While it’s good to see many hospitals moving to bedside medication verification, it’s still staggering to consider the full extent of medication errors that occur annually. According to the Institute of Medicine, around 1.5 million medication errors occur every year, resulting in about 7,000 deaths. It’s estimated that 70% of these errors are preventable.
The FDA recommends a Bar Code Medication Administration (BCMA) system to decrease the errors and risks of medication events. It has been proven that BMCA technology improves patient safety – but only when used properly. We’ve observed that if the technology is not correctly integrated into the nursing workflow or the hospital’s EHR system, the clinical staff often try to find workarounds to save time or “fix glitches” in the system.
IT departments are frequently called on to support and facilitate the use of BCMA systems. Common complaints amongst clinical staff include:
- Equipment not being available
- Inability to scan the armbands
- Inability to scan the medication
- The scanner not working
- Mobile workstations not working
- Wireless connectivity
On the surface, most of these complaints seem to stem from the technology not working properly. In reality, there are several possible reasons why the technology is not working, and it’s not always due to a problem with the scanner or computer cart. Successful BCMA certainly requires that the IT department take an active role in helping the clinical staff maintain functional equipment; but the clinical department must also communicate the real issue to help IT find the root of the problem.
At many of our clients’ sites, our consultants take the time to ask the following questions to help facilitate communication between the clinical and IT departments to find out why clinicians are creating workarounds.
- Are other errors occurring throughout the entire process, from receiving to administration? For example, wrong NDC numbers, filling dispensing cabinets incorrectly, or trying to pull medications from the dispensing machine for more than one patient at a time.
- Are bar code printing issues occurring?
- Are bar code scanning issues occurring?
- How has the clinical workflow been impacted by BCMA? If a strategic plan was not in place at rollout, how can workflow issues be overcome?
- Is there complete wireless coverage in every patient room?
- Have the different types of bar codes (1D or 2D) and scanners been researched properly?
- Is the bar code technology compatible with the hospitals EHR system? For example, Datamax with Meditech.
- Are the scanners programmed properly?
- Are tethered or wireless scanners better for nursing workflow?
- Is there a problem with the NPR reports that format wristbands?
- Has the clinical staff been trained properly on BCMA?
A BCMA system is not meant to be “plug and play.” There are several aspects hospitals need to consider before rolling out a new clinical process or refining an existing one. If the nurses are able to use the technology properly, statistics show that a solidly planned and implemented BCMA process avoids medication errors, increases nursing/patient satisfaction and improves patient outcomes.
Many, perhaps most, senior care communities are familiar with wandering management systems to protect Alzheimer’s sufferers or others with dementia. Typically, these systems monitor exits to prevent a resident leaving unescorted. But there is no visibility on the resident when they are away from an exit.
In recent years, this technology has evolved quite a bit, and it is now possible to locate a resident at any time. This trend is being driven by changes in the physical environment and the approach to wandering management.
As with other facets of dementia, wandering behavior is often progressive. It might start out with no more than mild forgetfulness or confusion. Why would you want to place such a person in a secure unit, or even restrict their movement within the facility?
Senior care communities are moving to more complex designs that integrate different levels of care and a range of services to encourage ageing in place. Residents have several communal areas that they can go to: cafeterias, barber shops, recreation areas.
Locating technology allows even wander-prone residents to have the freedom to move within the facility to access this services, but at the same time ensures that staff can find the residents if required. (Read how one community is using this technology.)
Wander systems have evolved to become personal security systems that allows a tailored approach to each resident. It’s a big improvement on a “one size fits all” approach.
California is no stranger to earthquakes, or to earthquake planning. The essential infrastructure of that state, including hospitals, is designed to a very high standard. But that doesn’t mean it can’t be made better.
A new initiative led by the University of California San Diego in partnership with the UC San Diego Health System is taking a major step forward in making hospitals even more earthquake proof. Storage carts and cabinets from Stanley Healthcare Solutions’ InnerSpace division will play an important role.
The engineers of UC San Diego are building a giant shake table, on top of which will rest a five-story hospital, complete with a surgical suite, an intensive care unit and all the other systems and equipment you’d find in a working hospital.
What the researchers are interested in is not so much the building itself, but the equipment inside it. Often, a hospital structure passes through an earthquake undamaged… but not the vital medical and support systems necessary to keep the hospital functioning.
