Island Health – Implementation of a fully automated Electronic

Health Record and Closed Loop Medication System – lessons

learnedJan WalkerRegional Leader, Medication Safety

Clinical Lead UDMD ProjectQuality & Patient Safety

Russ SwagaManager Pharmacy Informatics

Pharmacy Lead, IHealth

The right drug, the right dose, given to the right patient, at the right time…..

OHC Services the Oceanside geographic area consisting of approximately 50,000 residents.

Provides urgent care, medical day care, medical imaging, outpatient laboratory, primary care and integrated community care services (mental health, seniors health, home and community care, diabetes and home support)

Center is open from 0730-1030 daily. Seriously ill clients needing continuing care are

referred to one of 3 hospitals close by: Westcoast General, St. Joseph’s General or Nanaimo Regional General hospitals.

Oceanside Health Center

Medication Errors - Preventable Categories

https://intranet.viha.ca/

22million medications are mixed annually 14 million are mixed by nurses 8 million are mixed by pharmacy

WHY?

Systems and Processes to support Medication Error Reduction

CPOE – Computerized Provider Order EntryeMAR – Electronic Medication Administration RecordADC – Automated Dispensing CabinetsPPID- Positive Patient Identification (bar code scanning)BBVM – Bedside Barcode Verification of Medications (bar code scanning)

Evidence Based Order Sets

Dose Range Checking

Adverse Drug Event Rules

Med Reconciliation

Prescribing

Transcribing

Ordering and Dispensing

Administration

Documentation

Closed Loop Medication System (CLMS)

BPMH and PharmaNet Integration

BPMH and Prescription Documentation at OHC - 2014

Urgent Care Primary Care0

2000

4000

6000

8000

10000

12000

14000

16000

15906

1325

49574159

BPMH's DocumentedPrescriptions Documented

BPMH Compliance in UC- 2014

61.3%

# of Patient Encounters with No BPMH # of Patient Encounters with BPMH Performed

Prescription Writer

Sep-

13

Oct-1

3

Nov-1

3

Dec-1

3

Jan-

14

Feb-

14

Mar-1

4

Apr-1

4

May-1

4

Jun-

14

Jul-1

4

Aug-1

4

Sep-

14

Oct-1

4

Nov-1

4

Dec-1

40.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Barcode Scanning in Oceanside Health Centre Urgent Care

% of Positive Medication Identification

% of Positive Patient Identi-fication

OHC Compliance Report

Good Catches 

 

: 

 

Nurse retrieved correct medication, scanned and administered

Order for Gravol inj:

Nurse scanned diphenhydrAMINE 50 mg/mL Vial – 1 mL (Benadryl) and received a warning

Good Catches (cont) 

 

: 

Nurse scanned tetanus imm.glob.hum. 250 unit syr -1 mL for the order below and received an alert, prompting her to realize it was the wrong vaccine..

Education is key Physician engagement is key Timely order entry is key All professionals working within scope is key Appropriate staffing levels is key Understanding workload and workflow is key Computer login lag is a determinant Non Scannable Medications is a determinant Leadership turnovers early in adoption phase

is a determinant

Lessons Learned

Engage end users as early in the design process as possible

Ensure all stakeholders are involved◦ Nursing, Pharmacy, Quality and Safety

(MedSafety), Informatics, and I.T. Factor in ongoing support and maintenance

into Project Plan After stabilization, have an auditing and

metrics plan in place that is tied to a Continuous Quality Improvement (CQI) strategy

Takeaways

Implementation of a fully electronic health record, throughout acute and residential services within Island Health◦ One patient – One record wherever possible within

the organization A fully functional closed loop medication

administration system throughout acute and residential services within Island Health◦ Safer medication practices to enhance safe

patient care and reduced medication error incidents

Island Health future plan

A vision needs people – the right people!