Patients at Hill Country Memorial Hospital can be comforted knowing that as of July their medications are verified by computer before they are administered—as part of the Bedside Medication Verification (BMV) system.
The San Antonio Express-News reported in the August 10 edition, in a story called, “Dead by Mistake,” that the “Institute of Medicine recommended 10 years ago that hospitals take a number of steps that would prevent mistakes.” The story goes on to say, “Progress has been uneven at best, and expensive investments in electronic medical records, bar coding and CPOE (computerized provider order entry) for prescribing medicines have been particularly slow to occur.”
Hill Country Memorial Health System is therefore unique in its present initiative on patient medication safety. It has invested a year of planning time and expense to provide medication scanning for patients, as part of a local initiative to maintain high patient care standards. The hospital CEO, Michael Williams, DO, MBA, said medication verification is critical to patient safety.
“Our vision is to be the best community hospital—anywhere,” Dr. Williams said. “Our leadership in the administration of medicines is closely connected to that goal. Patient allergies, conflicting vital signs like escalated blood pressure, and timing of medications are just three areas where errors could occur. Our staff has recognized the value of computers in confirming medications. We truly care about our patients, and this achievement is a hallmark in which it shows. Launching medication scanning is a milestone on our journey to being the best.”
The medicine verification system begins with the pharmacy entering a prescription from the physician into a computer and the pharmacist is alerted to any allergies or possible drug interactions the patient may experience due to the drug. Once the prescription is affirmed, the pharmacist fills the prescription and it’s held in an automated dispensing cabinet until the nurse retrieves it and places it into a designated, secured patient drawer on a computer cart. The mobile computer cart is wheeled to the patient room.
When at the patient bedside, the nurse scans the patient’s wristband, then scans the medicine label and confirms the right patient will receive the correct medication at the appropriate time. Before administering the drug, the nurse is alerted to possible patient complications which may pose a risk to the patient. Only after the computer confirms all relevant variables does the nurse administer the prescribed medication.
Fred Evans, the chief information officer, attributes the program to hospital leaders, the project management team, the nursing staff and the pharmacy staff.
“Everyone has been dedicated to making this work from the beginning,” Evans said. “Employees, hospital wide, could see how this would help patients, and we have been determined to make it happen here.”
The project management team consisted of team leader Collette Miller, LVN; Larry Drake, LVN; Vanya Keyser, RN; Stacey Moellering, LVN, pharmacy technician ; and Holly Jennings, pharmacist.
“We had our share of ups and downs as we planned and began to implement the system,” Ms. Miller said, “but we have a great team. We were able to overcome pre-launch obstacles and make processes run smoothly from the beginning.”
A critical part of the system is building the computer setup and accurately labeling the medication. The hospital pharmacy had to make sure every medication was labeled with a drug and dose specific bar code. Some products can be purchased this way, others have to be pre-packaged in house or a flag label with a bar code has to be affixed to the drug packaging. Each and every product had to be tested to make sure it has a label that will scan. With over 2,000 drug items, it took months of preparation and testing to make sure the system was built correctly and ready for staff to use. Evans said he commended the Director of Pharmacy LeAnn Myers and the pharmacy department for helping achieve success.
“Everyone takes their job very seriously, and this is no exception,” Ms. Myers said. “Our team recognized early that this could be a difficult transition if we didn’t prepare well. We can prevent medication errors with this system and provide safer care for our patients. When an error is avoided, we’ll know about it. The system is that good.”
Chief Nursing Officer Robin Duderstadt said nurses explain to each patient that they must verify their medication before administering it. The response from patients has been positive.
“Patients are glad to have their wristbands scanned,” Ms. Duderstadt said. “After doing it once, they extend their wrist enthusiastically because they know it’s for their safety.”
Doctors are reassured by the system. Part of the BMV program is an electronic Medication Administration Record. It allows physicians to see what medications their patients have received with computer access from their office or their home.
James R. Partin, MD, an internal medicine physician, is chairman on the hospital information services advisory team. He said his fellow physicians are pleased with the system.
“The response has been overwhelmingly positive,” Dr. Partin said. “As we carefully prescribe medication, it’s important that we can conveniently confirm its administration. While our hospital employees have done exceptionally well for many years, computer validation is reassuring for everyone. We’re in a unique hospital where leaders and caregivers who already provide great care, seek out and implement technology which can deter an error from occurring.”