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Nursing Home Medication Safety: Bringing new tools to old challenges.

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Nursing Home Medication Safety: Bringing new tools to old challenges. Amy Vogelsmeier PhD RN Jill Scott-Cawiezell, Principal Investigator, PhD RN FAAN – PowerPoint PPT presentation

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Title: Nursing Home Medication Safety: Bringing new tools to old challenges.


1
Nursing Home Medication Safety Bringing new
tools to old challenges.
  • Amy Vogelsmeier PhD RN
  • Jill Scott-Cawiezell, Principal Investigator, PhD
    RN FAAN
  • AHRQ 5 UC1 HS014281-02HRQ

2
Primary Study Aim
  • Evaluated the impact of technology and focused
    quality improvement efforts upon medication
    safety practices.

3
Study Overview
  • Five nursing homes in three states participated
    in the study
  • Ranging in size from 60 to 400 beds
  • Both urban and rural
  • Both profit and not-for-profit
  • The nursing homes implemented full EHR and then
    eMAR.
  • The team observed medication administration and
    related processes for approximately 16,000
    medications.
  • Nursing homes each had a focused quality
    improvement team that met monthly throughout for
    about two years.

4
(No Transcript)
5
How Has Technology Helped the Medication
Administration Process?
  • Documentation of assessment parameters correlated
    to specific medications helped link clinical data
    to medication administration.
  • Elimination of monthly MAR change over reduced
    risk of medication errors and saved valuable
    staff time.

6
How Has Technology Helped the Medication
Administration Process?
  • Flags on eMAR are helpful the addition of
    green flags for new orders and yellow highlight
    for PRN monitoring have seen a positive response
    from staff.
  • Reduced transcription from five points to two
    points with the potential to go to remote
    physician access.

7
Pre eMAR Order Entry
8
Post eMAR Order Entry
9
Using Data to Improve Processes
  • New order reports identify new orders from the
    past 24 hours
  • Useful to stay current on resident condition and
    verify accuracy of new orders
  • High risk medication reports, such as
    anticoagulant and psychotropic agents, identify
    specific residents that may require careful
    monitoring and identify facility-wide trends of
    medication use

10
Using Data to Improve Processes
  • Late medications tracked via time stamping of
    actual medication administration times
  • Useful to identify trends of high volume
    medication passes and systems issues that impede
    medication administration
  • 30 day look back provides a 30 day MAR for each
    resident.
  • Medication exception report tracks documentation
    as to why medications were not administered
  • Useful to identify systems impeding medication
    administration

11
Moving from Paper to Touch Screen
  • Quicker process
  • Legible MAR
  • Focused eMAR for current medication
    administration
  • More organized medication administration
  • More accessible MAR
  • More accessible related health information
  • Real time medication orders

12
Technology Uptake Can Lead to Improvement
  • Maximizing success with technology requires
    diligence and creating interfaces which lead to
    updated clinical processes.
  • Data, data, data can drive how to maximize
    technology to improve resident safety and guide
    more directed and focused process improvement
    strategies.
  • Workarounds are a reality and occur despite good
    process improvement or instead of good process
    improvement.

13
What is a Workaround?
  • An informal temporary practice for handling
    exceptions to normal workflow.
  • A workaround occurs as a worker perceives some
    disruption or block in the system that prevents
    the worker from completing a task as desired.

14
Workarounds when the process had been improved
and integrated into technological updates.
Clinical Process Block Workaround
Medication dose limits in eMAR dictionary Unsafe dose not available in dictionary Selecting dose not matching ordered dose.
Administering medications using eMAR Time, perceived workload Administering medications via the dispensing device without checking eMAR
15
Workarounds when the process had not been
improved and integrated into the technological
updates.
Clinical Process Block Workaround
Accessing EHR for clinical information. Slow wireless system Relied on handwritten notes and verbal information exchange.
Communicating new orders to pharmacy. One fax machine for 180 residents available 24 hours a day. Handwriting and calling new orders to pharmacy.
16
How Facilities Defined Success
  • Data from the eMAR systems results in good QI
    information.
  • Increased communication, increased focus on the
    work, and a heightened awareness of the potential
    for mistakes we cannot let our guard down, we
    always need to think about the potential for
    error.
  • Recognizing that systems are underlying most
    errors feel like we are becoming better problem
    solvers.

17
What Have Been the Biggest Challenges?
  • Working with state surveyors.
  • Learning to maximize the use of data for real
    information.
  • Underestimating the learning curve.
  • Managing implementation with limited onsite
    resources.
  • Recognizing that technology will not solve all
    the problems.
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