InnerSpace storage systems and a range of other medical equipment will be installed on two of the upper floors. Researchers are interested in a number of questions. Will equipment be functional after an earthquake? Will machines lose their calibration?
This data will drive improved building codes and safety standards nationwide, and Stanley Healthcare Solutions is pleased to be able to contribute to this important effort.
You can follow the progress of the project on this web cam.
In 2010, a The Boston Globe investigation linked over 200 deaths in the United States (2005-2010) to problems with vital monitor alerts – many of them relating to “alarm fatigue.” In this case, “alarm fatigue” refers to the reduced response by clinicians to audible alarms set off by medical devices monitoring patients due to an onslaught of reoccurring alerts throughout the day.
We believe there may be a similar type of “fatigue” concern emerging within Clinical Decision Support (CDS), an EHR process that provides clinicians with relevant medical knowledge and patient information to enhance their decisions at the point of care. In many cases, an overwhelming number of automatic alerts are being sent to clinicians from previous electronic clinical orders. If a physician is bombarded with hundreds of alerts a day, CDS is facilitating a comparable desensitization to the alerts or “alert fatigue” as well as frustration towards the technology. This is a huge problem because not only is CDS an extremely powerful tool for clinicians but it plays a part in healthcare organizations’ Meaningful Use requirements.
Every hospital will face the challenge of building sophisticated CDS tools without causing “alert fatigue.” Key factors should include:
- A strategic plan which supports existing policies and practices
- Clinicians intimately familiar with best practices and the ways and means to deliver the right information at the right time and in the right format
- Skilled technical personnel familiar with your CDS within your EHR
- A highly engaged clinical leadership team
This is not suggesting “alert fatigue” is associated with patient mortality; merely stating there is a fine line between information empowerment and information overload and hospitals should learn from previously documented human propensities. Hospitals need to find a healthy balance in order to maximize the benefits and increase the adoption of a complete Clinical Decision Support integration.
We wanted to acknowledge the generosity of Beverly and Guy Ludwig, which enabled Grace Manor Assisted Living of Nashville, TN to install a WanderGuard system to help protect residents who might be at risk of wandering.
The donation was made in honor of Beverly Ludwig’s mother, Mattie Binnion, a longtime resident of the area who recently moved into Grace Living.
We are grateful that Grace Manor chose to put its trust in WanderGuard, and pleased that it will help the community to preserve the safety and mobility of residents.
Kevin Smith, product manager for patient security at Stanley Healthcare, recently appeared in the UK publication Public Service Review discussing the startling facts of mother/infant mismatching. You can read the article here.
Mother/infant mismatching is often the forgotten part of infant security. As Kevin makes clear, mismatches are much more common than abduction attempts. Think thousands a year, compared to perhaps 5 to 10 abduction attempts.
The matching bands system that is universally used to prevent mismatches is generally effective, but it’s also totally manual. Humans being human, mistakes inevitably happen: mixing up similar names, misreading ID numbers, etc.
That’s why electronic mother/infant matching is such an excellent support to the matching ID bands system. It provides an automatic backup to help prevent those human errors, all without adding any extra work burden to the nurse or nursing assistant.
The Kisses mother/infant matching component for Stanley Healthcare’s Hugs system is the most widely used electronic matching solution, and is trusted by hundreds of customers.
Kisses can easily be added to an existing Hugs system. Visit our web site to learn more.
In the aftermath of the massive, deadly tornado that struck Joplin, MO, many Americans were stunned with the horrific devastation detailed in media accounts of the tragedy.
Upon hearing news of the disaster and the subsequent call for healthcare volunteers, Kelly Smith and Lauren Horn, RNs from Stanley Healthcare’s Clinical Services Division, sprang into action, spending two days in Joplin helping survivors and relief workers navigate the crisis.
“We gave close to 100 tetanus shots to those clearing debris and provided primary care for volunteers and displaced families,” said Kelly. “For 360 degrees, all you could see was complete and total rubble. What we did was a drop in the bucket towards what they need.”
Although it’d been several years since Kelly and Lauren had worked as bedside nurses, their caregiving experience was in high demand while in Joplin. Many survivors and volunteers suffered from heat exhaustion as a result of the brutal temperatures and lack of shade. Kelly and Lauren canvassed the wreckage handing out water and encouragement to those who were digging out.
