Island Health – Implementation of a fully automated Electronic Health

Record and Closed Loop Medication System – lessons learned

Jan 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.

Medication Errors - Preventable Categories

22million medications are mixed annually

14 million are mixed by nurses

8 million are mixed by pharmacy

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)

0

2000

4000

6000

8000

10000

12000

14000

16000

Urgent Care Primary Care

15906

1325

49574159

BPMH's Documented

Prescriptions Documented

61.3%# of Patient Encounters with No BPMH

# of Patient Encounters with BPMH Performed

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Sep

-1

3

Oct-

13

Nov-1

3

Dec-13

Jan-1

4

Feb

-14

Mar-

14

Apr-

14

May-14

Jun-14

Jul-

14

Aug-1

4

Sep

-1

4

Oct-

14

Nov-1

4

Dec-14

Barcode Scanning in Oceanside Health Centre Urgent Care

% of Positive Medication

Identification

% of Positive Patient

Identification

:

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

: 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

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

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

A vision needs people – the right people!