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Joint Commission Update: Use these tools to comply with patient safety goals
Now that the Joint Commission on Accreditation of Healthcare Organizations has announced its 2003 National Patient Safety Goals, what are you doing to comply? Technology could be a crucial part of your strategy.
Effective Jan. 1, surveyors are looking to see whether you have implemented the Joint Commission’s recommendations, and failure to comply will result in a special Type 1 recommendation.
EDs are at high risk for errors for several reasons, says Catherine A. Hamilton, RN, MPH, clinical coordinator for the department of emergency medicine at University Hospital in Cincinnati. "This is due to the breadth of cases seen, the complexity of the many hospital systems involved in patient care, and the inherent lack of control in the ED environment," she says.
Overcrowding and delays increase risk, she says. "With the current increases in ED census and length of stay, systems that functioned well or marginally are being tasked beyond their design," she explains.
Use of tools such as bar-coded arm bands and physician order entry could prevent errors in the ED, Hamilton says. "These can provide effective short-term fixes to take steps out of complicated processes," she says. "We at University Hospital are just beginning to look into these possibilities."
The ED is becoming an increasingly unsafe environment due to overcrowding, according to Jonathan Kent, RN, CEN, assistant director for the emergency center at Medical Center of Central Georgia in Macon. Consider how technology can be used to reduce risks, Kent urges. "I know it is expensive to implement new products, and it is difficult to win folks over in the change process, but it is essential to our goal of doing no harm," he says.
Here are ways to use technology to comply with the patient safety goals:
• Bar-coding systems. Use bar-code reading pocket computers that are linked to the admission/discharge/ transfer system, Kent recommends. "These will alert you if you try to give a drug that has not been OK’d for the patient by a pharmacist or entered by a physician," he says.
Kent’s ED has implemented bar coding on patient armbands, which required the purchase of eight dedicated printers with upgraded memory at about $5,000 each, and $26,000 for custom-built software. "This has been a good investment," he says. "We see lots of applications for increased speed and accuracy of data entry."
Bar coding can ensure that the medication or test ordered for a particular patient is actually the one they receive, says Andrew Sucov, MD, medical director of Rhode Island Hospital’s ED. "With the use of Bluetooth or similar technologies, it also can decrease documentation issues. This makes staff more available, which indirectly contributes to safety." (Editor’s note: For more information, go to www.bluetooth.com/util/faq1.asp.)
• Medication dispensers. Kent’s ED recently invested in five new MedStation System 2000 automated medication dispensers, manufactured by San Diego-based Pyxis Corp. These allow for more accurate control and referencing of medications, Kent reports.
• Computerized order entry. With this system, you are required only to indicate the patient’s weight, and the computer calculates the correct dosage, Sucov says "Assuming the patient’s weight is correct, this virtually should eliminate this type of error," he adds.
Computer order entry is effective at preventing errors for nonstandard dosages, says Sucov. "This has great potential to ensure correct pediatric dosing," he says. Mistakes with pediatric doses are common, especially in the ED, according to recent research.1
The goal is to stop physicians from accidentally ordering nonstandard doses, Kent says. "The system sends up red flags for potential mistakes," he says.
For instance, if the patient has a known allergy, and someone inputs an order for a medication that is a potential allergen, the physician subsequently would have to take extra steps to verify that he or she wants to order the drug in question, Kent explains.
The system you choose should be seamless and easy to use, Kent says. "It will have to be secure from those who don’t need to access it, but easy to navigate for the ED docs. It has to be fast," he says.
Kent’s facility’s information services department is working on "getting order-entry devices as close to the bedside as possible" in the ED. So far, his ED has implemented the Accu-Chek Inform System, a "smart" glucometer manufactured by Basil, Switzerland-based Roche Diagnostics, he says.
He says that the costs included system upgrades, a server license agreement for five years to transmit the data from the glucometer to the system, and the per-meter cost of $625. "We have six meters and transmitter servers in the ED," says Kent.
"It is built on a Palm hand-held computer platform, so it is a model for the way an order-entry system would work in our institution," he says. The eventual cost for computerized order entry would include new hardware and software licenses, says Kent. The cost would vary widely based on the individual ED and facility. Since order entry is computerized, errors due to transcription mistakes also are reduced, notes Kent.
"However, you still have to deal with problems with deciphering bad handwriting, unless the order goes directly from the computer to a printer or Pyxis machine that isn’t susceptible to this type of error," he says.
1. Rasmus RE, Mitchell AL, Lesar TS. Medication prescribing errors in pediatric emergency medicine: Albany (NY) Medical Center. Abstract presented at American Academy of Pediatrics National Conference, Boston; October 2002.
• Catherine A. Hamilton, RN, MPH, Clinical Coordinator, Department of Emergency Medicine, University Hosp-ital, 231 Albert Sabin Way, Cincinnati, OH 45267-0769. Telephone: (513) 558-8081. Fax: (513) 558-5791. E-mail: Catherine.Hamilton@uc.edu.
• Jonathan Kent, RN, CEN, Assistant Director, Emergency Center, Medical Center of Central Georgia, P.O. Box 6000, Box 142, Macon, GA 31208. Telephone: (478) 633-3038. Fax: (478) 633-7879. E-mail: Kent.Jonathan@mccg.org.
• Andrew Sucov, MD, FAEM, Medical Director, Emergency Department, Rhode Island Hospital, 593 Eddy St., Davol 141, Providence, RI 02903. Telephone: (401) 444-2840. Fax: (401) 444-4307. E-mail: ASucov@Lifespan.org.
• The report, Computerized Physician Order Entry: A Look at the Vendor Marketplace and Getting Started, is available free at the Washington, DC-based Leapfrog Group’s web site (www.leapfroggroup.org/hospital.htm). Click on "CPOE Reports."
• The 2003 National Patient Safety Goals and associated recommendations can be accessed at the August 2002 JCAHOnline —- Monthly News Brief at www.jcaho.org. Click on "JCAHOnline" and then "August 2002." Frequently Asked Questions about the National Patient Safety Goals also are available on the web site.
Pathways for Medication Safety is a set of articles to reduce medication errors, developed by the American Hospital Association, the Health Research and Educational Trust, and the Institute for Safe Medication Practices. This resource is free at www.medpathways.info. The articles provide hospitals with a process to incorporate medication safety initiatives into strategic plans, perform an organizationwide risk assessment to identify areas for improvement, and assess the organization’s readiness to implement a bar-coding system for administering medications. For more information, contact: Health Research and Educational Trust, One N. Franklin, Suite 3000, Chicago, IL 60606. Telephone: (312) 422-2600. Fax: (312) 422-4568. E-mail: firstname.lastname@example.org.