Island Health – Implementation of a fully automated Electronic Health Record and Closed Loop Medication System – lessons learned Jan Walker Regional Leader, Medication Safety Clinical Lead UDMD Project Quality & Patient Safety Russ Swaga Manager Pharmacy Informatics Pharmacy Lead, IHealth The right drug, the right dose, given to the right patient, at the right time…..

 OHC Services the Oceanside geographic area consisting of approximately 50,000 residents.  Provides urgent care, medical day care, medical imaging, outpatient laboratory, primary care and integrated community care services (mental health, seniors health, home and community care, diabetes and home support)  Center is open from daily.  Seriously ill clients needing continuing care are referred to one of 3 hospitals close by: Westcoast General, St. Joseph’s General or Nanaimo Regional General hospitals.

Medication Errors - Preventable Categories

 22million medications are mixed annually  14 million are mixed by nurses  8 million are mixed by pharmacy

Systems and Processes to support Medication Error Reduction CPOE – Computerized Provider Order Entry eMAR – Electronic Medication Administration Record ADC – Automated Dispensing Cabinets PPID- Positive Patient Identification (bar code scanning) BBVM – Bedside Barcode Verification of Medications (bar code scanning)

Evidence Based Order Sets Dose Range Checking Adverse Drug Event Rules Med Reconciliation Prescribing Transcribing Ordering and Dispensing Administration Documentation Closed Loop Medication System (CLMS)

: Nurse retrieved correct medication, scanned and administered Order for Gravol inj: Nurse scanned diphenhydrAMINE 50 mg/mL Vial – 1 mL (Benadryl) and received a warning

: Nurse scanned tetanus imm.glob.hum. 250 unit syr -1 mL for the order below and received an alert, prompting her to realize it was the wrong vaccine..

 Education is key  Physician engagement is key  Timely order entry is key  All professionals working within scope is key  Appropriate staffing levels is key  Understanding workload and workflow is key  Computer login lag is a determinant  Non Scannable Medications is a determinant  Leadership turnovers early in adoption phase is a determinant

 Engage end users as early in the design process as possible  Ensure all stakeholders are involved ◦ Nursing, Pharmacy, Quality and Safety (MedSafety), Informatics, and I.T.  Factor in ongoing support and maintenance into Project Plan  After stabilization, have an auditing and metrics plan in place that is tied to a Continuous Quality Improvement (CQI) strategy

 Implementation of a fully electronic health record, throughout acute and residential services within Island Health ◦ One patient – One record wherever possible within the organization  A fully functional closed loop medication administration system throughout acute and residential services within Island Health ◦ Safer medication practices to enhance safe patient care and reduced medication error incidents

A vision needs people – the right people!