Saving hospitals money by implementing automated medication systems

Wireless technology can go a long way to help improve the efficiency of Canada's healthcare system and the dispensing of medications is an area that is seeing results on a limited scale. The Scarborough Hospital is one of a few Canadian hospitals that has moved to minimize medication errors and improve patient safety through an automated medication system.Patricia Macgregor, director of pharmacy services at the Scarborough Hospital, explained at a healthcare technology and medical devices forum in Toronto earlier this month that medication safety is of prime importance to healthcare. "We decided to look at streamlining our processes in our medication systems, given the number of errors that occur related to medication use," she said. The cost to the healthcare system of medication errors shouldn't be underestimated. Citing the Canadian Adverse Events Study that was published in 2004, Macgregor said many adverse events, including death, that occur to patients in hospital are related to medication errors. The study found the overall incidence rate of adverse events in hospitals was 7.5% - the equivalent of about 185,000 hospital admissions. Another study found nearly a quarter of patients (23%) discharged from a teaching hospital experienced adverse events, nearly three quarters of which (72%) were adverse drug events. Macgregor noted that not only do patients suffer from adverse events, but the healthcare system itself suffers financially from longer hospital stays, hospital readmissions, and staffing related costs.To understand what the hospital required, it conducted an assessment of where errors occur: prescription determination, transcription of the prescription, dispensing of the medication, and administration at the bedside. The Scarborough Hospital's survey found a substantial percentage of errors occurred at the final stage of administration at the bedside.Instead of focusing on one aspect, the hospital took a holistic approach and implemented a system to address all four facets of medication delivery. The facility created a blueprint of new technologies to put into operation including a computerized physician order entry system to ensure appropriate prescription of medication, a pharmacy information system to process the prescription, a pharmacy robot and cabinet where medication is stored to procure and dispense medication, and a point of care barcode scanning tool involving the introduction of a wireless network for real-time electronic verification and documentation at the bedside. Safety is guaranteed by positive identification, clinical notifications, and clinical alerts. Other features in the system include barcode enabled carousel storage, medication packagers, and automated medication cabinets."The systems are intended to protect patients, but how well the systems work depends on how you optimize equipment," said Macgregor. "The employees need to be educated about the importance of the systems and not to take any shortcuts or override the processes of the systems otherwise the The value of a hand-held wireless scanner at the point of care lies in its ability to document medication administration and ensure the right patient is getting the right medication at the right dose at the right time through the right route of administration, Macgregor noted."Few hospitals are doing this, but barcode verification at the bedside would be the best system to reduce medication errors," said Macgregor. "It can be challenging to implement a wireless network depending on the size of the facility."Because most healthcare workers are mobile and surveys have found the highest percentage of medication delivery errors occur in the mobile phase of medication delivery, mobile and wireless technology responds to the needs of healthcare workers and healthcare delivery, explained Macgregor.The implementation of intravenous infusion smart pumps on a wireless network is another aspect of the Scarborough Hospital's automated medication system. Several medical studies indicate that more than a third of medication errors are related to medications that are infused intravenously, with manual programming of the infusion device being the most common source of error. The upfront cost for these smart pumps is large for perennially cash-strapped hospitals, but the return on investment is clear if the technologies avert potentially numerous and costly litigations brought against a healthcare facility."It depends on how your organization views the (technology) investment," said Macgregor. "Do they value saving hard dollars and look at it as a capital purchase or do they look at it as operational purchases that will reduce errors and reduce the burden on overworked staff?" Lesson learned, model to followHospitals should look to the Scarborough automated medication delivery system as a model on which to build their own respective system. Macgregor explained that before embarking on the process of automating medication delivering, extensive study and planning needs to take place. Managers need to first consider barriers such as competing priorities at a healthcare facility, the lack of best practice standards, infrastructure and data standards being underdeveloped, legal and regulatory barriers that affect privacy of information, and cultural inertia in the workplace. Once a hospital decides to automate medication delivery, its choices of technologies are crucial. The technologies must be robust since hospitals run on a seven-day-a-week, 24-hour schedule that doesn't permit downtime, stressed Macgregor. The technology solutions must meet the needs of staff and patients, ensuring the security of patient information and blocking access by third parties. The solutions should use localization tags for hardware and patients, as well as avoid electromagnetic interference with medical devices.

Saving hospitals money by implementing automated medication systems

News | April 5, 2007

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