Originally Published MDDI May 2005
|Coming soon: The Alaris Auto-ID Module and Application will capture patient and clinician ID as well as order information.|
Although they may need more persuasion, hospitals will increase their use of point-of-care medication management systems (MMS) over the next five years, say industry experts. While the issue has been in the public eye for more than five years, adoption has been slow. Today, about 3% of hospitals use MMS, but system makers are starting to see progress.
“Automating the medication-use process is absolutely the wave of the future,” says Robert Christiansen, market manager for pharmacy solutions at Siemens Medical Solutions USA Inc. (Malvern, PA). “I don't see it turning back. Momentum is picking up, and the message is out there.”
The issue made headlines with a 1999 report from the Institute of Medicine. It claimed that between 44,000 and 98,000 Americans die each year from medical errors, many involving medication. MMS makers have used such reports to persuade hospitals to try their systems.
“If it gets to the point that someone's about to give the wrong medication to the patient, there's a 98% chance that the error won't be caught,” says Teecie Cozad, vice president of marketing at DocuSys Inc. Based in Mobile, AL, the company provides a system for the operating room that digitizes the anesthesia process.
As Cozad notes, the point of care is the critical one for ensuring safety. The MMS verifies the “five rights” of medication at the point of administration: right drug, right dose, right route, right time, right patient. Cozad asks hospital officials to look at errors that can be caught at the point of administration. She says they should consider critical care areas, such as ORs or intensive-care units, where potential errors could cause the most dangerous and catastrophic results.
|Cardinal Health's Pyxis PatientStation contains clinical information, along with patient access to perks, like television and the Internet.|
Getting the systems to work isn't always simple. Sometimes it's a matter of trial and error, says Don Rucker, chief medical officer at Siemens. “Part of the challenge is that this involves putting an electronic system in a place where it's never been used. Bedside checking is just not part of standard nursing training or experience. Once you have the infrastructure, things seem to go a lot more smoothly. The resistance is a combination of inertia from infrastructure and the need to have a pharmacy system that supports it. Hospitals are in various stages of willingness to replace their pharmacy systems with one that supports bar coding. If they're happy with their system, or it's recently been installed, it's unlikely that they'll want to remove it.
According to a PricewaterhouseCoopers report, hospitals spend 2.5% of their operating budget on technology. Those en route to digitization spend 3–5%. The costs seem to be worth it. Technologically advanced hospitals, says the report, have fewer medical errors.
To be effective, systems must not obstruct communication between nurses and patients. Work flow is a key concept, says Barbara Trohimovich, senior manager of clinical development for medication management at Hospira Inc. (Lake Forest, IL). “As with any electronic system, making work flow consistent with caregiver practice is a design goal that we focus on while developing software,” she says. “The what-ifs take the most time in terms of figuring out an acceptable solution that's not cumbersome for the caregiver.”
|Siemens' Medical Administration Check is designed to verify the five rights at the point of care.|
Because medication management systems exist in parts and pieces today, it can be a task for a hospital and a company to coordinate the information process throughout an entire system. “On the practice side, a challenge is to establish best practice methods and provide the support services to assist hospitals to create standards of practice that reflect their real practice,” says Claudia Russell, a vice president at Cardinal Health (Dublin, OH). “The technology challenges exist, because there are many generations of products in the market to connect.”
Sometimes firms have entered partnerships to provide better solutions. One example of this is Bridge Medical Inc. (Solana Beach, CA) and Hospira. The two recently combined their respective systems into one that uses wireless technology, connecting IV infusion devices with bar code medication administration verification. And last year, Cardinal Health acquired Alaris Medical Systems (San Diego) and then touted itself as the first to offer hospitals an integrated end-to-end MMS.
Hospital administrators will continue to look into MMS products, especially with all the negative attention being given to medication errors. Says Trohimovich, “I think we're on the beginning of the curve toward increased hospital adoptions of these kinds of systems.”
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