Drawing on Past Success

Sometimes, a solution that is originally intended to address one particular set of issues is so effective that, even after being modified and assimilated to address another set of issues, it performs just as well. In this case, the solution is a wireless barcode medication administration system that Beloit Memorial Hospital implemented to reduce medication errors and improve patient safety in its Family Care Center (FCC) unit. The results within just the first four months of operation were so profound, the hospital extended the system to four additional units. Once the lab also implemented the system, they too expected to see increased accuracy and patient safety.

Beloit Memorial Hospital is a 125 licensed-bed community hospital caring for a population of approximately 175,000 residents of the city of Beloit, Wis., and the surrounding communities of southern Wisconsin and northern Illinois. In 2006, the hospital saw 5,104 inpatient admissions, totaling 22,251 patient days with an average length of stay of 4.36 days. Beloit Memorial’s ED treated 32,850 patients that year; its physicians performed 5,046 surgical procedures and the laboratory department performed more than 358,000 tests.

In 2001, the hospital formed a patient safety committee of administrators and clinicians from departments throughout the hospital to generate new ideas for reducing the number of medical errors and increasing patient safety. A year later, out of the collaboration of the committee, came the recommendation that additional safeguards be put in place for medication administration. Senior management agreed, and the hospital set forth on an initiative to fund, select and implement a wireless bar-code technology in February 2003.

Finding a Solution With Vision
Jane Hogan, clinical director of the laboratory and pulmonary care unit at Beloit Memorial, assisted representatives of senior management, the nursing staff, pharmacy, quality management and IT departments with the evaluation of possible solutions. According to Hogan, the team identified five options and four vendors responded with comparable products. “But some of them really didn’t have a clear vision of where they wanted to go,” says Hogan.

Several had a solution for the pharmacy or medication management, says Hogan, but not a solution that could be used for other departments, such as the lab. After the vendors demonstrated their products, representatives from the hospital made site visits prior to the selection committee reaching its conclusion.

Hogan says that CareFusion made the most sense to her, because they provided the clearest picture of what they could offer going forward. Hospital Vice President Doris Mulder, who was also part of the selection committee, says that while they were evaluating their options, she and Hogan realized that some of the choices went beyond a solution for medication administration and others did not. “That helped narrow down the number of options,” says Mulder.

Beloit deployed the wCareMed medication administration solution over a period of 15 months throughout the Family Care Center, Multi-care Center, Critical Care Center and Intermediate Care Center and Special Care Center units. From September 2003 to November 2004, these five units together documented an 82 percent overall decrease in medication administration error rates. In April 2004, Mulder went back to the board of trustees and got their wholehearted support for the implementation of the vendor’s specimen collection verification solution, wCareCollect. “When you depend on the human factor, regardless of how hard people try to be accurate, trying hard just doesn’t always do it and that’s why we looked for technology that could help,” says Mulder.

Implementation
Even though the lab module did not yet exist at the time they selected the wireless bar-code solution for medication administration, Hogan and Mulder could see that the vendor had a plan for the lab department moving forward. Beginning in April 2004, Hogan tested an early version of the lab module while the vendor continued to configure the solution under her direction. “The vendor examined our processes and developed much of the software to include our preferences and specifications,” she says.

Beloit Memorial’s specimen verification solution utilizes the PPT8846 integrated hand-held bar-code reader from Symbol Technologies, which originally interfaced with an 802.11b wireless LAN. However, connection issues that arose after Beloit implemented the new lab system forced them to replace that wireless LAN with another from InnerWireless. As they began the implementation, Hogan also found that the data the system displayed was incomplete. “It would specify the amount of specimen that was needed in a tube, but it didn’t specify the color of the blood tube that was needed to be drawn,” says Hogan. She worked with the vendor to include all of the information the system needed to display.

According to Hogan, the adjustments she and the vendor continued to make didn’t involve significant changes to what the phlebotomists would see, rather the intent was largely to standardize the information to keep a sense of congruity to its display. Hogan wanted the labels the phlebotomists would be putting on the specimen tubes to resemble the screen they would see on the new lab system, and include the same types of information. “The process of testing the system took about four months, which I did on and off along with my normal workload,” says Hogan.

Getting Acquainted
When the phlebotomist scans the patient’s wristband, the system indicates the time when the blood needs to be drawn, the specific specimen needed and whether the draw is part of a routine. Hogan says the system’s ability to distinguish routine draws from those ordered by physicians prevents duplicate draws from being performed. When lab personnel sign on to the system, one of the first screens they see is the list of departments at the hospital. “When they click on the OB field, they can view all of the patients in OB who need blood drawn and the kinds of draws,” says Hogan.

The phlebotomist then performs the draw and labels the tube with a patient/specimen-specific label, which the system provides. The phlebotomist then scans the bar-code label on the tube, as an additional safety measure. If the labels don’t match, the system alerts the phlebotomist that the label does not match the patient. “The system can catch you from labeling the tubes incorrectly. It makes you stop and examine the label and doesn’t allow you to receive that specimen unless there’s a match,” says Hogan.

Training
A vendor team remained onsite around-the-clock during the first week of the implementation. They also assisted with some of the user training during this time. According to Hogan, previous implementations taught Beloit to not train new system users too far in advance. Senior management discovered that when training was completed several weeks ahead of go-live, some users had difficulty remembering how to use the new system. Keeping in mind those past lessons, Beloit trained staff close to actual go-live. “I trained lead personnel one week, and we went-live with the system the next,” says Hogan.

Relatively few issues needed to be addressed throughout the entire process, in fact, Hogan says, “the go-live was painless.” However, one issue that became apparent soon after the go-live involved Beloit’s legacy wireless infrastructure. The hospital was still in the process of replacing their wireless system, although at the time, it was difficult to determine the location of the weak link. According to Hogan, initially, they believed the hand-held bar-code readers were responsible for the wireless system’s spotty performance. However, replacing the WLAN resolved the connectivity issues. The system initially added some time to the specimen collection process, but Hogan reminded her staff that saving time wasn’t the goal, but rather to increase patient safety by ensuring correct specimen collections. “Using an electronic process doesn’t always save time—but hopefully it will improve the accuracy of the process,” says Hogan.

In 2001, the hospital formed a patient safety committee of administrators and clinicians from departments throughout the hospital to generate new ideas for reducing the number of medical errors and increasing patient safety.

Looking Forward
According to Mulder, the lab rollout was the hospital’s least complicated CareFusion implementation, and, as far as they know, they have not had a single wrong-patient event with their specimen collections in the three years they have been using the verification solution. “The results are as we anticipated,” she says.

Beloit also may use the wireless hand-held devices to scan specimens in the surgical area, and then again when they reach the lab to further ensure accuracy and safety. Though their healthcare facility has well-developed procedures that ensure patient safety, Hogan believes there is always room for improvement. “There are always new solutions to improve current processes,” she says.