Edited by Ken Congdon, Editor In Chief, Health IT Outcomes
While it may not be the trendiest mobile application, North York General Hospital says closed-loop medication administration delivers immediate patient benefits that can provide hospitals with a solid foundation for ongoing quality care.
A buzzword currently sweeping the healthcare industry is mHealth. For most providers, the term conjures up images of the latest iPad or smartphone clinical apps, cutting edge telehealth solutions, and remote monitoring innovations. However, for Sandy Saggar, Director of Information Technology and Clinical Informatics at North York General Hospital (NYGH), mHealth doesn’t have to be quite that ambitious. Currently, the primary mobility initiative for this Canadian community academic hospital in Ontario is closed-loop medication administration. Saggar is quite content to focus his efforts on this less trendy, but powerful, mobile initiative. In fact, he suggests that other hospitals would be wise to implement technologies that directly improve patient care before embarking on other mobility projects that have yet to show concrete outcomes. Based on the results NYGH is generating, it’s hard to argue with his logic.
Q: Why the focus on mobile medication administration?
Saggar: When it comes to healthcare mobility, there are a lot of shiny technology solutions, such as the iPad and other tablet devices, available to providers today. However, our primary motivation for any IT initiative is to build a technology foundation that will optimize clinical workflow and ultimately enhance patient safety and care. This is the methodology we used with our EHR rollout that enabled us to become the first community academic hospital in Canada to reach Stage 6 on the HIMSS Analytics EMR Adoption Model, and it is the same philosophy we apply to our mobile initiatives.
While definitely promising, the impact iPads have on patient care is still largely anecdotal. At NYGH, we felt that the patient care benefits of closed-loop medication administration were well documented and clearly measurable. Plus, this application of mobile technology was directly linked to our ongoing EHR implementation. The way I see it, mobile medication administration can have an immediate impact on patient care.
Q: Can you describe your mobile medication administration solution?
Saggar: We’ve developed a unique multi-vendor solution that brings a variety of technologies together to support the nurse’s workflow. The solution consists of a mobile medication cart from Rubbermaid, a Dell ultra-small form factor PC that provides access to our Cerner EHR, and Motorola MC75 handheld devices.
Typically, the mobile medication carts remain in our hospital hallways. Clinicians perform all the necessary EHR charting on the Dell computers connected to these mobile workstations. The carts also include accessories that hold the MC75 and other supplies. The MC75s are removed from the cart and taken directly to the patient bedside. These handheld computers come equipped with a bar code scanner that allows the nurse to scan bar coded medications and patient wristbands to validate the five “rights” of medication administration (i.e. the right patient, right drug, right dose, right route, and right time) before administering the medication. A wireless connection between the Cerner EHR and the MC75 allows the clinician to verify the medication information contained in the patient record using the handheld device. Once the medication is administered, the nurse closes the loop by noting that the drug was administered in the EHR using the MC75.
Q: What were the biggest challenges you faced with your mobile medication administration rollout?
Saggar: The two biggest challenges we faced after golive were battery life and wireless connection issues.
With paper, clinicians don’t have to worry about, nor will their workflows be impacted by, dead handheld batteries or poor wireless connections. With mobile computers, these factors can certainly impact adoption and compliance. For example, when a handheld computer gets low on battery life, it can become unstable. It won’t necessarily function properly. Likewise, sections or attributes of some hospital buildings (e.g. old microwaves, cordless phones etc.) can interfere with the wireless connection.
We continue to monitor and optimize the wireless infrastructure as well as the battery life and charging of our handhelds. Furthermore, we continue to educate our clinicians on how best to maintain and use these technologies. This collaborative effort has allowed us to achieve more than 87% compliance utilizing closed-loop medication practices thus far.
Change management is another common challenge but we were able to mitigate these issues by working closely with pharmacy and nursing during the project and post go-live.
Q: What are some mobile medication administration best practices you would suggest to other hospitals?
Saggar: Thoroughly review the end-to-end clinical workflows and follow lean and best practices whenever possible. Ensure your clinicians are engaged in the device selection process for your mobile medication administration solution. They are the ones who will be using the technology on a daily basis. Clinicians must be comfortable using the devices and confident that the solution will meet their needs. Engaging clinicians in selection of technologies will aid with overall adoption because they will feel included in the decision rather than feeling the technology is being forced upon them.
Q: What measurable results have you attributed to your mobile medication administration solution to date?
Saggar: It’s only been two years since we went live with our mobile medication administration solution, and so far we’ve actually averted 2,864 medication administration errors thanks to the technology. In other words, the handheld alerted the clinician that he or she was in breach of one or more of the five “rights” and prevented potentially catastrophic medication errors. These medication administration issues would have affected 1,615 of our patients. While this represents only a small percentage of the actual medication administration activities we performed throughout that time period, it’s reassuring that we have this safety net against human error that will protect our patients from potential harm.
Q: What other mobile health initiatives are on the horizon for NYGH?
Saggar: While we aren’t yet leveraging iPads to document in our clinical systems, our management team has started to use them in an effort to reduce our paper consumption and be more efficient. We are also piloting iPads as a vehicle to administer our patient feedback surveys. Instead of filling out a form or card, NYGH patients can now evaluate the care they received using an iPad app. This application automatically aggregates the patient scores we receive, eliminating much of the manual labor formerly associated with the survey process.
Another mobile initiative that is live at NYGH is biomedical device integration. This project focuses on linking “smart” biomedical vital sign monitors, ventilators, and other mobile/bedside devices to our EHR, infusing a whole new world of rich and accurate data into the patient record that is improving clinician efficiency allowing them to spend more time at the bedside and is enhancing the care we give to our patients.