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Baptist Health EnhancesSafety Using Medication Management Automation By Eric McVey, MD Vice President and Chief Medical Officer Baptist Health Systems, Jackson, Miss.  Eliminating Medication Errors Patient safety goes by many different names, including quality assurance and performance improvement. Regardless of the name, it has been the mission of Baptist Health Systems for many years. And now that numerous government and watchdog organizations have assigned a "body count" to problems such as medication errors, patient safety has become a hot-button issue. This spotlight provides added impetus for healthcare providers to focus on improving medication management. Our goal at Baptist? Provide safe patient care, from start to finish. To stay on track, we proactively identify where things can go wrong and then determine how to prevent the potential problems. Using this root cause analysis approach, we have identified gaps in our armor and are improving them through policy changes, workflow modifications and implementation of information technology solutions. Automating Medication Management Instead of simply "fixing" problems using technology solutions, we decided we would only invest in technologies that support the most effective workflow. A multidisciplinary task force identified as many as a dozen potential missteps in our process. We found vulnerabilities because of our practice to manually route medication orders from physicians to pharmacists to nurses to patients. More than 40 nurses and pharmacists participated in this medication administration review of more than 4,000 orders. Around 80 staff members took part in 150 hours of process redesign workshops. These efforts resulted in the resolution of more than 230 process issues and the creation of 34 workflow redesigns. Not only did we improve the overall process, but in some cases, we eliminated entire processes. Such extensive analysis made it possible for us to invest in technologies that met the needs of an optimal workflow. For example, instead of stocking unit-based cabinets with medications for all patients, we began using multiple medication carts on each floor. Now nurses don't have to wait in line at the dispensing cabinet. This single change has resulted in the elimination of 14,000 hours of idle time for nurses each year. Most importantly, the solutions, which include computerized provider order entry (CPOE), pharmacy automation, bar-coded medication administration and robotic dispensing technologies, work in concert to prevent errors. The solutions ensure the "five rights" of medication management — right drug, right patient, right dose, right time, and right route of administration. The redesign reduced the manual hand-offs where errors could occur and streamlined the medication delivery process at the same time. As Baptist has rolled out the systems, nursing units have administered more than 90% of medications electronically. As a result, more than 70% of our nurses and pharmacists report that the technology has helped them avert potentially dangerous mistakes. Moving Patient Safety to New Heights To truly affect patient safety, however, we realize how important it is to implement integrated information systems that support our over-arching quality goals — not merely employ stand-alone technologies. To that end, in addition to medication management automation, we rely on an electronic health records (EHR) system and a physician portal to enhance overall patient safety. With the EHR, clinicians gain immediate access to patient-specific information, while the portal adds value by enabling doctors to access patient data including radiology images, laboratory results and transcriptions anytime, anywhere. To move the patient safety needle even more, we plan to enhance clinical decision support tools in the future. We want to be sure physicians have all the relevant clinical research at their fingertips so they can make evidence-based decisions on the care decision at hand. The Continuous Quest to Improve Quality Through the automation of our medication management process, we have drastically reduced errors — but we know that the quest to provide safe patient care is never ending. As we move forward, we will continue to assess care, identify potential areas for improvements and implement technologies to support the optimal patient care experience. Our clinicians and patients deserve nothing less. Eric A. McVey, III, MD, currently serves as Vice President and Chief Medical Officer of Mississippi Baptist Health Systems. Dr. McVey is certified by the American Board of Internal Medicine in the specialty of internal medicine and the subspecialty of infectious diseases. He maintains a clinical appointment at the University of Mississippi School of Medicine as Assistant Clinical Professor. He has served as Chairman of the Council on Medical Education of the Mississippi State Medical Association, President of the Central Medical Society, and Chairman of the Board of Directors of the Mississippi Foundation for Medical Care, the peer review organization for the state of Mississippi. 
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