Island Health – Implementation of a
fully automated Electronic Health
Record and Closed Loop Medication
System – lessons learned
Jan Walker
Regional Leader, Medication Safety
Clinical Lead UDMD Project
Quality & Patient Safety
Russ Swaga
Manager Pharmacy Informatics
Pharmacy Lead, IHealth
The right drug, the right dose, given to the right patient, at the right time…..
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OHC Services the Oceanside geographic area
consisting of approximately 50,000 residents.
Provides urgent care, medical day care, medical
imaging, outpatient laboratory, primary care and
integrated community care services (mental
health, seniors health, home and community
care, diabetes and home support)
Center is open from 0730-1030 daily.
Seriously ill clients needing continuing care are
referred to one of 3 hospitals close by: Westcoast
General, St. Joseph’s General or Nanaimo
Regional General hospitals.
Medication Errors - Preventable Categories
 22million medications are mixed annually
 14 million are mixed by nurses
 8 million are mixed by pharmacy
Systems and Processes to support Medication Error Reduction
CPOE – Computerized Provider Order Entry
eMAR – Electronic Medication Administration Record
ADC – Automated Dispensing Cabinets
PPID- Positive Patient Identification (bar code scanning)
BBVM – Bedside Barcode Verification of Medications (bar code scanning)
Closed Loop Medication System (CLMS)
Evidence Based Order
Sets
Documentation
Prescribing
Dose Range Checking
Adverse Drug Event
Rules
Med Reconciliation
Administration
Transcribing
Ordering
and
Dispensing
15906
16000
14000
12000
10000
BPMH's Documented
Prescriptions Documented
8000
4957
4159
6000
4000
1325
2000
0
Urgent Care
Primary Care
61.3%
# of Patient Encounters with No BPMH
# of Patient Encounters with BPMH Performed
Barcode Scanning in Oceanside Health Centre Urgent Care
100.00%
90.00%
80.00%
70.00%
% of Positive Medication
60.00%
Identification
50.00%
% of Positive Patient
Identification
40.00%
30.00%
20.00%
10.00%
Dec-14
Nov-14
Oct-14
Sep-14
Aug-14
Jul-14
Jun-14
May-14
Apr-14
Mar-14
Feb-14
Jan-14
Dec-13
Nov-13
Oct-13
Sep-13
0.00%
Order for Gravol inj:
:
Nurse scanned diphenhydrAMINE 50 mg/mL Vial – 1 mL (Benadryl) and
received a warning
Nurse retrieved correct medication, scanned and administered
:
Nurse scanned tetanus imm.glob.hum.
250 unit syr -1 mL for the order below
and received an alert, prompting her to
realize it was the wrong vaccine..
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Education is key
Physician engagement is key
Timely order entry is key
All professionals working within scope is key
Appropriate staffing levels is key
Understanding workload and workflow is key
Computer login lag is a determinant
Non Scannable Medications is a determinant
Leadership turnovers early in adoption phase
is a determinant
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Engage end users as early in the design
process as possible
Ensure all stakeholders are involved
◦ Nursing, Pharmacy, Quality and Safety (MedSafety),
Informatics, and I.T.
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Factor in ongoing support and maintenance
into Project Plan
After stabilization, have an auditing and
metrics plan in place that is tied to a
Continuous Quality Improvement (CQI)
strategy
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Implementation of a fully electronic health
record, throughout acute and residential
services within Island Health
◦ One patient – One record wherever possible within
the organization
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A fully functional closed loop medication
administration system throughout acute and
residential services within Island Health
◦ Safer medication practices to enhance safe patient
care and reduced medication error incidents
A vision needs people – the right
people!