Crozer-Keystone Continues Clinical Transformation
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 Electronic Order Entry (EOE) at Crozer-Chester Medical Center, Springfield Hospital and Taylor Hospital has added the ability for physicians and other authorized staff to review patient care orders and organize the workflow for the patient’s care provider.
Crozer-Keystone will also implement Electronic Document Management (EDM) in February. This new system will “digitize the chart” by capturing reports such as lab and radiology results but most importantly all the paper records will now be categorized and scanned. The system will give care givers access to a patient’s final medical record all in one place from any place.
“By deeply understanding how healthcare 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 and Chief Information Officer for Crozer-Keystone. “We are effectively aligning people, processes and technology.”
Reducing Medication Errors
To understand the impact of the new systems, it’s helpful to see how the parts fit together. Take the example of ordering and administering medication for a patient. In the past, physicians or other providers wrote prescriptions by hand. The written prescriptions had to be transcribed and filled by a pharmacist and administered by the nursing staff using manual tools to check the order, check the drug, check the dose, check the date and time and check the patient.
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.
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, MAK 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 results 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.”
Enterprise Document Management
Starting on Jan. 29, all discharged medical records will be scanned into an Enterprise Document Management Portal, or (EDM). This means that the legal medical record will reside on-line and will no longer be available in hard copy.
Walt Bisbee, administrative Director of Health Information Management (Medical Records). indicates that his department will scan discharged inpatient records, short procedure, observations and hospital-based GI records into EDM. The repository will combine the scanned hand-written images with results from the Laboratory, Radiology and Pathology to create the legal medical record.
Any discharge after Jan. 29 will reside in EDM and will not be available in paper. All employees who are given appropriate access will need to view the chart online in EDM. In addition, physicians, starting on Feb. 12, will be able to complete deficiencies on-line and edit and sign dictated documents for discharges post-Jan. 29.