How one Davies winner used closed loop eMM to take aim at adverse events
The goal is a simple one, but an elusive one, as hospitals all over the world well understand: "Ensure the right drug and dose is given to the right patient by the correct route," said Joanne Hayden, clinical informatics pharmacist at St. Stephen's Hospital.
So, in a bid to improve its medication administration processes and better ensure patient safety, St. Stephens, based in Hervey Bay, Queensland, turned to health information technology, Hayden explained in a recent HIMSS20 Digital presentation.
Specifically, the hospital – which won a HIMSS Davies Award this past October and is also one of the first two HIMSS Analytics Stage 7 validated hospitals in Australia – set its sights on closed-loop electronic medication management technology and processes.
The goal was to decrease variance in the medication process across the hospital, and improve workflows for its staff along the way, said Hayden. By also broadening its use of computerized physician order-entry and bar code-medication administration, St. Stephen’s has enabled a "significant" decrease in adverse drug events and medication omissions.
St. Stephen's, a Cerner client, started by targeting some specific areas for improvement: adverse drug events, medication omissions, high-alert medication errors, transcription errors, duplication of therapy and more.
Closed-loop eMM, CPOE – and, especially, the hard work of ensuring staff buy-in – were key to helping the hospital achieve improvements across all of these goals.
The new process allowed for the creation of "in-house custom reports to show ward, patient and medication scanning rates for individual clinicians," said Hayden. This enabled "detailed oversight" of the staff to ensure clinicians were taking the new processes to heart.
While the Hawthorne effect – "people will perform better when someone is watching them" – was observed, she said, administrators were also able to gain visibility over time into various staffers' meds administration processes and were able to identify reasons for workarounds and scan errors.
It also engaged with techniques such as encouraging friendly competition and positive reinforcement to help boost adherence across the staff, but Hayden noted the value of individualized data, which "helps us target training and support those who need it."
Just as important, deployment of the closed-loop system helped "encourage real-time reporting of scanning failures, which allowed the ehealth team to be agile in investigating problems and implementing changes" where required.
"Moving from the paper environment to the digital environment enabled St. Stephen's to reduce the variance in their medication process," she said. "With an increase in CPOE adoption and the use of BCMA, St. Stephens has realized significant decreases in adverse drug events and medication omissions."
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