ISB_Mount Auburn_D8.docx

Group D8 Mount Auburn Hospital: Physician Order Entry Physician Order Entry (POE)   

An additional module to the PCI by MEDITECH Intended to reduce preventable ADEs (Adverse Drug Effects) Pilot implementation to be done in the labor and delivery unit

OVERVIEW OF THE CURRENT PROCESS

OVERVIEW OF THE PROPOSED PROCESS

•Physician submits written or verbal request to staff/nurse Ordering

Transcription

•Physician enters order into the POE Ordering

•Staff member transcibes order to medication administration record •Staff member faxes order to pharmacist

•Pharmacist fills in the order and delivers it to the hospital Dispensing

•Pharmacist fills in the order and delivers it to the hospital Dispensing

•Nurse dispenses medication to the patient Administration

•Nurse dispenses medication to the patient

•Patient receives the medication

Administration Monitoring

•Patient receives the medication Monitoring

Objectives and suggested recommendations Training of staff Any implementation of an extensive system such a POE needs to ensure all stakeholders are onboard the new process. This requires them to accept the changes as well as being sufficiently trained to take advantages of POE. To address the first issue, we suggest involving physicians, nurses, pharmacists etc. early on in the designing the system and discussing their key concerns. Once the entire staff feels part of the team implementing the change, they are more likely to accept it than if asked to adopt a predetermined decision. A system adoption statistic can be released monthly to encourage each ward to compete and speedily implement the new change. For training, staff should be fully trained in a seminar about the key aspects of the system that concern them. A systems manager should always be available for troubleshooting. Expansion of system adoption The decision to implement the phase 1 of POE in labour and delivery ward makes sense as the medication and treatments there are much simpler to try out the new system. POE system can be tested here for months and changes suggested can be implemented to improve it. The system can then be implemented in wards of increasing complexity/traffic of patients and variety of treatments. The time of trial at each stage depends on how quickly the system adopts to requirements of the ward as well as the ease of acceptance by majority staff involved in the process. The entire process can be shown below.

Group D8 Phase 1 in labour and Delivery ward

System performance feedback

Implemenation in more complex wards

Review and implement suggestion Suggestion for additional capabilities On many parameters, POE system currently proposed addresses most of the areas of concerns of ADEs as listed by researchers. However, the aspects of memory lapses and faulty drug identity checking seem to be insufficiently addressed currently. POE should have an interface for all key users in drug administration, e.g. nurses, pharmacists etc. It can have CRM like capabilities, but the main use to be targeted for managing all needs of all the patients. This way, nurses can be given capabilities to verify dosage requirements of their patients at regular intervals of the day, and physicians can easily bring up treatment history if any patient minimizing all memory lapses. Nurses and pharmacists can have an interface where they can verify drug order with their unique code, minimizing the faulty drug identification issue. Currently the POE system is mainly addressing the transcription stage of treatment. With many other functionalities, there is a wider role the system can play in streamlining all processes. Measurement of outcome A key issue in implementation of POE is the lack of benchmarking the performance of system in reducing ADEs as one can’t measure errors that have been prevented by the new process. We summarize the implementation challenges and suggestions as follows

Challenges

• Lack of statistical base to benchmark performance of new improved system • Difficult to motivate employees to use a new complex system without being able to quantify improvements • Justification of more than $300,000 worth investment

Suggestions

• Conduct and ADE survey before phase 1 implementation and after Phase 2 implementation in Mount Auburn • Get all staff onboard and convicne them the impact of avoiding the ADE in terms of human life and monetary costs • Review legal and ADE redessal cost saving pre and post implemenation