How Kaiser Permanente tied its EHR, CPOE and bar code tools together to cut medication errors
Medication errors have dropped and the number of nurses using bar code medication administration systems and physicians using computerized order entry systems has soared at Kaiser Permanente, which implemented a barcode system for medication management and an electronic health record system with built-in CPOE to accomplish these goals.
Achieving these goals also helped the health system meet medication error reduction standards promulgated by The Leapfrog Group.
Kaiser’s assistant medical director of quality and clinical analysis Benjamin Broder, MD, explained that minimizing medical errors and improving the safety of ordering and administering medications takes people-centered techniques and cultural adjustments on top of requisite technologies.
“The order entry was part of our deployment of the EHR,” Broder said. “The BCMA was planned and implemented as part of our strategy for medication safety.”
In the summer of 2008 when the bar code management system was launched, the compliance rate for caregivers scanning the medication and the patient wristband was at 80 percent. Today, that rate is at 98.5 percent, Kaiser Permanente Southern California said. To put the numbers in context, in April 2017, there were 1,695,172 drug administrations.
Broder added that Kaiser’s IT and operational teams understood well the importance and elements of a good medication safety system, and that the organization believed if it did the right things it certainly would meet the standards set forth by various organizations, including The Leapfrog Group.
“Medication errors have dropped after our implementation of the EHR and the BCMA,” he said. “Both of those technologies provide multiple opportunities for guardrails to encourage correct and safe behaviors and discourage unsafe behaviors. That includes things like alerting physicians to medication allergies or that an ordered dose seems suspiciously high or low. And at the point of medication administration, alerts to potential wrong patients or wrong doses.”
On achieving more than 95 percent in the scanning of both patient and medication barcodes, Broder said there are three components to Kaiser’s success.
“One is the personnel have to believe it’s important,” he explained. “We educate our nurses, and it was not difficult to show this was a technology that would improve patient safety. Two is making the technology easy to use, like having a bar code scanner on every mobile cart with a computer that is in or right outside the room for each patient. And three is transparency of data. We provided reporting down to the unit level of how components with the BCMA are doing. In Southern California, less than 2 percent of medication administration does not use BCMA, for example.”
Data transparency allows operational leaders to focus on areas and processes where medication administration via bar code can be more difficult, such as mental health, he added, an area of focus where Kaiser has been able to improve over time.
“There is a people process of educating doctors about the change, and making it clear in the hospital that if there is any resistance by physicians to entering their own orders then the nurses are expected to put the patient first and if needed escalate things to physician leadership,” Broder explained. “That process ended up not being required as it was a pretty painless process to get physicians to enter their orders. Computerized order entry is a fairly seamless process.”
Computers are ubiquitous in the hospital setting, of course, so there’s rarely an instance where a physician does not have a computer to use, he added.
“And again, data transparency – we publish in an open manner across the system how physicians are doing on these metrics,” Broder said. “And we far exceeded the metrics. We’re on the order of 95 percent physician order entry today.”