24 May UW Hospital completes deployment of error-reducing technology
MADISON – The University of Wisconsin Hospital has completed its hospital-wide deployment of a point-of-care bar code scanning application, with the final system being implemented in the hospital’s pediatric units. The system, developed by McKesson Automation Inc., is now operational in all 22 of the hospital’s units and has been reported to reduce medication administration errors by 87 percent. This reduction is possible by the use of a hand-held, wireless bar code scanner that caregivers use at the point of care to ensure the five key aspects of medication administration are correct, thereby reducing medication errors.
According to the hospital’s director of pharmacy, Steve Rough, UW-Madison’s pharmacy dispenses more than 1.5 million medication orders per year with an average of 4,300 orders daily. The bar code-based medication administration system, called Admin-RX, utilizes a three-way bar code check at bedside that assures the right medicine is delivered, in the right dosage to right patient at the right time.
Rough, who spoke at the recent spring meeting of the Wisconsin Dairyland Chapter of the Health Information Management Systems Society, said that the systems have replaced paper charts and reduced errors by monitoring patient activities as well as medication planning and administration. “Most medication errors are decision errors … the average hospital today has a 19 percent dosage error rate,” Rough said.
The system was initially installed December 2001 with a pilot project in the hematology and oncology units of the hospital. The pilot study involved eight implementation teams and took 18 months from inception to initial deployment. After just two months of use, the hospital conducted a study and discovered 87 percent of medication errors had been reduced as a result of new the bedside medication system.
The hospitals study reported dramatic improvements in medication administration and documentation accuracy, based on a direct observational study of caregivers by trained observers. Of the errors observed in the pre-phase of the study, 44 percent involved medications given at the wrong time, 21 percent involved the wrong dose of a medication, 15 percent resulted from the omission of a medication, 15 percent used the wrong dosage form (for example, injection versus oral medication) and 5 percent involved the use of an incorrect drug. Although the vast majority of these errors did not result in negative consequences, the systems proponents say the value of bar code-scanning medication applications lies in eliminating the small number of errors that can cause serious patient harm.
After the new system was deployed, the prevalence of wrong dose, wrong dosage form and omission errors were observed to decrease more than 90 percent, while medications given at the wrong time dropped over 75 percent.
“Nurses have come to appreciate Admin-Rx’s ability to avert errors,” Rough said “Based on data collected in the Admin-Rx software, we know that approximately 3.2 percent of doses scanned generate some sort of warning message to help nurses avert potential errors.”
Admin-Rx utilizes a hand-held computer that displays, receives and charts real-time patient and medication information. Before giving a patient medication, nurses scan a bar code on their identification badge, a second bar code on the medication and a third on the patient’s wristband. If there are any discrepancies regarding patient, dose, method or time, Admin-Rx alerts the nurse. If everything is verified, the nurse gives the patient the medication and documents it via Admin-Rx, which logs a historical record of all medications given to the patient.
During the presentation, Rough discussed how the system has contributed to dramatic improvements in medication administration and record documentation accuracy, with post-implementation precision exceeding 99 percent. He mentioned nurse satisfaction surveys have demonstrated a 42 percent overall improvement in nurse satisfaction regarding the medication administration and documentation process, and a 64 percent improvement in nurse perception of system efficiency and safety.
“These results can be attributed to the nurses having clear, real-time patient information at their fingertips — a reliable system that alerts the caregiver to late doses or medication omissions, and consolidation of medication verification, administration and documentation into a single step at the point of care,” Rough said.
These systems are not inexpensive. Rough estimated a system can cost anywhere from $500,000 to over $2 million to do bar code scanning, and that does not include additional pharmacy and nursing staff.