March 19, 2007

Scranton Hospital Steps Up to Bar Coding
By Laura Gater
For The Record
Vol. 19 No. 6 P. 6

Community Medical Center (CMC) in Scranton, Pa., took advantage of an opportunity to improve its medication management by obtaining a grant from Blue Cross of Northeastern Pennsylvania. The grant enabled CMC to apply new technological solutions to advance patient safety.

“We were trying to apply safety rules according to our information technology strategic plan, which put the goals of our institution in alignment with Joint Commission on Accreditation of Healthcare Organizations’ National Safety Board [NSB],” explains Joe Fisne, CMC’s vice president of information systems and chief information officer.

Once CMC had applied for and received a grant of nearly $300,000, it moved ahead with its plan to improve patient safety. The hospital chose MediWare Information Systems’ MediMAR software to handle its medication administration and documentation processes. MediMAR improves patient safety by allowing nurses to use bar code-driven tools to ensure that each patient receives the correct medication and dose at the right time.

CMC expected to utilize IT that would enhance or reduce any form of medication error, according to Fisne, including poor handwriting and transposed letters; technology would reduce the chance of error due to these causes. Meanwhile, barcode scanning was expected to eliminate a host of transcription errors and MediMAR was expected to help CMC identify and analyze medication errors, correcting them prior to the error occurring.

Fisne explains that the hospital had implemented bar coding on wristbands to improve patient identification, and the next logical step was for the pharmacy to improve the safety of medication administration by using bar coding as well.

“We felt bar coding was the way to improve the safety of medication administration,” he says. “The use of bar codes would help us align our patient safety goals and meet NSB requirements.”

Today, medication orders written by CMC physicians are scanned in by the pharmacy, verified electronically by nurses via e-mail, then bar coded. A wireless infrastructure was installed throughout the facility prior to the installation of MediMAR and mobile technology.

Mobile technology is an important aspect of CMC’s medication management process. Nurses utilize a cart with a hand scanner (or a wand) and software that is connected to the pharmacy. The computers on wheels (COWs) are rolled between patient rooms by nurses who use the wand to scan each patient’s ID bracelet and medicine. If the two do not match, an alert appears. Medication is taken to the bedside in a locked drawer on each COW cart.

The wireless infrastructure is beneficial not only to the pharmacy and the inpatient unit but also to other areas of the hospital. It enables radio frequency identification (RFID) software to track patients as they flow through the operating room.

The realized return on CMC’s and Blue Cross’ investment can be measured most effectively by how MediMAR enhances patient care rather than financial gain. “This type of return is assurance that we are doing the right thing by reducing potential for errors. It’s not a monetary return,” says Fisne.

In addition, nurses have more time to spend with patients, and MediMAR has improved communications between nurses and pharmacy staff, who now better appreciate each other’s function, says Joe Zarcone, RPh, CMC’s director of pharmacy. However, patients benefit the most from error identification and improved medication safety.

“The realized return actually took us further than we expected by opening up communications between nurses and pharmacy, and most importantly, reducing medication errors,” says Zarcone.

Even patients are happy to see the COW, says Zarcone. They know the technology is helping them receive better care and improving their safety.

Jeanie Bantell, CMC’s MediMAR project manager, acknowledges that the medication management project initially consumed more of the nurses’ time while they familiarized themselves with the COWs and the MediMAR software. Ultimately, MediMAR proved to be time-neutral by eliminating the need for charting administered medications and improving nurses’ efficiency.

Selecting and purchasing the MediMAR software as well as the COWs, along with installing a wireless infrastructure throughout the facility and introducing the process to nurses and pharmacy, took approximately one year. The system was operational in six months, and benefits were realized immediately.

Many medication administration software packages are separate entities and have to be built separately; however, MediMAR is integrated with WORX, the software already in use at the CMC pharmacy. WORX is used for order processing, inventory, label generation, and total pharmacy management. Unlike other software packages, MediWare Information Systems does not have to interface the two software programs and build dosage routes and frequencies, information that nurses would need when administering medications. The pharmacy and nursing staff share the same data. “Maps,” or workflow prompts, were created to ensure that the right medication and dosage were given to the right patient at the right time.

Patient allergies are stored on the electronic record, and if a patient is allergic to a medication he or she is about to receive, an alert will appear. Medications with restrictions are also handled according to a procedure that has been “mapped” in the software. For example, the COW will ask whether a patient’s blood pressure has been taken and note the reading before approving medication dispensation, or whether a patient’s blood sugar level has been checked prior to giving insulin.

William Oliver, senior project manager of the Medication Management Division at MediWare, notes that the entire implementation process at CMC was one of the easiest he has performed. Everything went fairly smoothly despite the culture change in nursing from paper to electronics.

Nurses cannot change a prescription when an alert appears; instead, they must call the pharmacy to clarify the order. In some cases, the physician must be contacted. The new electronic communication now enables nurses and pharmacy staff to text message each other regarding prescriptions when a matter is urgent. The pharmacy can also see what is dispensed from its shelves compared with what is administered on the floor, helping it to better track medications.

MediMAR has enabled CMC to go from a single-dimension workflow to a multidimension workflow, according to Oliver. “There are more checks in the workflow now. The nurses’ workflow is now fully integrated with the pharmacy,” he explains. “The biggest workflow change for the nurses was getting used to the electronic record used with the COWs.”

CMC learned that software was only part of the solution. Operating procedures between nursing and pharmacy had to be correlated, and the workflow was changed as well through the implementation of the new technology.

— Laura Gater’s medical and business trade articles have been published in Healthcare Traveler, Radiology Today, Corrections Forum, Credit Union BUSINESS, and other national and online publications.