Safety Series: Patient Safety

Filling the communication gap

Today’s computerized hospitals have access to some of the best tools for preventing medication errors. Hospital information systems are key to safer hospital settings. More and more providers are purchasing hospital information systems to facilitate better communication throughout the facility or integrated delivery network (IDN) for safer patient care. The question many group purchasing organizations (GPOs) and IDNs face, however, is where to begin.

“One of the greatest obstacles for hospitals is prioritizing the technologies available to us,” says Ray Maddox, director of clinical pharmacy, research and pulmonary medicine at Savannah, Ga.-based St. Joseph’s/Candler Health System. The IDN has worked closely with Cardinal Health Inc. in Dublin, Ohio, and two Cardinal companies, Alaris Medical Systems and Pyxis Products, both in San Diego, to implement several information systems over the last three years.

“The three biggest technologies we hear about are bedside barcode scanning, computerized physician order entry (CPOE) and smart pump/infusion technology,” says Maddox. Because few facilities can afford to implement all of these systems at once, consideration must be given as to which one can provide the greatest gains at the least cost. For St. Joseph’s/Candler, the starting point was to add pumps and infusion technology by Alaris, followed by Pyxis and Cardinal bedside barcode systems. As the implementation of barcode solutions nears completion, the IDN looks ahead to installing CPOE by 2007.

St. Joseph’s/Candler is confident that its new information systems are already helping to reduce the risk of medication errors. Alaris Smart Infusion technology, for instance, ensures that bedside nurses program IV pumps correctly.

“IV errors have the greatest potential for harm,” says Maddox. “This system has statistically reduced medication errors in our hospital system.”

“The Pyxis PARx barcode system running in pharmacy ensures that the correct product is removed from the shelf to refill the hospital’s Pyxis medication dispenser,” Maddox says.

Communication breakdown
“A breakdown in communication is the most frequent factor leading to adverse events in hospitals,” says Richard Croteau, M.D., executive director for strategic initiatives at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

A classic example is the lack of patient-specific clinical data available to doctors when they prescribe medications, adds Jim Hethcox, VP of corporate clinical affairs at Cardinal Health. “At the point of prescribing, the physician often has no lab values available and, sometimes, he or she must rely on memory when recalling certain medications,” he says. Sometimes, errors occur when different drug names sound alike. Drugs have difficult names, which largely accounts for difficulty interpreting handwritten orders or other miscommunications.

“Hospital information systems and electronic medical records are a big step toward reducing errors,” says Hethcox, who believes the greatest strength of these systems lies in barcode verification and CPOE. The Food and Drug Administration has stated that all manufacturers must have barcodes on packages by April 26, 2006.

“An information system must consider the whole hospital process,” says Hethcox. He says that for this reason, IDNs should contract for all-encompassing information systems, such as Cardinal’s SafetySource system. “SafetySource supports CPOE at the prescribing stages and offers greater transcribing accuracy.” This is critical when pharmacists are off-duty or otherwise not involved in the process. Cardinal also offers automated medication dispensers with built-in checks and balances, barcode verification systems and automated smart pumps.

“There is a strong push for evidence-based medicine, and electronic information systems can help,” says Hethcox.

Surgery information systems
Opinions vary as to which department a hospital should automate first. But if a hospital information system overlooks surgery, it may very well miss the point of the total management solution, according to Martin McKenna, general manager of perioperative technology for GE Healthcare in Milwaukee. “The surgery information system has become the total information picture,” he says. It provides the groundwork for managing a hospital or ambulatory care center.

The surgery information system should help accomplish several goals, including increasing efficiency, reducing costs and enhancing patient safety. To boost efficiency and better ensure patient safety, McKenna says surgery information systems should meet the following criteria:

  • Create an electronic patient record
  • Improve charge and cost capture
  • Provide better workflow management
  • Provide centralized scheduling.

“A big focus should be inpatient-outpatient convergence,” says McKenna. The surgery information system must ensure that the information a patient offers his doctor is available to other doctors and staff involved in the patient’s care. When more information is provided upfront, patient safety is better maintained, and scheduling and management become more efficient.

Integrate vs. interface
Operating room managers and vendors still debate the wisdom of implementing a single, integrated perioperative information solution vs. interfacing various components from different vendors’ systems. Integrated data provides a comprehensive, interactive picture, whereas interfaced data is a compilation of static or separate pieces of information. There is a definite distinction between integrated and interfaced solutions, according to experts.

McKenna says GE Healthcare started out offering a modular system but has since begun integrating certain databases in order to accommodate the changing needs of surgery centers. “Some standards, such as scheduling, are easily interfaced through an HL7,” he says. “However, others require integration.” For instance, when a user is dealing with data on medications or allergies, or other information that must be passed through the system, integration permits him to view all data simultaneously. This could be a huge factor in promoting patient safety.

“The key to a smooth running process is standardization and interoperability,” says Croteau. “The different systems within and between hospitals must be able to communicate with one another.” Systems must operate around the patient as he moves from one department or facility to the next. “It’s not enough for the system simply to support the caregiver,” he says.

Making the move
Although more medication errors are being reported today, Hethcox believes the true error rate has decreased. “In the past, medical error reporting has not been accurate,” he says. “Hospitals have driven error reporting underground to protect themselves.”

As healthcare transitions to a culture that emphasizes safety, and better technology becomes available to support this culture, more errors are being intercepted, according to Hethcox. “Safety is a continuous journey,” he says. “Everyone must be committed to it, from physicians and medical staff, to senior hospital executives.”

What might hold them back from hopping aboard the safety bandwagon and implementing a hospital information system? Limited finances are a big factor. But sometimes it is a matter of simply not knowing where to begin. “Do you start with CPOE or barcode scanning?” asks Hethcox. “Do you focus on one area in the hospital, while radiology and the lab become antiquated?”

Some IDNs prefer to wait until certain technologies are more mature and better standardized. Systems are expensive to implement, so hospitals do not want to move too fast, Croteau explains. Sometimes it makes sense to take a more conservative approach and wait until other hospitals have tried a particular system and can demonstrate what does and does not work.

Croteau says the Office of Health Information Infrastructure (part of the U.S. Department of Health and Human Services) will explore federal subsidizing of hospital information systems. What remains to be seen is whether the federal government considers safety important enough to subsidize a universal electronic health record.

Most experts agree that hospitals and IDNs are taking steps to provide a safer environment for patients. As safety continues to gain national attention, patients will continue to benefit.

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