Hospital reduces med errors to 0.1 per 1,000

Operating a small hospital doesn’t mean you can’t think big. Ellenville Regional Hospital (ERH), a 25-bed rural hospital in Wawarsing, NY, is enjoying success with a medication reconciliation and patient safety project that would be the envy of any large teaching institution by reducing medication-related events to a very low 0.1 occurrences per 1,000 doses dispensed.

As a result, Physicians’ Reciprocal Insurers (PRI), the second largest medical malpractice insurer in New York state, presented Ellenville Regional Hospital with its 2012 Best Practices in Risk Management and Patient Safety Award.

The program was born in 2008, says Michael Stearns, RPh, director of pharmacy. Stearns and others at the hospital had been eager to address medication safety issues, particularly the number of admissions due to unsafe medication practices, after the 2001 “To Err is Human” report.

“There were therapeutic duplications of medicine, overdoses of therapeutic medicines, underdoses, and things like that. They were all preventable,” Stearns says. “So we thought if we implemented some education protocols and sat down to really spend time with people, this could really be beneficial to our patients.”

Along with Stearns, Ashima Butler, CPMSM, CPCS, vice president of quality, compliance, and medical staff management, was worried about patient safety being compromised by medication errors. Those errors included those brought on by patients not fully complying with or understanding their medication use. “Being a small hospital, we weren’t having a significant amount of medication errors but enough that we really started to worry about where the gap was, why our staff were missing some key information and not getting the right medication to the patients,” Butler says.

The resulting program involves having Stearns, the hospital’s only pharmacist, see patients by appointment to discuss their medications. He also visits inpatients in the hospital. In addition, the program was taken outside the hospital to the hospital’s senior living center and family physician practice. “I’ve seen over 1,500 patients, and they all walked away with more knowledge than they came with,” Stearns says.

The number of medications was a first concern, but Stearns also considers issues such as how many doses per day the person was supposed to take of all the medications. “We found that some people were supposed to take 30, 40, 50 doses of their medications a day, and that was not feasible,” Stearns says. “We redesigned their programs to make them more achievable. Patients became more aware of their healthcare and were able to interact more effectively with their doctors and nurses.”

Patients often were counseled multiple times, but Stearns found that even meeting with a patient just once could produce significant improvement in medication compliance and safety. In what he refers to as “getting the pharmacist out of the pharmacy,” Stearns began interacting more directly with the physicians and staff during patient care, visiting to perform medication reconciliation at the bedside. “The doctor prescribed the medication, but instead of just having it delivered, he would sit with the patient and discuss what it was, how it worked, what kind of reaction they might have, how and when to take it,” Butler explains. “Mike also started reviewing the MARS [medication administration records] on a daily basis to make sure nursing wasn’t leaving any gaps, like a missed dose.”

The effort has changed the role of the hospital’s pharmacist from dispensing to consulting, says Steven L. Kelley, FACHE, president and CEO.

“The patient is working with the patient and the provider to make sure we have the best possible medication regimen,” Kelly says. “In the future I see the pharmacist becoming more the decision-maker, much more so than now, in recommending which medications to use. The provider will be focused on diagnosing and recommending treatment, and the pharmacist will be much more active rather than just dispensing on someone else’s order.”

Sources

Ashima Butler, CPMSM, CPCS, Vice President of Quality, Compliance, and Medical Staff Management, Ellenville (NY) Regional Hospital. Telephone: (845) 210-3037. Email: abutler@ellenvilleregional.org.

Steven L. Kelley, FACHE, President and CEO, Ellenville Regional Hospital. Telephone: (845) 647-6400. Email: skelley@ellenvilleregional.org.

Michael Stearns, RPh, Director of Pharmacy, Ellenville Regional Hospital. Telephone: (845) 210-3037. Email: mstearns@ellenvilleregional.org.