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Closed Loop Medication System

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Island Health Implementation of a fully automated Electronic Health Record and Closed Loop Medication System lessons learnedJan WalkerRegional Leader, Medication SafetyClinical Lead UDMD ProjectQuality & Patient SafetyRuss SwagaManager Pharmacy Informatics Pharmacy Lead, IHealthThe 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. Josephs General or Nanaimo Regional General hospitals.Oceanside Health Center

Medication Errors - Preventable Categories

22million medications are mixed annually14 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 SetsDose Range CheckingAdverse Drug Event RulesMed Reconciliation

PrescribingTranscribingOrdering and DispensingAdministrationDocumentation

Closed Loop Medication System (CLMS)

BPMH and PharmaNet Integration

BPMH and Prescription Documentation at OHC - 2014BPMH Compliance in UC- 2014Prescription Writer

OHC Compliance Report

Good Catches


Nurse retrieved correct medication, scanned and administered Order for Gravol inj:Nurse scanneddiphenhydrAMINE 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 keyPhysician engagement is keyTimely order entry is keyAll professionals working within scope is keyAppropriate staffing levels is keyUnderstanding workload and workflow is keyComputer login lag is a determinant Non Scannable Medications is a determinantLeadership turnovers early in adoption phase is a determinantLessons Learned

Engage end users as early in the design process as possibleEnsure all stakeholders are involvedNursing, Pharmacy, Quality and Safety (MedSafety), Informatics, and I.T.Factor in ongoing support and maintenance into Project PlanAfter stabilization, have an auditing and metrics plan in place that is tied to a Continuous Quality Improvement (CQI) strategyTakeaways

Implementation of a fully electronic health record, throughout acute and residential services within Island HealthOne patient One record wherever possible within the organizationA fully functional closed loop medication administration system throughout acute and residential services within Island HealthSafer medication practices to enhance safe patient care and reduced medication error incidentsIsland Health future plan

A vision needs people the right people!