with technology without fully understanding the user’s workfl ow. Any technology that does not meet the needs of the end user is likely to, in some way, be circumvented – in this case defeating the security enhancements. T e solution we chose fulfi lls as many “wish list” items as pos-
sible. Currently, we provide four core drawer confi gurations to meet the needs of distinct nursing populations and, most recently, our respiratory therapists. T e drawer systems are modular and can be replaced or reconfi gured on the nursing unit within minutes. Locking mechanisms are robust and durable. Carts are powered by a pair of lithium-ion batteries, providing up to 17 hours when fully charged; they can be hot-swapped from one cart to another when required. T e carts are heavy, but they roll very easily thanks to large wheels and a low center of gravity. T e drawers have hard plastic liners that can be easily removed for cleaning. T e range on the powered (nurses love powered) height adjustment easily meets the needs of our tallest and shortest staff members. Since our carts integrate into the ADC platform, Omnicell,
the staff benefi ts from a Web-based application called Anywher- eRN, which allows them to remotely schedule medications for removal from the ADC; this saves time and helps minimize lines, or queuing, at the cabinet. T e same application allows for remote documentation of waste for controlled substances, which was an additional security concern. Previously, two nurses would have to return to the ADC to document waste. T is could result in a staff member holding on to waste while waiting for a co-worker to become available. Remote waste continues to require two professionals for documenta- tion, but it’s done in a way that better integrates into workfl ow and is closer to real time. AnywhereRN also helps us
minimize interruptions in nurses’ workfl ow, which is a known risk for errors. According to a study pub- lished in JAMA Internal Medicine
The Omnicell Savvy Mobile Medication Workstation streamlines the medication administration process and provides safe and secure transportation of medications from the automated dispensing cabinet (ADC) to the patient’s bedside.
(April 26, 2010) titled, “Association of Interruptions With an Increased Risk and Severity of Medication Administration Errors,” the risk of a serious medication error doubles when a nurse is interrupted four times in the course of administer- ing a drug. T e mobile medication workstations help minimize this risk by enabling nurses to queue up medications from a quieter area, where they are less likely to be interrupted.
Here are a few helpful tips to aid with compliance:
• Work as a team: In order to ensure safe medication distri- bution, all departments must pursue the common goal of improving patient safety. T e pharmacy is instrumental in this pursuit by working with nursing, respiratory therapy, behavioral health, anesthesiology and other departments to understand each area’s medication needs. Listening to and communicating regularly with each department to deter- mine how medication needs can be safely met will improve medication management throughout the facility. Although pharmacy drove the acquisition of the cartless medication administration system at ECMC, our nursing staff is the most directly aff ected as the end users of the actual ADCs and mobile workstations. Figure out how to minimize the impact on workfl ow while still fulfi lling the regulations. You want to avoid having people circumvent safe practices.
• Involve the IT department early and often: Many of our projects are IT heavy. Earlier carts were computers on wheels with locking drawers. T ere was a battle as to who owned and fi xed them. Since the cart involved a computer, it ended up in IT’s lap. With an ever increasing project load on IT, work needed to be prioritized; a cart needing a 10-minute repair might have stayed out of service for days due to other priorities. While obtaining feedback from grassroots people on what products to purchase, you will also want to get IT staff involved as early as possible to ensure projects receive the dedicated resources on the timeline required. When we brought the current carts into the hospital, the pharmacy agreed to own and fi x any part of it other than the actual computer. Since the unit is modular, it is easy to service on- site, and we did not need a large fl eet of back-up carts. Most repairs can be made on the nursing unit.
• Train, train, train: Nothing can be done without the end users. Technology specialists understand the mechanics of new technology. In the same way, nurses and pharmacists are experts in their fi elds; they understand the dynamic fl ow of patient care and medication dosing, and the frequent interactions needed between numerous healthcare providers to provide that care. It is important for nurses to understand new technology, and for technology engineers to understand how the equipment and software will need to interface with the facility’s existing systems.
• Grassroots feedback: Involving the end users throughout all phases of the process, including the implementation and evaluation phases, is an important key to success in using these technologies.
By working as a team, including the IT department, adequately training staff and listening to grassroots feedback, ECMC has been able to meet and adhere to medication management standards. T e latest advances in medication tracking, storage, distribution and security help us drive effi ciency and improve patient safety. HMT
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