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Patient safety

St. Michael’s to expand medication management

TORONTO – Gone is the day when a pharmacist had to squint to decipher a doctor’s scrawl on a handwritten prescription. With the flick of a wand waved across a barcode embedded on a patient’s wristband, healthcare teams at St. Michael’s Hospital are now better positioned to prescribe medications, order tests and deliver safer patient care.

The barcode technology, introduced as a pilot project last year at St. Michael’s, is the latest milestone in a seven-step campaign to transform hospital patient record-keeping from paper to electronics. St. Michael’s is the first academic teaching hospital in Canada to attain industry recognition it has completed six of the seven stages in the process.

The addition of barcode technology to electronic patient records ensures that patients receive the right drugs, in the proper dosage at the correct time. It also eliminates the potential for misreading a handwritten prescription.

“We have created a safety net for our patients, doctors and nurses,” said Anne Trafford, the hospital’s vice-president for information management and chief information officer. “The doctor who is planning the care and ordering the tests, treatments and (medications) has information to guide them in their decision-making. The nurse has a system helping her to make sure she’s giving the patient the right dose as the right time.”

The prime beneficiary, Trafford said, is the patient, who will receive a higher quality, safer level of care.

Under the new system, physicians order medication electronically by entering the prescription in a web-based software system they can access inside or outside of the hospital on a desktop computer, laptop or, increasingly, an iPad.

The electronic order is sent to the pharmacist, who validates the prescription electronically and places the medication on a drug cart – also equipped with a mobile computer – which is sent back to the patient’s unit. The medication also has a barcode encrypted with instructions.

A nurse on rounds scans her own staff ID card, the patient’s wristband barcode and the medication on the cart. Information from the barcodes appears on a computer screen instructing the nurse on medication dosages and timing. The system is also equipped with checks and balances. If an improper dosage was entered, for example, an alert will flash on the computer screen.

The barcode system is now in place in eight in-patient units of the hospital. Three more will be added by June.

The shift to electronic records means healthcare professionals no longer have to scramble around a unit searching for patient charts. Now, a physician, nurse or pharmacist can go online and monitor a patient’s care. Studies show the implementation of electronic records decreases the rate of serious medication errors by up to 81 percent.

Trafford said another advantage to the system is that nurses used to congregate at the nursing station to dispense medication, review charts and do shift handovers. “Now they are always at the patient’s bedside,” she said. “It means they have more time with their patients and they have the information they need to plan their care.”

A hospital’s progress is monitored by the international Healthcare Information Management and Systems Society (HIMSS) analytics. It establishes benchmarks for hospitals, assigning levels of progress from 0 to 7. St. Michael’s Hospital is the first academic teaching hospital in Canada to have reached Stage 6. Stage 7 would mean all of the hospital’s patient records are electronic.

Posted May 19, 2011

 

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