikes’ Similar drug names ‘sound alike’ Missing information Legibility of handwriting Manual processes & checks Environmental factors Manual processes Legibility of handwriting Packaging ‘look alike’ Similar drug names ‘sound alike’ Missing information Environmental factors Incidents involving medications are the second largest category reported at HHS Current system is many years ‘out of date’ Patients during a hospital stay can receive many doses of many drugs/day HHS Drug inventory = 2,500 products A significant proportion of nursing time is spent on medications 3
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New Medication Management System Benefits
Enhanced patient safety Accuracy of medication system Efficiency of drug distribution system Tracking of drug utilization & costs Improved customer service Increased job satisfaction
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Vision for Future – Fully Automated Medication Management Process
Prescribing/ Ordering Preparation Distribution Unit-dose bar-coded medications ordered from distributor or bulk meds packaged. Pre-mixed IV solutions purchased and prepared. Medication placed in Automated Dispensing Units (ADU) on patient care unit. Pharmacy-based therapeutic checking & order verification Medication Orders update the eMAR CPOE Medication Ordered NEJM 2010 Brigham & Women’s Hospital, Boston. 41% reduction in errors in transcription and administration Administration Closing the Loop Using mobile cart and bedside computing, nurse leverages barcode to verify & administer medication Nurse validates Orders from eMAR & collects patient’s medications from ADU eMAR is updated & CQI reporting is performed and acted upon 5
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“Unit Dose” Packaging with Bar Code
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High Speed Unit Dose Packager (“ATP”) Installed at Oakville Pharmacy Nov. 1, 2011
Output = tablet or capsule packaged as a unit dose with a bar code
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High Speed Unit Dose Packager Team
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March 2012: “BoxPicker” High Density Drug Storage
Retrieval of Other Forms of Bar Coded Meds Interface to Omnicell ADUs
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Inside the BoxPicker: Robotic Arm and Containers Filled with Meds
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November 2011 to Early 2013 55 ADU Locations across 3 Sites:
Emergency/Outpatient Dept Surgical Day Care OR/Post-Anaesthetic Care Area Obstetrics Medical/Surgical Units Complex Continuing Care & Rehab ICU/COU Hemodialysis GH (Dec to Feb. 2012) Then OTMH then MDH 12
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Benefits of ADUs Improved Safety Improved Efficiency
Guides nurse to the drugs that are ordered for the patient ‘Look-alike’ & ‘sound-alike’ stored apart Bar Code scan on Pharmacy restock Improved Efficiency Quicker access to drugs At point of use After Pharmacy closed Improves narcotic management Decreases narcotic counts Decreases narcotic discrepancies More time to spend with patients Increased job satisfaction
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Unique Features of ADUs from
Multiple towers or “cells” linked together Access by Biometric I.D. (fingerprint scan) Anywhere RN, Singlepointe, Omniexplorer 14
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Unique Features of ADUs from
Drawers with lights to guide user to specific compartment/bin Drop-down “dispensers” Lidded Sensing Bins, Locked Bins Fridge Locks 15
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November 2011 to Early 2013 Med Carts Replace Aging Med Refrigerators
1 per 6 to 9 inpatient beds Transport meds from ADU to bedside Investigate alternative solutions Replace Aging Med Refrigerators 16
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2013-14 Electronic Medication Administration Record (eMAR)
Computers & Bar Code Scanners on Med Carts Scan patient wristband, drug, nurse ID 17
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Project Leadership Project Sponsor Sylvia Rodgers – Chief Nursing Officer & Professional Practice Leader Functional Department Lead Helena Trabulsi – Director Pharmacy Project Manager Diane Olmstead, PMP Advisory Group Medication Safety Committee Reporting Structure To the Chief Nursing Officer and To the Medication Management Steering Committee Quarterly (or more often) updates to the HHS Board and Senior Management
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Team & Advisory Members
Nursing: Angela Roode - PPC, Safe Med Practices Nursing Super Users – TBD Patient Care Managers – As each site/unit rolled out Pharmacy: Nicky Hillebrand, Katrina Stasik, Grace White - Managers Marie Descent, Boris Curcic, Janice Mack – Pharmacy Analysts Pharmacy Technician & Assistant Super Users Clinical Informatics: Elaine Hooper – Manager of Clinical Informatics Veronica Breadner – Clinical Analyst Vendor Project Managers: Omnicell – Dave Burleson, Maggie Wagner Swisslog – Tony Schrader, Cindy Doig (Consultant) Redevelopment – Jim Agnew Medication Management Experts (Consultants)– TBD IT Network and Technical Resource – as req’d
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Safety Expo
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Implementation Steps Workflow Redesign Standard Operating Procedures
Renovations Connectivity, Interfaces Installation Training – eLearning modules plus Live session Conversion/ Go-Live!
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Introducing Technologies for Safe Medication Practices…..
……Safer Patient Care! 22 22
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Handling Instructions for “Samples”
Open package from Left (sealed side) Separate along perforation at right (folded side)
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