Barcoding and the eMAR: Status Report and Organizational Impact

1
Barcoding and the eMAR Status Report and
Organizational Impact

• Mike R. Murphy, RN BSN MBA
• Vice President Administration/CNO
• SynergyHealth St. Josephs Hospital

2
AHRQ

• The work discussed in this presentation is
  supported in part through an Agency for
  Healthcare Research and Quality (AHRQ) grant
• Improving Patient Safety/Quality with HIT
• 1 UCI HS01528401

3
(No Transcript)
4
SynergyHealth

• St. Josephs Hospital
• 80 inpatient beds
• 4,900 IP admissions, HOV 61,000, ECC 16,000
• Physicians in addition to WBC
• New replacement hospital August 7, 2005
• West Bend Clinic and Satellites
• 75 physicians
• Office visits 430,000 annually

5
Hospital and Project Background

• Hospital and Technology Changes
• New replacement facility designed for patient
  safety from conception through post opening
• Repositioning from Rural to Suburban
  Hospital
• Several technical changes
• Pneumatic tube system
• Nurse Call System
• Wireless (IP) phone system
• Wireless Workstation On Wheels (WOW, formerly
  COW)
• Maternal Fetal Monitoring system
• For many staff the first time in their careers of
  driving to a different location

6
Hospital and Project Background

• Epic Implementations
• Interfaces and MPI Live February 2005
• Cadence Live in phases March August 2005
• Pharmacy Live April 2005
• OpTime Scheduling, Case Tracking and Charge
  Dropping) Live August 7th
• eMAR Live January 23, 2006
• ASAP Triage, Tracking White Board Live April 14,
  2006

7
St. Josephs HospitalWest Bend, WI

• Project
• Implement Epic eMAR with barcoding as first
  component to nursing documentation in EMR
• Objectives
• Achieve advances in patient safety reducing
  medication errors
• Begin the culture change associated with
  electronic medical record

8
Project Overview

• Organizational agreement that patient care is
  first priority
• Structure and Framework
• NFPP Planning and Change team associated with
  new EMAR/Barcoding system
• Established workflows

9
NFPP Committee

• Responsibilities of committee members
• Workflow development
• Dept input and feedback
• Consistent participation
• Become a super-user
• Assist with all training sessions
• Assist with Go-live
• On-going improvement of the system

10
Education

• Classroom
• Lab time
• Sample kits on the floors
• Simulations
• 2 hour training sessions with class room and
  hands-on practice in each dept.
• Role of NFPP members in competency training
• Mandatory Competency testing

11
Go Live Planning

• IS Staff, Epic Staff, Nursing Super Users, NFPP
  Members
• Command Center with - COFFEE.
• Identified Team Members with T-Shirts
• 724 planned for 72 hour
• First Weekend Planned coverage (Friday 3PM
  Saturday 3PM) (Sunday 7 AM Boredom)
• Closed Command Center Wed AM
• Issue tracking, Communication, Visibility on the
  Units, Resource Material

12
Our WOW
13
Distractions? We dont need no stinking
distractions.

• -SynergyHealth St Josephs Hospital management
  after hospital opening, 2005

14
First Year Since Inception of Synergy That We
Missed Budget (in 000s)
Fiscal 02 Fiscal 03 Fiscal 04
Fiscal 05 Fiscal 06 Budgeted Net Income
5,125 5,362 5,358 4,318
139 Actual Net Income(loss) 5,768
5,660 6,296 8,234 (
3,182) Better (worse) Than Budget 643
298 937 3,914
(3,321)
Before loss on disposal of Silverbrook
facility of 5,496,357.
15
Management Focus Financial Performance Excess
of Revenue over Expense Quarterly FY 06 (in
000s)
16
Latent Conditions

• Errors in the design, organization, training or
  maintenance that lead to operator errors and
  whose effects typically lie dormant in the system
  for lengthy periods of time.

To Err is Human, Institute of Medicine
17
(No Transcript)
18
Latent Conditions

• 1 Change in Med Timing Process Nursing
  to Pharmacy
• 2 Redundant Daily Medications
• 3 External Agency Staff will still be
  utilized

19
SynergyHealth St. Josephs Hospital Latent
Condition Rule

• Latent Conditions can never be eliminated, only
  minimized..
• Always assess workflow for impact on change and
  Latent Conditions

20
History Revisited

• Ignaze Philipp Semmelweis (July 1, 1818 August
  13, 1865)
• Hungarian physician the savior of mothers who
  discovered, in 1847, hand washing drastically
  reduced incidence of puerperal fever in
  obstetrical clinics.

http//en.wikipedia.org/wiki/Ignaz_Semmelweis
21
2007

• According to the CDC appropriate hand washing
  results in a reduced incidence of both nosocomial
  and community infections. Guidelines from
  national and international infection prevention
  and control organizations have repeatedly
  acknowledged that hand washing is the single most
  important procedure for preventing infections.
  Despite this, compliance with hand washing by
  health care providers is poor.

http//www.osha.gov/SLTC/etools/hospital/hazards/i
nfection/infection.html
22
Culture eats Strategy for Breakfast Glyn Elwyn
23
More Latent Conditions

• 4 Documenting means a whole lot more in the
  electronic world
• 5 Process related medication charging errors
  have a cascading effect and create a mountain
  of rework.

24
(No Transcript)
25
What value or actions are derived from these
entries?
26
(No Transcript)
27
(No Transcript)
28
From January 1 - April 30, 2007 137,092 eMAR
actions were taken.The following charts
represent this time period
29
(No Transcript)
30
(No Transcript)
31
(No Transcript)
32
(No Transcript)
33
(No Transcript)
34
(No Transcript)
35
Other Feedback

• Patients express a sense of feeling safer
• Staff acknowledge the system catches errors
• Charts are easier to review

36
Lessons Being Applied

• Monitor, Support, Revise, Enforce Workflows
• Consistent presence and leadership by clinical
  leaders
• Consistent unit representation and ownership
• Spend as much time as possible up-front with the
  systemstaff need to touch and play often and
  repeatedly
• Develop audit reports up front and establish
  audit responsibility
• Take quality time to understand interdepartmental
  impact

37
Conclusions

• We believe technology can and does positively
  impact patient safety
• We know that this requires a culture change owned
  by the whole team
• Anticipate and minimize casualties
• Fish early and often for Latent Conditions
• Enjoy the journey