Bar-Coding at the Bedside

Transcription

1 Bar-Coding at the Bedside Presented by: Diane W. Allen, RN, MS, CNOR Chief Nursing Officer & VP of Operations Concord Hospital Concord, New Hampshire

2 Our Results...

3 Medication Errors per 100 Adjusted Admissions % Reduction in Medication Errors '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02

4 Med Errors Compared to CMI CMI MedError

5 Med Errors Compared to RN Turnover Med Errors/100 Admits % RN Turnover

6 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% ISMP Survey Results December % 60% 56% 56%55% 55%54% 53%52% 50%49%49% 46% 46% 45% 42% 37% 34% MEMBER 17 MEMBER 21 MEMBER 15 MEMBER 2 MEMBER 6 MEMBER 16 MEMBER 18 MEMBER 4 MEMBER 9 MEMBER 14 MEMBER 10 MEMBER 11 MEMBER 12 MEMBER 19 MEMBER 5 MEMBER 3 MEMBER 8 MEMBER 1 MEMBER 7 MEMBER 13 MEMBER 20

7 ISMP Survey Results 2003 Compared to 2000

8 Concord Hospital - At a Glance (photo by Rixon Photography)

9 Concord Hospital - At a Glance 295 bed not-for-profit regional medical center Located in the capital city of Concord, NH 2nd busiest acute care hospital in New Hampshire Serving approximately 150,000 patients Regional referral center for: Orthopaedic Services Cardiac Services Women s Health Comprehensive Cancer Services

10 Clinical Technology Development & Medication Safety as Organizational Priorities 2001: One of 10 Most Improved HHN Most Wired Hospitals & Health Care Systems 2001: VIP Award for Clinical Achievement Awarded for reduction of medication errors McKesson Corporation 2002: One of 100 Most Wired HHN Most Wired Hospitals & Health Care Systems 2002: Cheers Award for Safe Medication Practice Institute for Safe Medication Practices 2003: One of 100 Most Wired Small & Rural HHN Most Wired Hospitals & Health Care Systems

11 Making Medication Administration Safe at Concord Hospital STAR Pharmacy System Decentralized Pharmacist Role Bar-Coding of Medications at Bedside Medication Administration Process PI VHA Collaborative ISMP Survey IHI Quantum Leaps in Patient Safety

12 MEDICATION ADMINISTRATION PROCESS Right Patient, Right Medication, Right Time, Right Dose, Right Route Purchasing & Inventory Unit Dose Prep MD Order 4 Pharmacy Order Entry 7 RN Prepares To Administer 5 6 Medication Preparation Medication Administered To Patient Medication Dispensed 8 9 Monitoring & Follow Up

13 Components of Medication Bar-Coding System Bar-Code Label affixed to all individual med doses Online Medication Administration Record as part of Clinical Documentation System Laptop computers with bar-code scanners - COWS Proxim 2mb/sec Wireless Network

14 Bar-Coding at the Bedside

15 Bar-Coding at the Bedside The Nurse Scans Bar-Code on ID badge to log on and as signature Selects patient online Selects and reviews medication order online Scans Bar-Code on medication

16 Bar-Coding at the Bedside The Computer Matches Bar-Code to medication order Checks 5 rights of medication administration & notifies nurse of any discrepancies Documents medication administration Charges patient for medication Reminds the nurse of missed and late medications

17 The Final Line of Defense in a Complex Process Purchasing & Inventory Unit Dose Prep MD Order Pharmacy Order Entry RN Prepares To Administer Medication Preparation Medication Administered To Patient Medication Dispensed Monitoring & Follow Up

18 Hidden Benefits of Medication Bar-Coding Enhanced Reporting Capabilities Support PI & education activities Recruitment & Retention Appeal of high tech environment Recognition of patient safety/safe work environment as important retention factors

19 Implementation Process 6-8 month planning process Extensive Staff Involvement & Champions Pilot Unit Developed standard procedures Implemented Meds & IVPB s only on first unit Resolved bugs & glitches Intense 24 x 7support by expert resources Timely roll out to other units Formal evaluation at 3-months & 6-months

20 Early Challenges Redesign of med administration process Uncovers practice issues Belief systems & assumptions Need to differentiate from computer issues Lack of commercially prepared individual med doses with bar-code labeling

21 What Have We Done Lately? Increased utilization of Bar-Coding Decreased work arounds and shadow system Upgraded scanners to newer more effective technology Improved quality of Bar-Coding labels Reinforcement of importance of Bar-Coding Implemented Bar-Coding on Maternity and AM Admit Unit

22 What Have We Done Lately? Executive Walk Arounds Blameless Culture and Anonymous reporting Focus on Near Misses as Opportunities to prevent errors Balance with accountability Birthdate as 2 nd identifier for med admin and other key processes Standardized Abbreviations

23 Where are We Going? Bring med carts closer to patients & Bar-Code scanning equipment Educate & involve patients in the process Implement bar-coding in PACU, Cardiac Cath Lab & Outpatient Units Implement hand-held devices for scanning patient ID bands Implement CPOE

24 Why Does It Really Matter? The Victims of a Medication Error 1.) The Patient 2.) The Nurse

25 Lessons Learned Don t underestimate the magnitude of the implementation Recognize that technology solves some problems but creates others A strong Pharmacy-Nursing relationship is essential Don t pilot on a specialty unit Standardization of med times across all units is essential

26 Lessons Learned EVERYONE needs to understand The WHY Accept you are never done

27 We are better than we were yesterday but not as good as we will be tomorrow!