Improving Medication Safety:

Update on the HHS Medication Management System Project

Helena Trabulsi, Director of PharmacyHHS Management MeetingNovember 11, 2011

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Why Should We Care About This?

Incidents involving medications are the second largest category reported at HHS

Increasing use and complexity of drug therapies

HHS Drug inventory = 2,500+ products

A significant proportion of nursing time is spent on medications

Current system is many years ‘out of date’ inefficient, and frustrating for staff

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Current State Limitations Loose tablets, crowded drawers Packaging ‘look alikes’ Similar drug names ‘sound alike’ Missing information Legibility of handwriting Manual processes & checks Environmental factors

New Medication Management System Benefits

Enhanced patient safety Accuracy of medication system Efficiency of drug distribution system Tracking of drug utilization & costs Improved customer service Increased job satisfaction

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Vision for Future – Fully Automated Medication Management Process

Prescribing/Ordering

CPOEMedicationOrdered

Pharmacy-based therapeutic checking & order verification

Medication Orders update the eMAR

Unit-dose bar-coded medications ordered from distributor or bulk meds packaged. Pre-mixed IV solutions purchased and prepared.

Preparation

DistributionMedication

placed in Automated Dispensing Units (ADU) on patient care unit.

Administration

Nurse validates Orders from eMAR & collects patient’s medications from ADU

Using mobile cart and bedside computing, nurse leverages barcode to verify & administer medication

Closing the LoopeMAR is updated & CQI reporting is performed and acted upon

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“Unit Dose” Packaging with Bar Code

High Speed Unit Dose Packager (“ATP”) Installed at Oakville

Pharmacy Nov. 1, 2011

Output = tablet or capsule packaged as a unit dose with a bar code

High Speed Unit Dose Packager Team

March 2012: “BoxPicker” • High Density Drug Storage

• Retrieval of Other Forms of Bar Coded Meds

• Interface to Omnicell ADUs

Inside the BoxPicker: Robotic Arm and

Containers Filled with Meds

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November 2011 to Early 2013 55 ADU Locations across 3 Sites:

Emergency/Outpatient Dept Surgical Day Care OR/Post-Anaesthetic Care Area Obstetrics Medical/Surgical Units Complex Continuing Care & Rehab ICU/COU Hemodialysis

GH (Dec. 2011 to Feb. 2012) Then OTMH then MDH

Benefits of ADUs Improved Safety

Guides nurse to the drugs that are ordered for the patient

‘Look-alike’ & ‘sound-alike’ stored apart Bar Code scan on Pharmacy restock

Improved Efficiency Quicker access to drugs

At point of use After Pharmacy closed

Improves narcotic management Decreases narcotic counts Decreases narcotic discrepancies

More time to spend with patients Increased job satisfaction

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Unique Features of ADUs from

• Multiple towers or “cells” linked together

• Access by Biometric I.D. (fingerprint scan)

• Anywhere RN, Singlepointe, Omniexplorer

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Unique Features of ADUs from

• Drawers with lights to guide user to specific compartment/bin

• Drop-down “dispensers”• Lidded Sensing Bins, Locked

Bins• Fridge Locks

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November 2011 to Early 2013

Med Carts 1 per 6 to 9 inpatient beds Transport meds from ADU to bedside Investigate alternative solutions

Replace Aging Med Refrigerators

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2013-14 Electronic Medication Administration Record (eMAR)

Computers & Bar Code Scanners on Med Carts

Scan patient wristband, drug, nurse ID

Project LeadershipProject Sponsor

Sylvia Rodgers – Chief Nursing Officer & Professional Practice Leader

Functional Department Lead Helena Trabulsi – Director Pharmacy

Project Manager Diane Olmstead, PMP

Advisory Group Medication Safety Committee

Reporting Structure To the Chief Nursing Officer and To the Medication Management Steering Committee Quarterly (or more often) updates to the HHS Board and

Senior Management

Team & Advisory Members Nursing:

Angela Roode - PPC, Safe Med Practices Nursing Super Users – TBD Patient Care Managers – As each site/unit rolled

out

Pharmacy: Nicky Hillebrand, Katrina Stasik, Grace White -

Managers Marie Descent, Boris Curcic, Janice Mack –

Pharmacy Analysts Pharmacy Technician & Assistant Super Users

Clinical Informatics: Elaine Hooper – Manager of Clinical Informatics Veronica Breadner – Clinical Analyst

Vendor Project Managers: Omnicell – Dave Burleson, Maggie Wagner Swisslog – Tony Schrader, Cindy Doig (Consultant)

Redevelopment – Jim Agnew

Medication Management Experts (Consultants)– TBD

IT Network and Technical Resource – as req’d

Safety Expo

Implementation Steps

Workflow Redesign Standard Operating Procedures Renovations Connectivity, Interfaces Installation Training – eLearning modules plus Live

session Conversion/ Go-Live!

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Introducing Technologies for Safe Medication Practices…..

……Safer Patient Care!

Handling Instructions for “Samples”

Separate along perforation at right

(folded side)

Open package from Left (sealed side)