Lifespan Corp. is a health system based in Providence, R.I., and affiliated with the Warren Alpert Medical School of Brown University. Our four hospitals have an annual volume of approximately 56,500 discharges. There are more than 11,000 employees; annual operating expenses are $1.3 billion. Patient safety is our highest priority.
Since Lifespans inception in 1994, the systems hospitals have worked together on information technology. The Lifespan information services department is a centralized department with each partner participating in governance. Partners discuss major decisions in an integrated information services strategy and steering committee, then choose and deploy common systems. The long-standing focus on patient safety, along with the drive to use technology to optimize patient safety, has resulted in the project we are submitting, which we call the Closed Loop of Medication Safety.
This project refers to high-functioning electronic safeguards at each step in the medication process. The process begins with the physicians access to the patients electronic medical record, containing robust reference data from hospital visits, laboratory and radiographic encounters. The physicians entry of a medication order triggers decision support, checking for minimum-maximum dose along with drug-drug and drug-allergy interactions. It also identifies therapeutic and generic duplicates. A rules engine interrogates other patient information such as laboratory results to advise if the order is safe and appropriate. An electronic interface to the pharmacy system places the order onto a pharmacists work-list. The pharmacy system also uses a laboratory results interface and its own rules to enhance the safety of certain medications. When the pharmacist completes the order review, the order is electronically transmitted to the electronic medication administration record (e-MAR) and to the appropriate automated dispensing machine. The nurse electronically reviews the medications due for administration and retrieves the patients medications from the automated dispensing unit. The nurse uses bar-code technology to check the five rights of medication safety: right patient; right drug; right dose; right route; and right time by scanning the nurses ID badge, the patients wristband and the unit dose of medication. A green light informs the nurse that the medication can be administered. It also electronically charts the drug administration in the e-MAR, which is available to all of the patients caregivers.