"Wireless barcode charting is critical to completely closing the loop on medication safety", stated Ron Small, Vice President, Quality Outcomes and Chief Pharmacy Officer at Wake Forest University Baptist Medical Center. "As a result of our partnership with IDX, technology has been extensively deployed into the medication use process, which has made our processes more efficient so that people can be more effective. With this functionality in place, our clinicians will use Carecast's advanced decision support at every step of the medication cycle starting when the order is entered via CPOE, continuing through dispensing at the pharmacy, and concluding when the medication is administered at the patient's bedside. This is another step toward achieving the desired six aims of health care as outlined by the Institute of Medicine: that care delivery should ensure patient safety and be timely, effective, efficient, equitable and patient-centred."
Barcode charting provides safeguards against errors during medication administration, the last stage in the medication cycle and the second-most likely place for errors to occur (JAMA, 1998). The technology reinforces the "five rights" of medication administration that the right dose of the right drug is being administered to the right patient via the right route at the right time, and alerts clinicians if there are any discrepancies.
When barcode charting is fully implemented at NCBH, each unit dose of medication, including IVs and respiratory care pharmaceuticals, will receive a barcode before it leaves the pharmacy. NCBH also is moving forward with a project to barcode all laboratory specimens, to track materials as they are transferred throughout the hospital. Clinicians will be equipped with wireless scanners with which to scan the codes on the medication or specimen tag and the patient's ID bracelet.
Because barcode medication charting is built into the IDX enterprise clinical system, scanning the tags automatically enters the drug, dose, time of administration and other relevant data in the patient's chart, an important feature for the NCBH team in charge of selecting the technology. Real-time charting ensures a more accurate record than entering the information manually at intervals during or at the end of a shift, and also gives nurses and other clinicians more time for direct patient care.
"Wireless medication barcoding gives our clinicians an important tool to fulfil the hospital's mission of making a difference in the quality of care our patients receive", stated Mary Ann Anderson, Director of Nursing, Clinical Systems, Wake Forest University Baptist Medical Center. "The functionality also supports our nursing team's commitment to the Joint Commission on Accreditation of Healthcare Organization's national patient safety goal to ensure that patients are accurately identified and medical information verified prior to medication administration and other procedures."
NCBH plans to go live with barcode charting on a pilot nursing unit in January 2006, immediately after it completes its upgrade from LastWord to Carecast, and thereafter will roll out the scanning technology to the remaining 41 units. Members of the organisation's Nursing Clinical Information System (NCIS) team will work closely with IT staff to build and test the system, as well as train staff nurses and provide peer-to-peer support when the functionality goes live.
"From our senior executives to clinicians on the front lines of care, NCBH is committed to consistently leveraging advanced clinical information technology to reduce errors and provide high-quality care", stated Paul LoRusso, Chief Information Officer, Wake Forest University Baptist Medical Center. "Through the hard work of our team and our partnership with IDX, we've realized measurable achievements in safety, productivity and the cost of care delivery. With barcode medication charting, we look forward to further strengthening our use of technology to safeguard against medication errors."
NCBH began its implementation of CPOE in 2002, and since then has documented a 60 percent reduction in preventable adverse drug events. Today, 70 percent of NCBH's inpatient services are live on CPOE, and many physicians use wireless devices to support electronic order entry at the point of care. With Carecast, the organisation intends to continue its comprehensive use of electronic medical records and expand CPOE across inpatient and ambulatory settings.
The organisation also has established a robust electronic medical record (EMR) with 100 percent adoption among its physicians, according to Paul LoRusso. NCBH estimates that with the EMR it saves more than $4 million in medical records costs and $2,7 million in direct expenses per year resulting from increased productivity and efficiencies, and prevents an estimated 65.000 duplicate or conflicting medical tests per year.
NCBH supports more than 14 million weekly transactions on its electronic patient records system. Both Carecast and IDX LastWord are built on the HP NonStop platform, known for its ability to deliver 99,9 percent uptime and to process large numbers of simultaneous transactions with subsecond speed, a crucial characteristic when an IT system supports direct patient care. In a recent report, Gartner Inc., emphasized that "as care delivery organizations increase computer-based patient record use for clinical care, they will become increasingly intolerant of downtime". (Hieb, Barry, M.D.; Scott, D., 9 November 2004 "Clinical Automation to Drive High Availability Requirements.")
NCBH clinicians rely on the IDX enterprise system for comprehensive clinical documentation, on-line results reporting and viewing, medication charting, assessments and numerous other applications central to direct patient care. The organisation also relies on the IDX Imagecast Radiology Information System and Web viewer for enterprise-wide access to radiology information including full-fidelity radiology image review.
"Wake Forest University Baptist Medical Center and NCBH are constantly pushing the bounds of using information technology to advance fail-safe care", stated Mike Raymer, Senior Vice President and General Manager, IDX Carecast Operating Unit. "Barcode charting will provide the NCBH team with another valuable tool for enhancing quality patient care, and we look forward to working with them to further advance technology use across the medication cycle."
Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university¬??s School of Medicine. The system comprises 1282 acute care, psychiatric, rehabilitation and long-term care beds.
More news about IDX is available in this VMW issue's article IDX Digital Healthcare Community spotlights the next-generation EMR connecting providers and spanning care settings.