Our stories - UMHS Prescribes Technology for Medication Safety
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| James Stevenson, Pharm.D. |
“When it comes to medication error, if we really want zero defects, we have to eliminate the dependence on human checks alone,” says James Stevenson, Pharm.D. Eliminating the human factor means introducing technology to heighten accuracy, impose control and save steps.
As director of Pharmacy Services for the University of Michigan Health System, Stevenson and his staff chose to address potential medication error through technological means. This level of safety translates to a huge investment, but Stevenson remarks, “Of course, it’s an investment we have to make.”
How to be a major – yet safer – health system
The Institute for Safe Medication Practices says that medication errors are seldom the result of a single, isolated human error and suggests that such errors result from multiple small breakdowns in the many systems that handle the drugs. In other words, the chance for human error increases with the numbers and types of medications dispensed, when medications are unpacked from the distributor and repackaged for individual use, and the numbers of people handling the medications.
For a health system the size of the University of Michigan’s, the statistics are enough to make the typical consumer’s head swim. UMHS’s inpatient pharmacies – which support the hospitals – process about 3.1 million prescription orders a year. They also dispense 21,000 doses of oral medications and 5,200 doses of intravenous medications a day.
UMHS One of the First to Use State-of-the-Art Automated Dispensing Systems
Stevenson’s answer to such a demanding output was to implement different pharmacy automated dispensing systems – some that would handle the 24/7 demands of the hospital and another for the Ambulatory Care Pharmacy that handles outpatient prescriptions.
UMHS uses more than 100 Omnicell cabinets in the hospital units. “They’re like an ATM for drugs,” explains Stevenson. Each drawer in the cabinet holds a different medication. The medications are placed in the drawers using bar-code verification that the right drug is put in the correct place. The cabinet remains locked until nurses request a drug by using a biometric ID pad, which reads their fingerprint, or screens their name and password, before allowing entry. Omnicell records the nurse’s name, the date and time of withdrawal, and the name of the prescription taken.
Nurses reportedly like the system’s guiding-light technology, which directs them to the cabinet drawer and bin where the correct medication is located, reducing the possibility of errors. The system also deters narcotic theft (missing medications can automatically be traced to the staff person who opened the bin) and generates government-required reporting for narcotics.
Several huge Omnicell carousels containing about 800 different medications each reside in the basement of the main hospital – and this is what feeds the Omnicell cabinets that, in turn, provide some medications to nurses on the hospital units.
In an adjacent room, a robot from Automated Healthcare, Inc., receives medication orders from computerized patient profiles and fills 24-hour cassettes containing many of the scheduled medications for patients. This robot also utilizes barcode technology – making short work of another medication error stumbling block – what the pharmacy profession refers to as “picking and stocking.” With the latest technology, the robot cannot possibly fill the cassettes with a medication that is incorrectly picked or has expired.
The main Ambulatory Care Pharmacy uses a ScriptPro robot, which also uses bar code technology and dispenses prescriptions at a rate of 150 an hour. A person can safely fill about 20 prescriptions an hour. ScriptPro fills 40 percent to 45 percent of all Ambulatory Care Pharmacy prescriptions.
The system is a huge boon to a pharmacy that processes about 102,000 prescriptions a year. “It gives the pharmacist more time to talk directly to the patient about the mediation they’re taking,” says Stevenson, “by freeing time that was previously necessary to simply fill prescriptions. In addition, the bar code scanning technology results in greater accuracy in dispensing.”
And, behind the scenes is UMHS-specially designed barcode packaging technology, which ensures that when medications arrive from the manufacturers in bulk quantities they are repackaged into unit of use form and labeled accurately every time.
UMHS First to Use ValiMed System for High-risk Compounding
In 2005, Stevenson discussed with a colleague a new system that monitored the fluorescence of some drugs to detect potential narcotics diversion in the Operating Room. Stevenson wondered if such a system could be used to increase safety in the compounding of high-risk, injectible drugs such as insulin, antibiotics and painkillers like morphine. The U-M Pharmacy team ended up working with the manufacturer of the product (ValiMed, CDEX, Inc.), which scans high-risk intravenous medications compounded in the pharmacy, and compares the sample’s fluorescence fingerprint with a library of standards before dispensing the drug.
U-M pharmacists worked with the manufacturers of ValiMed to create a library of 10 high-risk medications, and performed pilot testing of the system before implementing it at C.S. Mott Children’s Hospital. Since May 2005, the Valimed system has helped prevent five potentially significant medication errors. Stevenson says, “The University of Michigan Health System is the first in the nation to use this type of technology to prevent medication error in the compounding of high-risk intravenous products.” Now, the Mott team is working with the manufacturer to develop libraries for more medications. “This is the kind of technology that enhances an already-good system,” says Stevenson.
UMHS Works on Closing Medication Loops
In training, nurses learn the Five Rights as a means of minimizing opportunities for errors: “The Right Medication in the Right Dose to the Right Patient by the Right Route at the Right Time.”
In order to assure that the Five Rights are consistently confirmed during medication administration, Stevenson foresees that in the not-too-distant future, nurses will use handheld, bedside barcode technology to scan the patient’s hospital wristband – making sure that that right patient is the one who should receive the drug. The medication also will be scanned to check that it is the correct medication, in the correct amount, via the correct route, and at the right time. “We’re looking forward to closing all the loops so we keep our patients even safer,” says Stevenson.
In 2004, Microsoft’s Bill Gates and Sun Microsystems’ Scott McNealy nominated the University of Michigan Health System for two Smithsonian Institution Computerworld awards. UMHS won both awards*, and the Smithsonian applauded the health system “for visionary use of information technology that produces and promotes positive social change.”
For UMHS – and its efforts to combat patient medication error – those awards were just the start of something big.
