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Reducing Errors at St. Clair Hospital

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When it comes to medication administration, nurses at St. Clair Hospital, Pittsburgh, offer their patients a higher level of safety, thanks to barcode point-of-care and radio frequency identification (RFID) on a single handheld device.

Perhaps most importantly, the integrated technology has helped to reduce medication errors at St. Clair by 16 percent in the last year, according to Joan Massella, MBA, MEd, RN, St. Clair's chief nursing officer.

The system uses RFID for patient identification and user sign-on. When a handheld computer - in this case, pocket PC - is placed within 3 inches of the patient or user ID, the personalized data is automatically updated into the hospital's information system; if the information syncs, the device is activated.

The system decreases the number of steps in the process of medication administration and saves time for the nurse by automatically recording the transaction to the patient's electronic medical record.

Safety Features

Studies have shown that in hospitals, up to 32 percent of adult patient medication errors occur in the administration stage. Technologies are helping to address these errors. However, the process begins with the electronic entry of the physician's orders. Sue Ann Langfitt, RN, nurse manager at St. Clair, said the process incorporates an important safety feature: the medication cannot be dispensed until it has been confirmed by the pharmacy.

Another safety feature requires the nurse to electronically chart the administration. If the user fails to chart the medications and attempts to directly select a new patient or scan additional medications, the system issues an alert.

Nursing Input

St. Clair has been using the system for about 4 years, Massella said, and the nursing staff was involved with the deployment.

Langfitt added: "During the rollout, nurses were encouraged to provide their input, to bring information from the floor. This led to significant changes in how we implemented the system, which ultimately resulted in enhanced patient safety and workflow management."

She also noted that as part of the rollout, nursing managers worked closely with their staff to resolve issues related to using the technology. "In this way, we could hone in on a problem and work toward raising the nurses' comfort level with the system," said Langfitt.

Accountability

With nurses on the front line of medication administration accountability, both Langfitt and Massella, feel the expectation with this system was that nurses would use the technology and the system would back up accountability.

Massella said the system is used for almost all medications administered to in-house patients. "There are exceptions," she said. "We cannot use the system in an emergency situation where an order has not been entered or verified. The system can, however, still be used for identification of the patient if the medication does not have a barcode."

Massella said the hospital's information technology (IT) department is responsible for training staff on the system. "We also have a nurse who works part-time in IT to provide training and assistance to nurses," she said. "This level of cooperation between IT and the front-line staff only serves to make nurses more comfortable with the technology.

"Nurses have found [the system] to be fairly fool-proof," she added. "It didn't take them long to adjust, and now both nurses and patients have come to embrace and even rely upon it."

In 2007, St. Clair Hospital was one of six hospitals in the U.S. to receive a Stage 6 designation from HIMSS Analytics, a leading healthcare information technology research firm. Stage 6 is a classification of hospitals that have successfully implemented information technologies to improve quality outcomes, patient safety and planning for future business changes. St. Clair was also recognized as a best practice facility from the Institute for HealthCare Improvement (IHI) for medication reconciliation.

Ellen J. Hoffmeister is a freelance writer. 


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