Making a medication error is one thing. Willingness to talk about it is quite another. But with study after study pointing to the need to change healthcare processes in order to improve patient safety, people are doing just that and the results are beginning to show.
"What we're seeing right now is a real drive towards improving processes," says Ed Albrough, system sales director at Omnicell Inc., a provider of systems targeting patient safety headquartered in Mountain View, Calif.
According to Albrough, national interest in medication management is growing as healthcare professionals ask, "Where can we generate a safer experience for the patient?" The notion is that simplification and standardization of processes can reduce the likelihood of medication error, and one of the first steps is acknowledging the problem in the first place.
As Medication Errors: The Human Factor, a January 2008 article in the Canadian Medical Association Journal, states: "The immutable reality is that humans make mistakes. Patients will be safer when we accept this reality and design clinical tasks accordingly."
Guelph General Hospital, an acute care facility serving 180,000 people in and around Guelph, Ont., met that challenge head on. Last May, the hospital completed its implementation of Omnicell's Point-of-Use Medication System as a way to reduce medication errors and increase efficiency. Rather than relying on anecdotal evidence, the hospital took the bold step of conducting a comparative analysis in order to put some hard numbers behind the perceived benefits.
"We went into the system with the thought in mind of measuring it both pre- and post-implementation," says Jane Martin, director of pharmacy at Guelph General. "When we did a literature review, there always seemed to be a decrease (in medication error), but I was very impressed to see our own results."
Relying on an independent third-party consultant, Guelph General took measurements over a three-month period prior to implementing Omnicell and again over a three-month period six months after installation was completed. Among the findings were: a decrease in medication incidents (including near misses) from 90 to 66; a reduction in the number of missing and out-of stock medications from 17 and 22 per day respectively to 2.5 and 3.25 per day; and, a shorter turnaround time – the time elapsed between an order written and the medication becoming available – from nearly 4.5 hours to just 42 minutes.
Prior to implementing Omnicell, Guelph was using a traditional Mosaic drug distribution system. According to Martin, it was a labour intensive process that involved obtaining orders, processing them, dispensing medications into individual patient vials and sending them out to nursing stations either by pneumatic tube or delivery by a pharmacy technician. When patient orders changed or were discontinued, the whole process would need to be repeated.
Now, medications are maintained in 35 Omnicell dispensing units located at 23 different stations throughout the hospital. Using a personal identification number (PIN), nurses access pharmacy-approved orders via a touchscreen computer, and the medication system then "walks" them through picking the right medications using a guiding light to help them quickly navigate the various drawers in the cabinet. Pharmacy orders and inventory are automatically managed through an interface to the hospital's Meditech information system and PACMED packager from McKesson Corp.
The Omnicell cabinets are replenished by pharmacy technicians, and many of the drugs are automatically picked and packaged by PACMED, reducing the need for excessive handling, says Martin. For high risk drugs – sound-a-like medications that are easily confused – Guelph uses SafetyStock™, an Omnicell product that uses barcode scanning as a secondary check to prevent errors.
For nurses, the time savings are huge. Rather than running to four or five different drug locations and making calls to pharmacy, they now have 95 to 98 percent of the medications they require in one spot. If a particular drug isn't available, they use an Omnicell feature called Omni-Explorer to locate it in another dispensing unit that has it in stock. In fact, calls to the pharmacy have decreased from 71 to 16.5 per day, says Martin.
The combination of efficiency-increases and patient-safety gains serves as confirmation that simplification and standardization of processes works, notes Albrough. "You expect to see time savings and reduction but when you actually measure it and see what the reductions were and what their savings were, it wasn't necessarily shocking, but surprising," he says. "It certainly justifies their model switch."
By Dianne Daniel
Reprinted from Canadian Healthcare Technology, April 2008 issue
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