St. Luke’s Medication Dispensing and Administration Project

1. St. Luke’s Medication Dispensing and Administration Project Clark Averill, Director of Information Technology Amy Jutila, RN, AcuScan Project Coordinator

2. About St. Luke’s • Located in Duluth, Minnesota • 267 bed Level II Trauma Center • 22 Physician Practices • Helicopter trauma service • JCAHO certified- June 2002 • 1600 paid FTE’s • 50,000 patient days and 10,165 admissions • 350,000 clinic visits annually

3. Decision to automate Medication Dispensing and Administration • Why automate this process • Patient Safety • Decrease Pharmacy medication dispensing errors • Decrease Nursing medication administration errors • IOM Report, Leapfrog • JCAHO • Pharmacy Process Improvement • Shortage of pharmacists • Charge on Administration (replace crediting process) • Prepare for increased utilization by “baby-boomers”

4. Where Medication Errors Occur

5. System Selection Process • Identified Strategic Vision • Define Benefits and Risks • Understand Market Place • Executive Team Support • Vendor Review/Selection • Contract • Implementation

6. IT Strategic Vision at St. Luke’s • Utilize IT as part of St. Luke’s Strategic vision • Utilize fewer, highly integrated and stable vendors for as many systems as possible • Acquire new IT systems focusing on patient centered care and strengthening the financial viability of St. Luke’s • Evaluate and select vendors on an enterprise-wide basis • Maximize the value of current and future systems by investing in training and IT support • Focus on improving business processes as well as incorporating system functions when implementing new systems • Create business partnerships with affiliated organizations to share technology resources and costs

7. Benefits Realization Study(BRS) • Define/Understand the current Medication dispensing and administration process • Quantify labor expenses • Quantify current Medication errors • Patient and nurse satisfaction • Document Current systems • Quantify advantages of “Charge on dispense” vs. “charge on administration” • Current floor stock inventory

8. BRS Study • Current pharmacist FTEs • Current technician FTEs • Current drug formulary • Pharmacist/ technician work flow • IVPB system utilized > AddVantage • Decentralized service present? • Available space for Robot-Rx

9. BRS Study • Staffing levels after implementation • Clinical intervention program need • Need for RPh and RN project staff • Other services identified to save money • Big question is “ will this cost us money?” • Projected cost of the project= $$$$

10. Benefits for Nursing • Verification of the 5 Rights • Automatic Charting • Real-time MAR • Missed dose monitoring • To Do List

11. Benefits for Pharmacy • Reduced labor for cart fills • Reduced labor for medication verification • Reduced labor for crediting • Focus Pharmacists on Clinical interfacing with Physicians

12. Administrative/ Board Approval • Reviewed process and recommendation with Administration and the Board of Directors • Hard dollars • Soft dollars • Safety for patients • Safety for nurses/RPhs • Complements St. Luke’s “mission” and “vision” • Projected new RPh. services

13. Selected Automation System • McKesson Automated Solutions • RobotRx • Dispenses medications in the pharmacy • AcuDose • Dispenses narcotic and PRN medications on the floor • AcuScan (AdminRx) • Bedside Medication verification and documentation

14. Network Infrastructure • Hardware/devices • AcuScan uses 802.11b wireless network • Extensive site survey was required to ensure coverage • Wireless Security • Current AcuScan devices require “static” keys • Network Security was a “huge” concern

15. Implementation Time Line • Spring 2001 – System selected • Fall 2001- install Robot-Rx • Fall 2001- Pak-Plus implementation • March 2002- implement 14 AcuDose cabinets • January 2003- AcuScan trial • February 2003-gradual roll-out by nursing unit • May 2003-AcuScan implementation complete

16. Lessons Learned • Need dedicated nurse project manager • Need ongoing nursing support and training • Need dedicated pharmacy resources • Underestimated IT engineering/support time • Interface testing/re-testing • Medication process needs to be maintained: 24 hour MAR checks and verify against physician order

17. Lessons Learned • Workarounds and new sources for error: • Downtime • Interface issues and software • Complacency-scanning after administration/not scanning • Patient wristbands • Don’t underestimate magnitude of implementation

18. Lessons Learned • Barcodes • Length of barcode on wristband • IV Solution barcodes • New barcode types-keeping up with manufacturers • Maintaining database • Infant/Pediatric wristbands

19. Lessons Learned • User Training • Small size of AcuScan handheld screen • Device failure • Battery life/charging • Technical issues

20. Lessons Learned • Physician involvement is very important • Physician access needs to be addressed • Reporting options need to be understood, along with the options for customization

21. Future Plans • Pharmacy Information System conversion • Improved Reporting • Upgrade to color handhelds • Integration with IV pumps

22. Questions Clark Averill caverill@slhduluth.com Amy Jutila ajutila@slhduluth.com