Not long ago, the hospitals in the Lifespan network did things the same way as most of their peers. Doctors handwrote their orders, or just told a resident or a nurse what to do. Patients’ records were kept on paper, attached to clipboards or in folders.
What visitors to Rhode Island Hospital saw on Monday, however, was very different.
Doctors logged on to computers on which they could access, from a single screen, every test result, every X-ray, every medication administered, every note taken during rounds – and then enter new orders for tests, procedures and drugs.
Nurses logged on to see the pending orders for each of their patients, then scanned bar codes on the containers of the drugs to be administered and the patients’ wristbands, to ensure the drugs were going to the right person, at the right time, in the right dose.
Had the visitors peeked into the hospital’s pharmacy, they would’ve seen what happened in between the doctors’ and the nurses’ actions: pharmacists going through the orders, one by one, ensuring no mistakes were being made, and flagging any possible problems.
This is computerized physician order entry (CPOE) taken all the way – a rarity still in U.S. hospitals. A February report by KLAS Enterprises showed only 327, or 5.7 percent, of the nation’s 5,759 civilian hospitals had CPOE systems in place (up from 4.1 percent in 2005), and only 187 reported that doctors used them for at least half their orders.
In Rhode Island, some hospitals have computerized individual functions, such as emergency department patient tracking at Memorial Hospital of Rhode Island. And the Care New England network is preparing to implement an enterprise-wide system.
But Lifespan has been recognized nationally for being ahead of the curve; in fact, the hospital network’s efforts were a key part of why last week Rhode Island was recognized for having the highest rate of e-prescribing in the nation (see related story on Page 27).
As Gov. Donald L. Carcieri was accepting the award at the State House, Lifespan clinical, pharmaceutical and IT leaders were hosting a national symposium with Siemens, one of the primary vendors involved in developing Lifespan’s records and order entry system.
Charles Mahoney, director of pharmacy and materials management for the network, described the progression from paper to a fully electronic system, starting with the adoption, in 2000, of the Pyxis Rx system, which allowed pharmacists to manage drug dispensing online.
Over the course of several years, the Lifespan hospitals adopted a separate electronic records system, began having doctors enter their orders online, then began integrating the two systems. At this point, said Dr. Reid Coleman, medical director for information services, Rhode Island Hospital, Hasbro Children’s Hospital, The Miriam Hospital and Newport Hospital all have fully operational, integrated patient record, physician order entry, and pharmacy systems.
Mahoney said the integrated system has dramatically sped up order turnaround, from an average of 90 minutes, to 11. Because the program checks for common drug interactions, allergies, etc., doctors are making fewer mistakes when they enter orders, he said: 86 percent fewer missed drug allergies, for example, and 35 percent fewer excessive doses.
At the same time, by connecting the doctors’ orders to patients’ lab results, Mahoney said, the system has enabled pharmacists to catch twice as many errors involving such things as doses that could harm the kidneys.
Each intervention not only spares the patient’s health, Mahoney noted, but also saves money – an estimated $4,696 per incident, or hundreds of thousands of dollars each year.
The final piece of Lifespan’s CPOE system, label scanning, began being implemented at Rhode Island Hospital in December, and is now used in about 40 percent of the units at that facility and Hasbro, and about 30 percent of units at Newport Hospital, Coleman said.
Sue Whetstone, manager of nursing informatics, said the scanning system (Siemens MAK) ensures “the five rights: right patient, right drug, right dose, right route, right time.”
Implementing the system has taken extensive training and support, she said, but nurses who might have been resistant at first quickly saw the value – when, for example, a nurse thinking she was holding one drug scanned it, got an error message and realized that she’d come close to administering the wrong medication.
“As soon as they see that, they realize it’s a huge patient safety initiative,” she said.
On a tour afterward of a unit using the full system, Dr. Dominick Tammaro, an internist and coordinator of Rhode Island Hospital’s residency program, said that every quarter doctors get a detailed report of their errors, and he’s using it as an educational tool. Each resident can look at his or her own mistakes, but the most common errors make it onto handouts he gives to all the doctors.
Since that began, Tammaro said, “there was a huge drop in the incidence of errors.”