Patient-centric implementation of an electronic medication management system at a tertiary hospital in Western Sydney

Naren Gunja, Ian Dunlop, Milan Vaghasiya, Kevin Kuan, Simon Poon

Abstract


Background: Traditional implementations of electronic medication management (EMM) systems have involved two common formats – a ‘big bang’ approach on the day of go-live, or a phased ward-by-ward approach over months.

Objective: To describe the patient-centric roll-out, a novel implementation model in converting from paper to EMM.

Method: This model iteratively converted a large tertiary teaching hospital to electronic from paper medication charts, commencing the roll-out in the emergency department (ED). The tenet of ‘one patient, one chart’ was maintained with new patients commenced on EMM, while existing inpatients were maintained on paper charts until their discharge. In the second week, all other intake points commenced patients on EMM, and in the third week, all remaining patients were manually converted to EMM. The implementation was assessed with training completion rates, staff satisfaction surveys, focus group interviews and incident logs.

Results: At go-live, 79% of doctors, 68% of nurses and 90% of pharmacists were trained in the EMM system. The ED converted to electronic prescribing within 24 hours; by day 20, all patients were on EMM. Two hundred and thirty issues were logged, none critical, of which 22 were escalated. Of the 51,063 medications administered, there were 13 EMM-related clinical incidents including three double dosing errors, none of which led to an adverse event or death. Overall, 77% of staff surveyed were satisfied with the EMM implementation.

Conclusions: The patient-centric roll-out model represents an innovative and safe approach with a single medication chart reducing transcription and improved medication safety for the patient and the organisation.

 


Keywords


electronic health records; hospital medication systems; implementation; medication errors

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References


Hron JD, Manzi S, Dionne R, Chiang VW, Brostoff M, Altavilla SA, et al. Electronic medication reconciliation and medication errors. Journal of the International Society for Quality in Health Care 2015;27(4):314–9. https://doi.org/10.1093/intqhc/mzv046. PMid:26130746.

Kramer JS, Hopkins PJ, Rosendale JC, Garrelts JC, Hale LS, Nester TM, et al. Implementation of an electronic system for medication reconciliation. American Journal of Health System Pharmacy 2007;64(4):404–22. https://doi.org/10.2146/ajhp060506. PMid:17299180.

Westbrook JI, Gospodarevskaya E, Li L, Richardson KL, Roffe D, Heywood M, et al. Cost-effectiveness analysis of a hospital electronic medication management system. Journal of the American Medical Informatics Association 2015;22(4):784–93. https://doi.org/10.1093/jamia/ocu014. PMid:25670756; PMCid:PMC4482274.

Mekhjian HS, Kumar RR, Kuehn L, Bentley TD, Teater P, Thomas A, et al. Immediate benefits realized following implementation of physician order entry at an academic medical center. Journal of the American Medical Informatics Association 2002;9(5):529–39. https://doi.org/10.1197/jamia.M1038. PMid:12223505; PMCid:PMC346640.

Sardaneh AA, Burke R, Ritchie A, McLachlan AJ and Lehnbom EC. Pharmacist-led admission medication reconciliation before and after the implementation of an electronic medication management system. International Journal of Medical Informatics 2017;101:41–9. https://doi.org/10.1016/j.ijmedinf.2017.02.001. PMid:28347446.

Anderson LK and Stafford CJ. The ‘big bang’ implementation: not for the faint of heart. Computers in Nursing 2002;20(1):14–20; quiz -2.

LaCasse PE. Botsford’s big bang. A Michigan hospital counts down the days to its EMR system launch and readies for meaningful use. Health Management Technology 2010;31(12):14–5. PMid:21197897.

Day RO, Roffe DJ, Richardson KL, Baysari MT, Brennan NJ, Beveridge S, et al. Implementing electronic medication management at an Australian teaching hospital. The Medical Journal of Australia 2011;195(9):498–502. https://doi.org/10.5694/mja11.10451. PMid:22060071.

Owens K. EMR implementation: big bang or a phased approach? The Journal of Medical Practice Management 2008;23(5):279–81. PMid:18472602.

Wong D, Wu N and Watkinson P. Quantitative metrics for evaluating the phased roll-out of clinical information systems. International Journal of Medical Informatics 2017;105:130–5. https://doi.org/10.1016/j.ijmedinf.2017.06.007. PMid:28750906.

Boffa DP and Pawola LM. Identification and conceptualization of nurse super users. Journal of Healthcare Information Management 2006;20(4):60–8. PMid:17091792.

Halbesleben JR, Wakefield DS, Ward MM, Brokel J and Crandall D. The relationship between super users’ attitudes and employee experiences with clinical information systems. Medical Care Research and Review 2009;66(1):82–96. https://doi.org/10.1177/1077558708325984. PMid:19047764.

Yuan CT, Bradley EH and Nembhard IM. A mixed methods study of how clinician ‘super users’ influence others during the implementation of electronic health records. BMC Medical Informatics and Decision Making 2015;15:26. https://doi.org/10.1186/s12911-015-0154-6. PMid:25889076; PMCid:PMC4407776.

Cresswell KM, Bates DW and Sheikh A. Ten key considerations for the successful implementation and adoption of large-scale health information technology. Journal of the American Medical Informatics Association 2013;20(e1):e9–13. https://doi.org/10.1136/amiajnl-2013-001684. PMid:23599226; PMCid:PMC3715363.

McLane S. Designing an EMR planning process based on staff attitudes toward and opinions about computers in healthcare. Computers, Informatics, Nursing 2005;23(2):85–92. https://doi.org/10.1097/00024665-200503000-00008.




DOI: http://dx.doi.org/10.14236/jhi.v25i3.1005

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