Leverage Technology To Reduce Medication Errors And Improve Workflow

North York General Hospital (NYGH) in Toronto is a HIMSS Stage 6 certified hospital that recently set its sights on enhancing patient safety by implementing Computerized Physician Order Entry (CPOE) and an advanced, closed-loop medication administration system. While the initiative fostered numerous workflow changes throughout the hospital, one of the most ambitious involved the redesigning of the Medication Administration process.

Prior to the initiative, physician orders and medication administration records (MAR) were paper-based. Nurses were required to transcribe physicians' hand-written medication orders onto a printed MAR, a process fraught with the potential for error. Nurses also shared master medication carts and a single binder containing the unit's MAR, which created a workflow bottleneck. At standardized administration times, many nurses would be vying for access to the same cart. Furthermore, the turnaround time between the physician writing an order and the order being reviewed, transcribed and the medication administered by the nurse could be four to six hours.

With the implementation of CPOE, orders are entered directly into the system and an electronic MAR is updated in real time, eliminating the time and inherent risk associated with transcribing the orders. Nurses, however, still had to contend with the traffic jams forming around one or two computer terminals and medication carts.

Since the underlying goal of any automation effort is to improve patient safety and the quality of care, we endeavored to address the acknowledged deficiencies in the existing medication delivery process with the deployment of computerized medication carts. In combination with handheld devices to document medication administration at the patient's bedside, it ensured that the right medication would be administered to the right patient at the right time.

About the authors:
Sonia Pagliaroli is Manager of Clinical Informatics, and Russ Swaga is CPOE Application Consultant in Clinical Informatics at North York General Hospital in Toronto, one of Canada's leading community teaching hospitals.