Inside Healthcare Computing ENews Update
July 3, 2008 Issue
Penn Researchers Identify Flaws in the Barcoded Technology Used to Reduce Medication Administration Errors
In the first study of its kind, researchers led by The University of Pennsylvania School of Medicine’s Ross Koppel, Ph.D. studied how hospital nurses actually use bar-coded technology that matches the right patient with the right dose of the right medication. The surprising result is that the design and implementation of the technology, which is often relied upon as a “cure-all” for medication administration errors, is flawed, and can increase the probabilities of certain errors.
Equally surprising is that the urgencies of care and the ingenuity of nurses to cope with these shortcomings have the unintended consequences of creating other medication errors. These findings appear in the July/August issue of the Journal of the American Medical Informatics Association (JAMIA). The study also illustrates how adjustments to workflow and the technology can dramatically reduce the risk of these errors.
The study was conducted at 5 hospitals in the Midwest and on the East Coast, but not at the Hospital of the University of Pennsylvania (HUP) because it does not yet have medication barcoding. Researchers examined close to a half-million instances where nurses and other staff scanned patients and medications. The researchers found a remarkably high proportion of scans involved nurses overriding the technology with workarounds to compensate for difficulties with the barcode systems. These researchers found that nurses scanning the barcode on the medication or the patient’s ID bracelet overrode the technology for 4.2% of patients charted and for 10.3% of medications charted. In contrast, vendors of barcode medication administration (BCMA) systems report error rates that are a small fraction of this study’s numbers; but vendors focus primarily on the ability to physically affix and read barcodes, not on the totality of the many processes in actual use. In addition to examining the ½ million scans, Dr. Koppel and colleagues spent years shadowing nurses using the technology, participated in many BCMA implementation meetings, and conducted scores of interviews with pharmacists, nurses, and IT leaders.
Hospital patients, on average, are subject to one medication administration error a day, according to the Institute of Medicine, and in hospitals, medication administration accounts for 26% to 32% of adult patient medication errors. Thus, an automated system using barcodes to reconcile a patient’s medications and orders with the patient’s identity would be a great advance, helping to ensure the right patient receives the right dose at the right time.
But what Penn’s Professor Koppel and his colleagues found in the five study hospitals were 31 “causes” of problems that engendered workarounds by the nurses. These causes included: unreadable medication-barcodes (crinkled, smudged, torn, missing, covered by another label); malfunctioning scanners; unreadable or missing patient-ID-wristbands (chewed, soaked, missing); non-barcoded-medications; medications in distant refrigerators, lost wireless connectivity; problems with patients in contact isolation, and emergencies.
Researchers emphasized, “It’s not that staff are lazy or careless, it’s that the system does not work as well as it should. If the refrigerated medication is two floors and a long hallway away, you’re not going to wheel your 87 year old patient to the fridge. You make a copy of her barcode. And while you do that, you help another two patients who also need refrigerated medications.”
“Bar-coding is still under development,” says Koppel. “Administrators and vendors may expect it to be fool-proof, but users know it’s not. It’s a very promising technology that still requires constant refining and careful observation of on-the-floor workflow to get it right.”
The researchers found that in the pressurized, “can-do” culture of today’s hospital, nurses compensated for the imperfect technology and workflow by devising 15 types of workarounds. The study also presents typologies of workarounds, BCMA “causes,” and the kinds of errors associated with each.
----
NextGen Healthcare Expands Its Relationship With Banner Health
NextGen Healthcare Information Systems, Inc., a wholly owned subsidiary of Quality Systems, Inc. and a provider of ambulatory healthcare information systems and connectivity solutions, announced that Phoenix, Az.-based Banner Health, one of the largest non-profit health systems in the country, has purchased a significant number of licenses for NextGen EMR (Electronic Medical Records) and NextGen EPM (Enterprise Practice Management) software. Banner Health has been a NextGen Healthcare client for approximately four years,and this purchase marks the next phase in its long-term ambulatory physician strategy.
Banner Health has 20 hospitals in seven western states, and provides hospital care, home care, hospice care, long-term care, nursing registries, surgery centers, laboratories and rehabilitation services. The new NextGen software licenses will be offered to a number of existing physicians.
---
Massachusetts Hospital Selects MedQuist Enterprise Technology for Clinical Documentation and Speech Recognition
MedQuist Inc. announces that Noble Hospital, a community hospital located in Westfield, Mass., has selected and begun implementation of MedQuist Enterprise technology solutions to provide hospital-wide dictation, transcription and speech recognition capabilities. MedQuist's Enterprise Platform and its embedded speech recognition capability will be used throughout the hospital to help Noble's Health Information Management department progress with technology and provide a more timely, efficient, and most importantly, reliable capture of data.
Noble Hospital creates more than 19,000 clinical reports annually. In recent years, the hospital has seen its transcription volume grow significantly, and has also hired several hospitalists who are generating a significant volume of reports. Currently, Noble employs four full-time transcriptionists and has found it necessary to identify a solution to manage the increased workload.
