May 11, 2007

Bar code med system improving efficiency

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Kelly Randell-Odum, R.N., B.S.N., scans the wristband of patient Phillip Pillow. (photo by Susan Urmy)

Bar code med system improving efficiency

Horizon AdminRx, a computer application used in medication administration, is helping protect inpatients at Vanderbilt University Medical Center from medication errors.

Now in use on four units, the application will spread throughout Vanderbilt University Hospital by the end of the year.

Use of AdminRx hinges on the pharmacy assigning bar codes to any medications that arrive from vendors without a code (approximately 35 percent), and on caregivers electronically scanning both the medication and the patient's wristband before giving the drug.

The system checks the scanned codes against the electronic medication order and confirms immediately whether it is the drug intended for the patient, in the right dosage and within the right period of the day. If anything doesn't match, an alert appears.

On the project's pilot units, AdminRx is already credited with sparing several patients from receiving wrong dosages and receiving medications at the wrong time of day; on one occasion, a nurse who had entered the wrong patient room to administer medications discovered the error only after scanning.

People close to the project say successful adoption of AdminRx by care-givers will substantially aid Vanderbilt's quest to lead the nation in medication safety.

“This is part of our ongoing work to make Vanderbilt the safest hospital in the United States,” said Marilyn Dubree, R.N., VUMC chief nursing officer and executive sponsor of the project.

“Coming on top of our other checks and precautions, this tool provides a further, critical level of protection. This is a tremendous new support for our nurses, who I know all place patient safety at the heart of their practice.”

The application also supports richer electronic documentation. Today at VUH, the medication administration record is consigned to the paper record. The new data streaming in from AdminRx has allowed Vanderbilt computer experts to build an interactive medication administration record in StarPanel, Vanderbilt's electronic medical record application.

“There is a considerable benefit for physicians in being able to turn to StarPanel for the record of when drugs are administered, together with any electronic notes nurses may insert regarding these meds,” said Keith Churchwell, M.D., assistant professor of Medicine and assistant director of the Vanderbilt Heart & Vascular Institute, a user of the new electronic documentation.

Pharmacy Informatics Specialist Fred Hargrove, D.Ph., estimates that fewer than 10 percent of hospitals routinely scan bar codes before giving drugs to patients, and that fewer than 10 percent of hospitals use computerized physician order entry, a technology in which Vanderbilt is a longtime leader. The two working in combination will provide exceptional benefits, he said.

“This project shows Vanderbilt's real commitment to be best of class in medication safety.”

Nurses and respiratory therapists on the AdminRx units now wheel computer workstations into patient rooms as they administer meds.

“This adds some extra steps for our nurses, but they believe it's necessary to ensure patient safety,” said Judy Araque, R.N., manager of cardiac step-down units 7 North and 6 South, where pilot implementation began in January.

“Our nurses have taken everything in stride. Their attitude has been fantastic,” said Jennifer Graham, R.N., interim assistant manager on the pilot units. Her advice for units who've yet to use AdminRx: “Relax. It's not going to be as bad as you think.”

6 North and 5 South joined up in mid April and next comes 5 and 6 Round Wing.

Neal Patel, M.D., M.P.H., chief medical information officer for inpatient areas and co-medical director for Pediatric Critical Care Services, noted that five potential adverse drug events were averted in the first week of the pilot alone.

“Everyone has worked tirelessly to make this project happen. The expertise and enthusiasm of this management team is everything we would ask to help our institution usher in this important new clinical tool,” Patel said.

The implementation project is a joint effort of Informatics, System Support Services, Patient Care Services, Respiratory Care and Pharmacy. AdminRx implementation is led by Kathy Moss, R.N., manager, Health Systems Projects; Karen Hughart, R.N., director, System Support Services; Carol Eck, R.N., administrative director, Cancer Patient Care Center; and pharmacists Hargrove, Steve Huffines, Pharm.D.; Phillip Stewart, D.Ph.; and Carly Feldott, Pharm.D. Unit Manager Judy Araque, R.N., has also played a central role.