According to the Institute of Medicine (IOM) in its 2000 report “To Err Is Human: Building a Safer Health System,” at least 44,000 and as many as 98,000 deaths due to “preventable adverse events” occur in hospitals each year. That exceeds automobile accidents, breast cancer and AIDS as a leading cause of death in the United States. The report further states that medication errors account for one in 131 outpatient and one in 854 inpatient deaths, and cites another study that found 2 percent of admissions experience a preventable adverse drug event (ADE). Not all ADEs result in death. However, when it comes to our health or the health of our loved ones, what percentage is acceptable?

Michelle Geurink is an IT analyst at Methodist Medical Center in Peoria, Ill. She also is a trained pharmacist. When she arrived at Methodist in 1999, the organization was implementing a new hospital information system (HIS) for pharmacy, lab, nursing documentation, radiology and order management. As a part of the client services department, Geurink was to make sure the new systems flowed well with IT and the pharmacy. Another Methodist IT analyst, Jennifer Nelson, R.N., was charged with the same task on the nursing side. As a team, they set out to ensure a smooth HIS installation and staff training.

The HIS software included several modules that Client Services intended to roll out one at a time, starting with Nursing Documentation. But when the IOM report came out, Methodist’s executive IT steering committee chose the Meds module because it contained bar coding technology and would address the need to reduce the risk of medication errors and ADEs. Even though studies showed Methodist experienced a statistically tiny number of ADEs compared to the national average (only five in 10,000), they knew they could improve. Instead of lowering their standards, they raised the bar.

By 2001, Geurink and Nelson were attending classes to learn how to build and implement the modules with Methodist’s policies and procedures. They chose the oncology floor as the pilot unit and held a vendor fair so staff could evaluate the new HIS hardware’s placement, and decide whether to go with permanent fixtures or mobile carts. The nurses were given evaluation sheets and asked to state their likes and dislikes. They chose permanent-mounted, all-in-one units that would be installed at the bedside and include a flat-screen monitor/CPU combo, mouse, keyboard and bar code scanner.

While the nurses evaluated the hardware, Geurink and the Methodist pharmacy buyer evaluated their meds. If they weren’t already packaged with unit-dose bar codes, pharmacy would find a company that sold them that way, or purchase them in bulk bottles, print their own unit-dose bar codes and repackage the meds. Today, Methodist always tries to buy meds unit-dose bar coded. Says Geurink, “Every time someone touches them there’s the possibility for human error. And then there’s the cost.” Although Methodist could print their own unit-dose bar codes, it was determined to be more cost-effective to purchase the meds already bar-coded. “I don’t know if we save any money, because, as opposed to a bottle, the unit-dose meds are more expensive, but then you save the labor cost,” says Geurink.

The Little Bang Approach

“When the nurses came in, the first thing we told them was that this was not about saving them time, it was about patient safety,” says Geurink. According to Nelson, the average age of nurses today is 45. That meant some of them needed to learn how to use a mouse and turn on a computer before being taught how to use the bar code system. She says the initial acceptance of the new system by the nurses was not good. “They were so used to having paper, we kind of rocked their world with introducing the equipment in the room–by logging in and scanning–we changed their whole process of delivery of medication.”

Geurink and Nelson trained the first set of nurses to work with the new system and then established a program where each floor’s nurses would train on the system, practice until proficient and then train the next floor in line. They called it the “little bang” approach to training, versus a big bang, where all floors are rolled out simultaneously. The method fostered camaraderie by providing support from within and also gave a sense of ownership to the nurses.

Today, Nelson says the nurses have totally accepted the bar code scanning system, though there are still issues to overcome. Methodist is not yet a paperless hospital, so the nurses are managing two systems, which has its challenges. “It’s hard when some of the physicians still write their notes and orders on paper,” she says. The nurses can, however, do their assessments and chart all their medications online, which is a good thing, because the nurses want more–more technology, more information on the computer and more things done on the computer. “We can’t roll it out fast enough.”