“There was no shade to be found anywhere,” noted Lauren. “Most everything within a six mile radius was demolished by the 180 mile per hour winds. It’s hard to imagine, but the wind was so strong it even blew the bark off of the trees.”
Kelly and Lauren both agreed their time spent in Joplin was extremely gratifying. “Our patients all wanted to tell us where they were when the disaster struck. A procedure that would normally take us 15 minutes to perform, ended up taking 30 minutes because they wanted to share their traumatic stories with someone,” said Kelly. “It was humbling for us to be there and we hope to go back in the future to do whatever else we can to help.”
It hasn’t taken long for developers working on the Android platform for smart phones to dive into healthcare. The honor of the first FDA approved app might have gone to the Apple iPhone, but Android medical or healthcare related apps are starting to appear in numbers.
If you’re an Android user, you might want to take a few minutes to review this blog post on apps for the Android for nurses.
Most are quite generic aids like health calculators for drug dosages or references works, but there are some products from medical systems vendors, like Vocera, which offers two-way voice communication systems. It seems clear that the healthcare field is going to see a lot more of this kind of app for all the smart phone platforms.
Electronic patient security, especially for newborns, is pretty well established in the US. Most hospitals have some kind of “infant protection” system in place, and the technology has been around for more than a decade.
Now, hospitals worldwide have started to see the benefit of “baby tagging” technology, as it is often called.
What’s interesting is the differences in how the technology is implemented into the clinical environment, and what’s important in each country.
In the United Kingdom, for example, the entire birth process is overseen by midwives, who have responsibility for mother and baby from admittance to discharge. They own this space, and have definite ideas of how they want infant protection implemented. Fortunately, the Hugs system is very flexible and adapts to different workflow systems. (You can read about Hugs at one UK hospital here.)
The Hugs system was also recently chosen for several hospitals in Saudi Arabia – and Kisses mother/infant matching will be used with every one of them. Mismatches are seen as just as serious a risk as abduction, and any extra step that the hospital can take to reduce that risk should be taken.
Come to think of it, maybe that would be a good approach in North America as well!
I recently came across a blog posting about the challenge of sustaining lean initiatives in hospitals. There are many comments posted as to why these initiatives are not successful, but in my experience it boils down to the training style, and the need to involve many different levels of employees.
It can’t just be a management decision, and can easily fail at the grassroots (front line workers) level without the active involvement of middle level management. The combination of management commitment and employee buy-in can deliver projects that improve processes and reduce waste.
For many hospitals it seems like getting those folks into the same room at the same time is what hinders the ability to move forward. It is often difficult to justify taking people away from jobs that equal revenue in order to bring them into a room for value stream mapping or other lean tools.
Here are some suggestions from Stanley InnerSpace based on our experience with hospitals that might help you to successfully launch your lean efforts:
- Install a communication board in the target department and ask staff for 1-2 ideas to help decide potential projects needed.
- Schedule time to observe the staff doing the work, and document those observations to be reviewed during the session. If possible, include a person from the management team in the walk.
- Create a preliminary agenda for a 6 hour meeting. Determine exactly what you want to accomplish and who needs to be involved in the meeting. Coordinate calendars and schedule coverage as needed. Even if this has to be a few weeks out, it is better than not having it scheduled.
- Schedule the session from 9-3. Bring in lunch and use that time as a team building exercise.
- Be sure to confirm everyone’s attendance a few days before the meeting. Be prepared on meeting day. Have all materials such as dry erase markers, presentation paper, flip charts and any other supplies that might be needed. Create a printed agenda to follow and ask someone to keep the time on each agenda item.
- As work progresses throughout the day, assign someone to take notes and pictures to share information on the communication board
- The last 45 minutes of the planning session should be dedicated to creating an implementation plan.
- Follow up by sending the implementation plan, pictures and other notes to all participants.
Whether you are doing value stream mapping, A3 problem solving or developing a 5S project, it is critical to allow enough time to work through all the issues with the people doing the work. The payback on the time invested will come in the results from the project. This first meeting is the most difficult but once you have that success story, you will find scheduling future project planning sessions easier to justify!
