Linking EHRs with medication cabinets for improved safety
Increasingly hospitals are recognizing the value of interoperability between electronic health records and automated dispensing cabinets, or ADCs. In addition to eliminating redundancies during the medication ordering process, linking them helps to reduce medication errors at the point-of-care.
Now nurses are able to easily interface with the complete medication management system within one application at the patient's bedside, said Nilesh Desai, director of pharmacy at HackensackUMC.
"With the addition of the interoperability piece, it is now embedded directly into Epic and as you open a patient's chart, automatically you can launch and schedule the medications and view if the medication has been delivered by pharmacy or not," said Desai.
With this interoperability, he said, that there's not a separate login and the nurse doesn't have to remember another password: It's connected to the EHR and it directly opens up to the patient's chart.
Normally when there is a medication that has to be delivered from the pharmacy, the nurse has to go back to the cabinet or look into the cabinet to see if pharmacy delivered it or not.
"If the medication is not delivered the medication is grayed out and the nurse will be unable to remove it," said Desai. "As soon as a pharmacy technician delivers a medication, it lights up. As a nurse, you don't have to go to the cabinet to find out if the medication has been delivered. A nurse can do it directly from a computer from anywhere in the nursing unit. It saves quite a few steps and time."
Shafiq Rab, MD, vice president and chief information officer at HackensackUMC, points out that there are other benefits of interoperability between EHRs and ADCs. One is that while the drug is being procured from the pharmacy system, it also checks for allergies, drug-to-drug interaction, and drug-to-food interaction.
Clinical inefficiencies raise red flag for hospitals
A benefit analysis extrapolated from a 2013 white paper prepared by Cerner, "The Clinical Benefits of CareAware Enhanced Dispensing," revealed that prior to interoperability between EHRs and ADCs, nurses at Penn State Milton Hershey Medical Center were spending on average of 8.5 minutes on a single patient's medication pass resulting in clinical inefficiencies within the medication administration and reconciliation process. Post-implementation they spend on average 5.8 minutes, a 32 percent improvement.
To address the inefficiencies due to disparate clinical information systems, Penn State Hershey partnered with CareAware, Cerner's device connectivity architecture that provides interoperability between CareFusion's Pyxis MedStation ADC and Cerner's Millennium EHR.
According to the white paper, CareAware "allows clinical information to be shared seamlessly between the two systems improving workflow and patient safety," while allowing the nurse to view the same information in both systems.
Flip Groves, vice president of business development in the Medication Management Solutions Group at CareFusion/Pyxis, said such interoperability extends not only to the EHRs, but also into the entire, end-to-end, medication-management process.
"Interoperability means connecting the automated dispensing cabinets into enterprise-wide pharmaceutical resource inventory management system, to IV prep check systems, to microbial surveillance systems, bringing together oversight and optimization of the end-to-end management of medication processes and resources," said Groves.
He added that interoperability also enhances patient safety and clinical workflow by eliminating opportunities to introduce errors, and by providing the users with the right information, through the right application, in the right place, at the right time.
Dan Pettus, vice president for IT in the Medication Management Solutions group at CareFusion/Pyxis, said that interoperability is significant not only for EHRs and ADCs but also for other devices including IV pumps and ventilators.
That capability, said Pettus, is the tie-in to all of the necessary connections that you need to make these applications from products interoperable.
"It's beneficial to our customers to have one-stop shopping when it comes to those technology platforms," said Pettus. "Less interfaces, less complexity, it reduces to maintain these things over time."
Point-of-care medication errors averted
Mark Neuenschwander says that for years he has tried to draw attention to the gap between the point-of-dispensing and the point of administering medications.
"It is possible for nurses to get the right medications for the right patients at dispensing cabinets and then to administer them to the wrong patients," said Neuenschwander, a Bellevue, Wash.-based consultant on bar code-enabled medication dispensing, preparation and administration.
Bar code medication administration, Neuenschwander says, has matured and become commonplace in today's hospitals to verify patients and medications to address this problem, but be noted that in addition to verification, a sound medication use process requires information.
"In addition to verifying that they have the correct medications for a particular patient, they also need to have access to information about medications both when they come from dispensing cabinets and when they are at the point-of-care."
Neuenschwander, cofounder of the unSUMMIT for Bedside Barcoding, asserted that nurses must document what is administered and that this must occur at the point of care, not at the point of dispensing.
"It is critical that what the nurse sees at any point is up to date. I am thrilled with the ongoing efforts and success in integration information with information systems, dispensing cabinets, and point of care technologies," he said.