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Crozer-Keystone Implements New Electronic Systems Aimed at Ensuring Patient Safety

Erica Adams, R.N., uses the medication
administration checking system at Taylor.

In Brief

  • As part of Crozer-Keystone Health System’s continuing efforts to enhance patient safety and reduce medication errors, the health system recently introduced medication administration checking and began piloting computerized provider order entry (CPOE).
  • Medication administration checking, also known as MAK, is an electronic system that helps to ensure that the right patient receives the right medicine, at the right dose, at the right time and through the right route (oral, topical, nasal, etc.).
  • CPOE integrates the automated entry of physician orders with laboratory, radiology and pharmacy systems.
  • MAK was introduced on the Telemetry Unit at Taylor Hospital in early June. CPOE is also being piloted at Taylor.

As part of Crozer-Keystone Health System’s continuing efforts to enhance patient safety and reduce medication errors, the health system recently introduced medication administration checking and began piloting computerized provider order entry.

Medication Administration Checking

Medication administration checking, also known as MAK, is an electronic system that helps to ensure that the right patient receives the right medicine, at the right dose, at the right time and through the right route (oral, topical, nasal, etc.). MAK was introduced on the Telemetry Unit at Taylor Hospital in early June. Eventually, the system will be incorporated in all Crozer-Keystone hospitals and is part of the health system’s comprehensive efforts to use the latest technologies to ensure patient safety. 

Barcodes are at the heart of the MAK system. All medications used at Taylor now have a barcode. Patients have their own barcode on their identification armbands. Caregivers have their own barcode. Nurse station devices and mobile carts on the unit help to accommodate the barcode processing. 

When nurses who use the system want to give a patient a medication, they scan their own barcode, scan the medication and then scan the patient. The system matches the scanned information with the information entered into the system to ensure that the administration of medication is correct. 

In addition to ensuring that the medication administration is correct, the MAK system automatically checks for potential problems, such as patient allergies and drug contraindications. It also aids clinical staff in documentation. Physicians using the online Net Access system can review patient medications on any computer with Internet access.

Implementing the system for use at Taylor was a multidisciplinary, system-wide effort involving professionals from a range of departments, including Information Services, Nursing, Pharmacy and Administration.  

“It started about two years ago with the installation of an advanced Siemens pharmacy system. Since that time, many people throughout Crozer-Keystone have been working diligently to make this happen. It’s just another example of how the health system is dedicated to implementing new health information technologies that have a positive impact on patient safety,” says Don Reed, vice president of Information Services for Crozer-Keystone.

Diane Miller, president of Taylor Hospital, says that Taylor’s clinical team really embraced the MAK project.

“We are fortunate to have strong, engaged physician leaders as well as forward-thinking and enthusiastic nurses. And the fact that we already had computerized nursing documentation along with a reliable wireless network, carts and mobile devices made the adoption of the new technology more seamless,” Miller says. 

Janice Perry, R.N., assistant vice president of Clinical Services, says, “As always, our nurses worked extremely hard to learn these new technologies and incorporate them into caring for their patients.”

Computerized Provider Order Entry

Another important technology being implemented at CKHS that is aimed at improving patient safety is computerized provider order entry, also known as CPOE. A pilot of CPOE began at Taylor in late June. 

CPOE integrates the automated entry of physician orders with laboratory, radiology and pharmacy systems. It allows physician orders to be automatically checked for a variety of contraindications, including food, drug and environmental allergies, duplicate ingredients and therapy and maximum/minimum dose checking.

In the first phase of the pilot at Taylor, nursing and unit clerks are using the system to enter written orders such as radiology and labs. In phase 2, physicians themselves will place orders directly through the computer, no longer writing on paper order forms. Like MAK, CPOE will eventually be used throughout the health system.

“With the use of CPOE, the delay that normally occurs between handwritten orders and actual patient care will be eliminated, allowing patients to receive medications and tests faster. But the main goal in all of our technological advances is to enhance patient safety. Entering orders directly by the physician can greatly reduce errors that may occur with handwritten orders, reduces the chance of adverse drug interactions and helps to ensure compliance with clinical best practices,” says Karen Scoles, M.D., a Crozer-Keystone internal medicine physician as well as medical director of Information Services for the health system.

The rollout of CPOE and MAK through the health system will take years to complete. Look for future articles related to rollouts of these and other technologies dedicated to patient safety.

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