Closed loop medication process in a teaching hospital in 9 months
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1 Closed loop medication process in a teaching hospital in 9 months LUIS MARTINEZ ESCOTET, MD e-huca+ project manager Hospital Universitario Central de Asturias 1
2 Where are we located? We are at the North of Spain Oviedo is Principality of Asturias capital city
3 HEALTHCARE GEOGRAPHIC DISTRIBUTION 1,075,948 citizens
4 HEALTHCARE GEOGRAPHIC DISTRIBUTION
5 HEALTHCARE GEOGRAPHIC DISTRIBUTION
6 HEALTHCARE GEOGRAPHIC DISTRIBUTION 2,700 beds 989
7 Hospital Universitario Central de Asturias (HUCA). Oviedo, Spain Tertiary care teaching hospital. 989 beds 7 adult intensive care units (ICU), 1 neonatal ICU, 1 pediatric ICU
8 GESTION DEL CAMBIO WWW: ayuda de los sistemas de información TIC S EVOLUTION WEB 1.0 Data recorder Not interface WEB 2.0 P2P Virtual communities Information share WEB 3.0 semantic web Using metadata and tags Natural Language SNOMED y Semantic Search
9 JUNE 2014: hospital move and model change From To Paper medical records Handwritten medication orders Electronic medical records (EMR) Computerized prescriber order entry (CPOE) Clinical decision support systems (CDSS)
10 Advantages & disadvantages Illegible handwriting Transcription errors Lack of traceability No access to the full medical history Real-time access to patient records Avoid transcription errors and illegible issues Improve workflow efficiency Help prescribers with decision support systems New type of medication errors
11 GESTION DEL CAMBIO: AJUSTE DE PROCESOS The cost of care based on memory Adverse events, which represent between 3% and 5% of all hospital admissions in the UK, costing the NHS around 500 million GBP Hospital errors leading to preventable adverse events, typically occur in: Medication management during the entire cycle Computerized prescriber order entry (CPOE) CV Lab Rad 56% 4% 34% Electronic medication administration Pharmacy Management Indications managemet In UE, make a mistake until 60 million in non-electronic prescriptions per year, (3% of all prescriptions issued) With a 40% adoption of electronic prescribing, 40% of the errors could be avoided British Journal of General Practice. In Spain, adverse events accounted for 3.47% of admissions in large hospitals (ENEA). According to AHQR (Agency for Healthcare Research and Quality's) each adverse event linked to medication costs about 3, / XX
12 CPOE+CDSS reduce prescribing errors. However, they have no effect on medication administration errors. Closed loop medication management systems, which combine CPOE+CDSS with other proven technologies to prevent errors at each step of the medication pathway, show great promise for preventing clinical adverse events. Ranji SR, Rennke S, Wachter RM. Computerised provider order entry combined with clinical decision support systems to improve medication safety: a narrative review. BMJ Qual Saf 2014;23:
13 Closed loop medication process
14 CPOE Pharmacy Inpatient Formulary: 2,070 products
15 CPOE 2,254 Inpatient Medication Orders (Indications)
16 CPOE 4,765 Inpatient Medication Order Sentences
17 CPOE Search options: Drug name Brand name
18 CPOE Using Tall Man Letters for look-alike drug names to reduce confusion between similar drug names (following ISMP recommendation)
19 CPOE IV Sets: 1,015 - Continuous infusion: Intermittent infusion: 263
20 CPOE IV sets Standardization in critical drugs (amiodarone, dobutamine, ). Standardization in IV sets preparation (instructions for nurses). Use of low-volume fluids to reduce the % of positive fluid balances. Avoid compatibility problems.
21 CPOE Medication containing PowerPlans: 362
22 CPOE A. Drug powerplans
23 CPOE B. Clinical situations powerplans
24 CPOE Intravenous fluid therapy powerplans: 27
25 CPOE ICU PowerPlans: 77
26 CPOE NICU PowerPlans: 69
27 CPOE PICU PowerPlans: 29
28 CPOE Emergency PowerPlans: 27
29 CPOE Anesthesia PowerPlans: 15
30 CPOE Cardiology PowerPlans: 23
31 CPOE & CDSS Intoxication management PowerPlans: 13
32 CPOE & CDSS Intoxication management PowerPlans
33 CPOE & CDSS Therapeutic Interchange Program PowerPlans: 135 Therapeutic alternative for 223 drugs
34 CPOE & CDSS Therapeutic Interchange Program PowerPlans
35 CPOE & CDSS PowerPlans signed in a week Médico ACL. Médico ACV. Médico ANR. Médico CAR. Médico CCA. Médico CGD. Médico CMF. Médico CPE. Médico CPL. Médico CTO. Médico DER. Médico DIG. Médico END. Médico GIN. Médico GRT. Médico HEM. Médico MFC. Médico MIN. Médico NEF. Médico NEO. Médico NFL. Médico NML. Médico NRC. Médico NRL. Médico OFT. Médico ONC. Médico ONR. Médico ORL. Médico PED. Médico RAD. Médico REH. Médico REU. Médico SLA. Médico SME. Médico TRA. Médico UCI. Médico UPE. Médico URG. Médico URO.
