In the previous installment of our Avoiding Medication Errors series, we looked at how vast the issue is, with over 7,000 deaths occurring annually.  Today in part 2, we’ll look at how Mobile Device integration impacts the reduction of medication errors with an EHR. 

Let’s frame this in terms of a reality that most every clinician and nursing executive can relate to:  with centralized medication storage on each unit (i.e. Pyxsis or Omnicell machines) how does one best integrate mobile devices for bedside medication verification into the nursing workflow and still meet Joint Commission Standards and FDA recommendations?

In traveling around the country and working with various healthcare facilities, we’ve seen numerous  models for BMV currently being adopted, including:

1. Assigning one medication pass nurse to administer all patient medications per shift via a medication cart that carries all the patients required medications

2. Using shared mobile workstations with drawers to transfer patient medications out of the Pyxsis or Omnicell units to pass medications

3. Using dedicated mobile workstations (1 per clinician) with drawers to transfer patient medications out of the Pyxsis or Omnicell units to pass medications

4. Using wallmounted cabinets inside or outside the patient room to store and access patient medications

5. Hand-carrying individual patient medications from the Pyxsis or Omnicell to the patient room for medication passes

There are pros and cons to each of these models as outlined below:

TIME IS ON MY SIDE … YES IT IS.   OR IS IT?
Assigning one medication pass nurse per shift to administer all patient medications via a medication cart that safely accommodates all patients’ required medications can be difficult.  Joint Commission standards state that a medication must be administered within 30 minutes of the scheduled dosage time.  It can take a large unit with 20+ patients as much as 4 – 5 hours to complete a single medication pass depending on the number of patients and their corresponding medications.

IT’S NOT SIMPLY “SHARE AND SHARE ALIKE”
Using shared mobile workstations with medication drawers to transfer patient medication from the Pyxsis or Omnicell to the patient bedside can lead to medication errors even with individualized patient medication drawers.  Medications can be inadvertently placed in the wrong patient’s drawer (extra time can be spent searching for medications between patient drawers in these instances), unadministered or refused medications may not make it back into the Pyxsis or Omnicell in a timely manner, if at all, and often medications are left or forgotten in the patient drawers for several days after patient discharge.

BEWARE THE LURE OF THE “CATCH-ALL”
Using dedicated mobile workstations (1 per clinician) with drawers that allow for transfer of medications out of the Pyxsis or Omnicell to the patient bedside often result in the drawers becoming a catch-all for nursing supplies intermixed with patient medications.  These drawers are often propped open during bedside procedures or med administration leaving the patient medications unsecure.  In the event of an emergency (i.e. a code) where the clinician is called away during a medication pass, the drawers can be left open and unattended for thirty minutes to an hour.

LOCATION WILL AFFECT DISTRIBUTION
Using wallmounted cabinets inside or outside the patient room for patient medications can increase the time pharmacy requires to distribute medications and often requires an increase in pharmacy headcount.  This also increases the number of areas throughout the hospital where medications are stored, need to be monitored and managed.  It is important to have strong security with this type of system.

ARE YOU WEARING COMFORTABLE SHOES?
Hand carrying individual patient medications from the Pyxsis or Omnicell to the patient room for medication passes can increase the time spent going to and from the Pyxsis or Omnicell to patient rooms.  It can also jeopardize medication integrity and increase the risk of misplaced medications if the clinician places the medication in their pocket against the body during transfer.

It is important to integrate the correct mobile device strategy for your particular workflows when implementing a BMV.  Be sure to include a risk assessment of the various models for BMV being considered and select the strategy that best fits into your workflows.

Stay tuned as we share some of the “lessons learned” from previous customer implementations in our next post.