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By Jeannell M. Mansur, RPh, PharmD, FASHP
Practice Leader, Medication Safety
Joint Commission Resources, Inc.
Driven by regulatory agencies as well as their own desire to make the practice of medicine safer and more effective, hospitals are investing considerable resources in technology that automates processes and eliminates paper. Increasingly, we're seeing a convergence of technologies — a physician writes an order, an infusion pump delivers the drug to a patient, and the information that is captured is stored in an electronic health record.
The deployment of this technology at different points in the medication process is growing rapidly, and many organizations have achieved outstanding results that have made medicine safer and more efficient for patients. The fact that use of technology is not even more widespread can be attributed in part to the reality that implementing these systems is complex; demands considerable resources of money, time and talent; and must be constantly updated to be effective.
Ensuring a Successful Deployment
To achieve successful deployments, health organizations must develop a clear understanding of what is required in terms of people, time and resources. As the number of implementations has grown, we are now at a point where we can learn valuable lessons based on experience.
For example, the successful rollout of any medication administration technology, whether Computerized Provider Order Entry (CPOE) or bar-code readers, demands the realization that signing a vendor contract is just one of many steps along the way.
Setting the Stage
A healthcare institution must begin by:
 Carefully evaluating vendors and their products.
Seeking out advice and lessons learned from other
organizations who have implemented this technology.
Understanding the care setting — inpatient,
emergency room, surgical suite or ambulatory.
Examining current workflow processes and
procedures for risks and inefficiencies. Don't automate
bad processes.
Deciding on the best sequencing of
technologies — which do you implement first?
Involving clinicians and staff affected by
technology and ensuring they interact with IT staff.
Assessing supporting procedures, technologies
and resources.
Developing processes to monitor and correct
problems during implementation.
Setting clear responsibilities for staff
involved in the implementation.
Using the Available Expertise — External and Internal
External: When considering different vendors, all groups – clinical, financial and information technology staffs – should be involved in the selection process. Outside evaluations such as KLAS ratings and the experiences of other healthcare institutions can provide a means of judging specific providers and applications.
Internal: Insiders can help in evaluating the unique needs of the setting that the technology will affect. What works in an inpatient environment may be totally out of place in the emergency department or an ambulatory clinic. The needs and the processes are different, and one product will not fit all departments and settings.
Evaluating the Need for Process Change
Another reason to avoid imposing a system on a clinical setting lies in the way technology changes processes. Moving from a paper-based system to an electronic one involves far-reaching changes in work habits and procedures. When a physician uses CPOE to create a medication order for a particular patient, the steps required are going to be very different than using a paper document.
The organization must appreciate and understand how that technology is going to influence the process and workflow of caregivers. For example, medication alerts provide valuable data that can prevent adverse drug incidents. Yet too many warnings that have to be overridden can create "alert fatigue" and ultimately lull clinicians into ignoring real problems.
Keeping Technology Effective
IT administrators need to install software updates to support the continued effectiveness of the technology. For example, required upgrades ensure new drugs and their interactions with other medications are incorporated into the database to prevent medication errors. By staying current with software updates, health systems maintain the benefits of technology.
In the years to come, more organizations will implement technology as they see the benefits that can be reaped. It has become very clear that good technology properly implemented can help prevent medication errors. It is when technology is not implemented with a clear understanding of work process that these systems can introduce their own problems.
Jeannell Mansur is Practice Leader for Medication Safety with Joint Commission Resources (JCR), which provides consulting, education and publication solutions to its worldwide clients. Dr. Mansur provides leadership to clients and JCR on medication system design and enhancement, technology implementation, medication safety design and sustainability within the medication processes. She has published and presented extensively in the areas of medication safety and pharmacy operations improvement. Dr. Mansur has consulted throughout the US and internationally in Asia and the Middle East.
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A Sentinel Event Alert from the Joint Commission, issued in December 2008, examines actions to help safely implement health IT and converging technologies, such as medical devices. The alert cautions providers of the safety risks and preventable adverse events that could occur from the interaction of humans with the technology or from the design of the system. The alert recommends that technology implementations include clinicians and staff in planning, and take into account the workflow process, adoption and other factors.
Read the Joint Commission Alert for 13 actions that can help promote patient safety related to the implementation and use of health IT and converging technologies.
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