36 CPOE & CDSS Indications included in PowerPlans signed in a week Médico ACL. Médico ACV. Médico ANR. Médico CAR. Médico CCA. Médico CGD. Médico CMF. Médico CPE. Médico CPL. Médico CTO. Médico DER. Médico DIG. Médico END. Médico GIN. Médico GRT. Médico HEM. Médico MFC. 0 Médico MIN. Médico NEF. Médico NEO. Médico NFL. Médico NML. Médico NRC. Médico NRL. Médico OFT. Médico ONC. Médico ONR. Médico ORL. Médico PED. Médico RAD. Médico REH. Médico REU. Médico SLA. Médico SME. Médico TRA. Médico UCI. Médico UPE. Médico URG. Médico URO.
37 CPOE & CDSS Flowsheets and quick indications
38 CPOE & CDSS Flowsheets and quick indications
39 CPOE & CDSS Drug alerts: Interactions
40 CPOE & CDSS Drug alerts: Therapeutic Duplications
41 CPOE & CDSS Drug alerts: Allergies
42 CPOE & CDSS Drug alerts Fatigue To avoid alert fatigue: Inactivation of non clinically significant drug-drug interactions. Daily review of alerts to eliminate non significant ones. Autovalidation increase
43 CPOE & CDSS Other alerts: Dose Range Checking
44 CPOE & CDSS Other alerts: using Rules Intravenous to oral therapy conversion
45 CPOE & CDSS Other alerts: using Rules Intravenous to oral therapy conversion
46 CPOE & CDSS Pharmacist Interventions: clinical interventions
47 CPOE & CDSS Pharmacist Interventions: reporting Adverse Drug Reactions
48 CPOE & CDSS Pharmacist Interventions: compassionate-use
49 Oncology CPOE Implemented in May 2015 Developed and used in hematology: conditioning regimens and GVHD prophylaxis. Will be used for Ambulatory Treatment Center indication and administration: not only chemotherapy. Need of onco-hematology treatments standardization.
50 Oncology CPOE
51 Oncology CPOE
52 Oncology CPOE
53 CERNER integrations at Pharmacy Department Indication Pharmacist Validation Inventory management Dispensing
54 Safe drug administration: BCMA Bar-code medication administration (BCMA)
55 Safe drug administration: BCMA Implemented in Child and Adolescent Inpatient Psychiatric Unit. All medications dispensed from Pharmacy Department with bar-code identification. Nurses trained in bar-coding. Reduces administration errors.
56 HiMSS Analytics Stage 6 - April 2015
57 Outpatient Pharmacy - Retail Pharmacy Outpatient Formulary: 432 products
58 Outpatient Pharmacy - Retail 432 Outpatient Medication Prescriptions
59 Outpatient Pharmacy - Retail 464 Outpatient Medication Prescriptions Sentences
60 Outpatient Pharmacy - Retail Implemented in July ,000 patients per year (HIV, HCV, HBV, Multiple Esclerosis, Cancer patients). Retail integrated with a robotic dispensing system.
61
62 Smart infusion pumps Infusion pumps with software that can alert users to potential errors. Library of drugs that provides medication dosing guidelines, by establishing concentrations, dose limits, and clinical advisories. Indications ready to use the new pumps.
63 PowerChart Oncology integration with LUG technology Drug preparation work sheets on screens inside biosafety cabinets. Voice commands. Bar-code technology. Computer-assisted gravimetric production control.
64 Implement BCMA in the rest of units. Specific order sentences for weight and age ranges. Increase dose range checking alerts: new drugs.
65 Include new alerts, new rules: e.g. antibiotic treatment duration. Develop Discern Analytics 2 reports to link indications with clinical parameters: e.g. erythropoietin and hemoglobin levels.
66 Conclusions 1. Closed loop medication process improve patient safety reducing medication errors. 2. Development of the tools we have will lead our institution to increase patient safety and reach a high-quality care.
67 Speaker contact information Luis M. Martínez Escotet, MD e-huca+ project manager
68 Thank you for your attention 68
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