By Christina Orlovsky Page, contributor
March 18, 2011 - Patient safety is always a priority for health care professionals, and one that is universally recognized every March during National Patient Safety Awareness Week, held this year from March 6-12. While ultimately patient care is in the hands of the provider, several organizations highlight the important role health information technology (IT) plays in keeping patients safe?from the admission to discharge, pharmacy to the bedside, and everywhere in between.
According to the Agency for Healthcare Research and Quality (AHRQ), more than 770,000 people are injured or die from adverse drug events each year, with medication errors a frequent cause of these events. As such, reduction of medication errors is a major focus of clinicians and health care organizations across the country, and one area in which technology can have a major impact. In fact, AHRQ research indicates that computerized systems can dramatically reduce the occurrence of medication errors and drug events, and that anywhere from 28 to 95 percent of adverse drug events can be prevented.
P. Jon White, M.D., health IT portfolio lead for AHRQ, points to one specific technology that has made a significant difference in this effort.
“Bar-coded medication administration, where clinicians use bar codes and scanning technology to ensure that the right patient gets the right medication, has clearly been shown to reduce medical errors,” he said.
According to David A. Collins, director of health care information systems for Healthcare Information and Management Systems (HIMSS), pharmacy in general is one of the top areas where technology is helping advance patient safety.
“In the pharmacy, you have everything from dispensing machines?including Pyxis machines and robotics?to e-prescribing. All of those help the pharmacy provide the continuity of care and double-checks that help patient safety,” Collins explained.
“Of course, medicine is both an art and a science, and you can’t take for granted that everything ordered is correct for that patient and that situation. Technology is not a panacea; it has a helpful role, but still takes some thinking,” he added. “The whole medication reconciliation process is a quandary for most and it’s a tough area because there are so many moving parts. The more technology that can be brought in to keep things consistent between the patient and different providers, the more the process will improve.”
Critical to medication administration is another area in which technology has proven beneficial: patient identification. Collins also pointed to bedside bar coding for dispensing medication and blood products, as well as unique patient identification techniques like iris scanning.
“This is a cool technology that reduces confusion around duplicate names or instances when someone swaps out insurance cards,” he explaied. Similar technologies scan the unique vein map in patients’ palms to reduce same-name confusion during patient admission.
Both Collins and White point to clinical decision support as technology that can significantly improve patient safety.
“Clinical decision support, which provides clinicians and patients with relevant information in actionable ways, has clearly been shown to improve process measures of quality,” White said.
Collins explained that with leadership buy-in and the right fine tuning for providers to see clinical decision support as more than just an alert system, this technology has major benefits in a health care organization.
“Clinical decision support is a treasure in the rough; it’s like a pocket brain for health care providers, and the more it’s integrated and embraced, the more benefit there will be,” he said. “Clinical decision support can provide reference materials, templates and actionable alerts to help providers?physicians, nurses and pharmacists?think of the full gamut of medications, actions and recommendations for a specific patient with a specific condition.”
Collins added that with the right level of clinical decision support built into a system, it can help reduce “never events” like hospital-acquired infections, which are one of the key patient safety goals of organizations like AHRQ and the Joint Commission.
For the future, Collins sees opportunities in areas like health information exchanges, inteli-health for increased access to care and greater patient involvement through web portals and electronic health records as ways that patient safety will be improved through advanced technology. For now, however, the experts point to goal setting and proper and effective implementation of existing technologies and electronic health records as the best ways to improve patient safety.
“The single greatest implementation challenge is to keep an unwavering focus on the goal of any given technology and to ensure that you achieve that goal by the end of your implementation,” White said. “Conditions and products and people change along the way, systems are used, or not used, in unintended ways, and you’ll find out things you didn’t know existed in your health care organization. If you don’t clearly understand up front what you hope to achieve, you can’t hope to improve the safety of health care in your implementation.”
Joyce Sensmeier, MS, RN-BC, vice president of informatics for HIMSS, emphasizes the importance of nurses’ role in the implementation of all technologies to ensure success and improved patient safety.
“A key challenge in the implementation of any technology is the impact on workflow. If workflow and usability are not considered in the design of IT systems, there may be workarounds used by nursing and other clinical staff that bypass the correct use of the system and may jeopardize patient safety,” she said.
“For example, if bar-coded medication administration is installed without careful consideration of workflow, or if it is installed separately from a closed-loop medication administration system that includes order entry, decision support and electronic documentation, it can disrupt workflow and set up the nurse for medication errors, since the system checks and balances may not be fully leveraged.”
Finally, Sensmeier points to key facts about nurses that have nothing to do with technology yet have perhaps the greatest impact on patient safety.
“Nurses are the ultimate patient advocates,” she says. “They see the big picture and are involved with care delivery from patient admission to discharge. Nurses are mindful of the care continuum and the importance of carefully executed transitions of care. Nurses are good communicators, ensuring that there is care coordination and that the patient is included and central to the discussion. These are all key factors in maintaining patient safety.”
For more information, visit the AHRQ and HIMSS websites.
© 2011. AMN Healthcare, Inc. All Rights Reserved.
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