The Detroit Medical Center is a 2,000 bed academic integrated delivery network working in conjunction with Wayne State University Medical School. With eight hospitals, it is the largest, nongovernmental employer in southeast Michigan. Five DMC hospitals were among the six in Michigan who received the 2008 Leapfrog Group award for quality and patient safety, acknowledging the DMC's commitment to patient safety through the use of technology.
In 2006, the DMC began their journey to transform how healthcare is delivered with the aid of technology. After successfully implementing an EMR in the acute care and emergency venues, DMC began to automate the surgical services workflow. As the new surgery system was being implemented, a discussion began about medication administration. The question was raised, “What do we do about the medications that are delivered to our patients?”
“We don't make medication errors in the OR Suite.” That was the initial response from the OR staff when discussing closed-loop medication administration. However, when asked to consider whether the patient in the OR deserves the same standard of care and the same safety measures as any other patient within the DMC, the staff answered with a resounding ‘Yes'. Facing the challenges of a fast paced OR environment, a vulnerable patient population and unique environmental situations (sterile field) the OR staff, pharmacy, physicians and leadership designed a new order entry and medication administration workflow and technology.
At the DMC, there are over 57,000 surgeries performed each year. The DMC has a total of 81 operating rooms, some scheduled seven days a week and used 24 hours per day. To accomplish a closed-loop medication administration process, the DMC formed an interdisciplinary team consisting of surgeons, OR nurses, clinical transformation nurses, pharmacists and information technology. Two technology requirements were solved immediately as the project began: 1) Each OR room and adjoining hallway were outfitted with wireless antennas and 2) Every surgical patient was provided a bar-coded patient ID wristband. The team then reviewed every surgeon's procedure and created electronic orders, including the medications and patient-specific doses.
For every surgical procedure, the surgeon's orders are placed electronically, verified by pharmacy electronically, the patient's identity is verified by scanning the wristband and medications prior to placing on the surgical field or administering. This process ensures the five rights of medication checking are correct: right patient, right medication, right dosage, right time and right route. This information is available online to all caregivers instantaneously, thereby closing the loop. The closed-loop medication administration process has been successfully instituted in all operating rooms at three DMC hospitals with the remaining hospital ORs targeted for completion by the end of August. The DMC is the first in the nation to implement closed-loop medication administration within the OR suite.
Patients are now safer with this technology because only proper medications are delivered while the system checks for patient allergies as well as drug-drug interactions. The use of the closed-loop medication administration process safeguards the patient from many potential adverse drug events. Focusing on pharmacist verification of medication orders prior to administration alone offers significant benefits. Previously, pharmacists did not verify medication orders before OR administration. The Institute of Medicine has stated that pharmacist review of medication orders detects between 0.61 and 3.13 errors per 1,000 orders. This statistic helped to drive The Joint Commission's Medication Management standard, whereby pharmacists must review all nonemergency drug orders before the patient receives the medication. The DMC has delivered 28,417 medications since going live with this new process and technology. Electronic pharmacist verification of OR medications is now at 100% for nonemergent medications, resulting in a safer administration process for one of our most vulnerable patient populations. Using the Institute of Medicine's error rate, pharmacist electronic verification alone has prevented up to 80 medication errors in the first 6 months of the project.
Adoption of the new process continues to improve as the staff integrates the new workflow/technology into their clinical practice environment. Huron Valley Sinai Hospital was the first DMC facility to implement this new process/technology in November of 2008. The scanning compliance data reflect in the chart below reflects their successful adoption and is consistently seen at all of the DMC Operating Rooms that have implemented this new process/technology.
The total cost of this project amounted to $1,026,760. The software and servers that facilitated the closed-loop medication process were approximately $75,000 for all hospitals. The hardware consisted of a WOW (wireless on wheels) 20-inch adjustable height cart with a 4-hour battery for each room. The cart had a laptop with 2GHZ processor, 120 GB hard drive and 802.11 wireless Ethernet capabilities, 17-inch mounted flat screen, a tethered or wired 2-D omni-directional scanner to the laptop. The total cost of the WOW was $7,000 each. Each OR room also required one or two wireless, 802.11-compliant, mobile, 52-key, infrared handheld scanners at $1,700 each—including separate charging cradle and battery. The wireless room & hallway antennas cost $1,100 each. Total cost of the hardware was $833,760. Total cost for labor to build, test, install and support during the go-live event amounted to $118,000.
The DMC continues to look for other technologies that provide better and safer care to all patients. The success of this project has encouraged other clinicians and departments to look for more ways to improve patient care even further.
Michael LeRoy
Chief information officer
Detroit Medical Center
Detroit
