Crozer-Keystone Continues Clinical Transformation

In Brief

• Crozer-Keystone continued its clinical transformation at the end of 2012 and the start of 2013 with new advancements in information technology systems related to medication administration, patient information and more.
• All four Crozer-Keystone hospitals with inpatient units are now using Medication Administration Checking (MAK).
• Computerized Provider Order Entry is available at three hospitals (CPOE).
• Electronic Document Management will begin in February.

Crozer-Keystone continued its clinical transformation at the end of 2012 and the start of 2013 with new advancements in information technology systems related to medication administration, patient information and more. 

In November, Delaware County Memorial Hospital joined three other Crozer-Keystone hospitals by introducing Medication Administration Checking (MAK) system in its inpatient units. MAK is an electronic system that uses bar codes and scanners to ensure that patients get the right medication, at right time, at the right dose and through the right route.

The new eCare Navigator system, launched in conjunction with MAK, lets nurses and physicians enter and access patient care information from any computer without having to go read a paper record.

The launch of Computerized Provider Order Entry (CPOE) at Crozer-Chester Medical Center, Springfield Hospital and Taylor Hospital lets physicians and other authorized staff review patient care orders online and means that medication orders are now entered electronically, which reduces the risk of error.

Crozer-Keystone will also implement Electronic Document Management in February. This new patient medical record system will capture digital records, such as lab and test results, as well as house-scanned paper records. The system will give aregivers access to a patient’s final medical record all in one place.

“By deeply understanding how health care is delivered and how information technology can support the most efficient and safe patient care processes, our teams of physicians, nurses, administrators and experts have been developing systems that are transforming care at Crozer-Keystone,” says Don Reed, vice president of Information Services for Crozer-Keystone. “We are effectively aligning people, processes and technology.”

Reducing Medication Errors

To understand the impact that the new systems will have, it’s helpful to see how the parts fit together. Take the example of ordering medication for a patient. In the past, physicians or other providers wrote prescriptions by hand. The written prescriptions had to be transcribed (with the chance of misreading a quantity or type of medication), and then the order could be filled and then administered by the nursing staff.

Now, the CPOE captures prescription orders electronically. In 2013, DCMH will join other CKHS hospitals in using CPOE. In the future, CPOE will use evidence-based medicine principles to assist providers in making patient care decisions.

With online entry of medication orders, CPOE is a critical part of reducing errors caused by transcribing handwritten prescriptions and, with the integration of the MAK process, medication administration errors are being drastically reduced, says Karen Scoles, M.D., medical director of Information Services and Crozer-Keystone Health Network internal medicine physician.

Statistics from a 2010 New England Journal of Medicine report demonstrated the dramatic impact a fully integrated information technology system can have on reducing errors, Scoles says.

According to the Journal, ordering errors accounted for 39 percent of all serious medication errors at the hospitals they studied but after implementation of CPOE, there was a 55 percent reduction in errors. Errors in the transcription of the medication orders accounted for 12 percent, but with electronic medication administration record, there was a 100 percent reduction in errors. On the pharmacy side, dispensing errors originally accounted for 11 percent of errors, but pharmacy bar code scanning reduced the errors by 67 percent. Administration errors by nursing staff accounted for the remaining 38 percent, but after bar code scanning as part of medication administration, there was a 51 percent reduction in errors.

“One of the benefits of CPOE is that we’re developing a whole community of superusers. Handwriting issues go away as providers place orders online,” Scoles says. “Also, orders are part of a condition-specific order set which guides people to do best practices and can do drug allergy checking and drug interaction for them.”

To prepare all the hospitals to use MAK, in the summer of 2011 Crozer-Keystone centralized the pharmacy model throughout CKHS and implemented the use of drug carousels. The carousels automate the process of fulfilling medication orders and provide a standardized drug distribution platform.

Through eCare Navigator, CKHS also provides physicians with access to the online Lexi-Comp system, a robust information source for medication information. Lexi-Comp provides clinical information about medications, new FDA approvals, clinical calculators and drug plan information. CKHS also provides physicians with accesss to the health system’s pharmacy formulary and the CKHS Laboratory Manual on eCare.

Consolidation of the formulary has generated cost and efficiency benefits, says Dave Keenan, director for Pharmacy Service for CKHS. “We used to have different formulary models for each of the hospitals. The new approach offers a standardization of care that's more reliable and reproducible. In the end, it helps drive best practices out. From a pharmacy perspective, CPOE helps handle new medications, drug shortages, and protocols, instead of trying to customize them for each site,” he says.

After the prescription is ordered and filled, the nursing staff gets involved through MAK. From picking up the drugs through to administration, multiple checkpoints use a bar code scanner to verify that the patient is getting the right medication. Any discrepancies between the profiled medication and the medication in hand result in an alert.

MAK integrates with eCare, which lets the nursing staff electronically record and view critical documentation such as the medication administration record, vital signs, pain assessment, fall/risk assessments, IV rate, etc. Physicians can now access the same information online anytime, rather than reading a paper record in person. This reduces errors and duplications of services.

Elizabeth Procaccio, R.N., nurse director at DCMH, led the recent transition to MAK there. “MAK is all about patient safety as we move toward being a High Reliability Organization. The system records the medication administration into eCare automatically, so there’s nothing to write down. It alerts you if there is a potential allergic interaction when you scan in the medication. Before, you had to look at the allergy section of the paper record. Then, every user had the potential for making a mistake,” Procaccio says.

A critical part of launching the system in a month, Procaccio says, was the training: “The four educators of the Nursing Education department poured every ounce of energy into training, and the Information Services group was supporting us around the clock.”

Since eCare was launched at the same time, the hospital set up a computer lab to show doctors what eCare encompasses and how they could use it to improve patient care. “The doctors just love it,” she says.

Now that all the inpatient units are using MAK, CKHS will explore implementation in other units where medication is administered, such as the emergency department, perioperative units and cardiac cath labs.

In addition, the way care is ordered and provided becomes reproducible; nurses who move from hospital to hospital will now have a familiar process to follow, no matter where they are.

MAK also provides care instructions following medication administration. Keenan says, “It’s about a system of care. If you just gave pain medications, the system tells you to check how the patient if faring. In the paper-based system, the nursing staff used stickers and stamps as reminders.”

Electronic Document Management

By scanning in paper charts and capturing all digital test and lab results in one system, care providers will be given a powerful resource for ensuring that patients are getting the right care, based on their full medical record.

Walt Bisbee, administrative director of CKHS Health Information Management (Medical Records), says that Crozer-Keystone will start scanning in all paper charts starting in February, but that electronic information is already in the system.

“The system captures lab results, radiology tests, pathology tests and EKGs that are already in an electronic database,” he says. “Doctors’ progress notes and nurses’ flow sheets are handwritten. We’ll scan them to an image that will be stored in the system for access by anyone who needs to see it. The paper records will then be destroyed.”

Another advantage is to save doctors and clinicians a lot of time.

“In the past, a physician would request 20 medical records by next week,” Bisbee says. “Now, they’ll be able to go online without having to contact the medical records department; it will be at their fingertips. In addition, the physicians will be able to review transcribed notes and complete their records online from anywhere they are.”