The pen is the most dangerous, wasteful medical device, according to a healthcare technology evangelist. The paper problem is particularly acute in mental healthcare. Casework involves reviewing and producing reams of paper as a means of sharing information.
“We do a lot of our work via multi-disciplinary teams, so there can be a psychologist, social worker, nutritionist and psychiatrist, all working on the same case,” said Bruce Swan, CEO of the Royal Ottawa Healthcare Group (ROHG), which delivers specialized mental healthcare services to the Ottawa-Carleton region of Ontario.
The problem goes beyond inefficiencies in sharing casework information. The medication error rate in paper-based drug dispensing processes ranges from three to 20 per cent, and the problem is compounded in mental healthcare.
“We’re an acute care psychiatric unit, so drug orders change quickly, especially when the patient is first admitted. We may see the same drug dosage change five or six times in a week,” said Steve Layton, director of pharmacy at the Royal Ottawa Hospital (ROH), one of several facilities that comprise the ROHG.
The ROH recently introduced an automated pharmacy dispensing system developed by Montreal-based McKesson Canada to reduce medication error and clinical time spent by pharmacists and nurses. The system comprises kiosks that package and dispense drugs in each patient-care unit and software. The latter links the kiosks to the hospital’s patient records and pharmacy inventory systems.
The McKesson system tackles a number of issues inherent in a manual system. The ROH was using a traditional hospital distribution system, which supplies bulk quantities of drugs to each floor. Nurses assemble and distribute all the medications needed on their rounds based on patients’ charts, and a paper trail is used to track information.
This process is rife with weak links. The wrong bottle may be selected, or the patient’s chart may be misread, or the medication may not be administered. As is the case with many hospitals, it is the ROH’s policy to recycle unused drugs, which increases the risk of contamination or of a pill being returned to the wrong bottle. For narcotics, nurses do a time-consuming end-of-shift count of pills to track the number on hand. With the McKeeson system, the kiosk can hold up to 350 different kinds of medications in its cabinet.
“It looks like a vending machine, and it knows the amount to drop,” said Olivier Martin, director of medication system design at McKeeson Canada.
Nurses log on to the system and call up a patient’s record on a touchscreen, which presents all active medications prescribed by the physician for the patient. The kiosk delivers single doses, which are packaged and labeled with the dosage strength, lot number and a bar code to identify the patient. The risks of error or contamination are significantly reduced. When medication stocks are depleted, the kiosk sends a message to the pharmacy system to replenish.
“The pharmacy area enters orders specific to the patient [in their inventory database], which in turn feeds info to the kiosk. So there is consistency between the two,” said Martin.
The system offers another benefit that is critical to a publicly funded healthcare system that is subject to scrutiny.
“Case-costing will be much easier. We want to know how much a patient’s hospital stay costs,” said Layton. Getting an accurate read was difficult with the old system, because the costs for medications were charged to the ward, instead of being tracked by patient.
In the next phase of the project, wireless integration will extend tracking of medication to the last mile: the patient bedside. “You have a barcode on the package, plus a barcode on the nursing unit, and the next step is to have a barcode related to the patient, so you could use a handheld device to scan barcodes to get a three-way match at the bedside,” said Martin. This next step will substantially reduce the amount of charting and paperwork done by nurses.
The introduction of the McKesson system at the ROH is an advanced component of the ROHG’s broader strategy to expand and upgrade its facilities and services. Construction is underway for a new 188-bed hospital and research facility, slated for completion in December 2006.
When the new hospital opens its doors, it will be the first in Canada to be entirely wireless. The McKesson system will be integrated with the new hospital’s wireless infrastructure.
“When we move in, the kiosks will be on every floor. We are putting some across our current site now so nurses can become familiar with the technology and processes,” said Layton.
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