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In 2003, it was time for Children's Hospital of
Wisconsin, a 236-bed facility located in Milwaukee, Wisconsin, to replace its
decentralized medication cabinets in 21 nursing stations. A multidisciplinary
team of pharmacy, information technology, and nursing staff was assembled to
select a new vendor. The team's primary focus in acquiring technology was to
enhance patient safety, although each member had disparate needs and concerns.
After a thorough analysis of the pros and cons of several systems, the group
unanimously agreed on one system engineered with medication safety at the top
of its functionality. Factors like built-in access controls and true unit-dose
dispensing greatly impressed Children's Hospital. The new cabinets have not
only saved the hospital time and money, they have also improved the
satisfaction of the nursing staff, who report that the units help them do
their jobs more efficiently.
An Expectation of Excellence
As the only stand-alone children's hospital in its state, Children's Hospital
of Wisconsin is a highly respected and technologically advanced facility. It
was named one of Child magazine's 10 best hospitals for children in
2007. In the 247-question survey of the National Association of Children's
Hospitals and Related Institutions, Child magazine examined many facets
of the organization, including efforts to reduce medical errors.
A prime example of technology for patient safety
is automated medication dispensing cabinets. Three years ago, the system at
Children's Hospital was in need of an update. The old SureMed system no longer
met our needs. I headed the selection process. I had previous experience with
MedSelect while serving as Director of Pharmacy (DoP) for Milwaukee's Covenant
St. Francis Hospital. It was clear that the MedSelect organization (owned by
AmerisourceBergen) put a premium on security, accuracy, and ease of use.
However, it would have been unwise to make a unilateral decision for all of
Children's Hospital based solely on one person's input.
I engaged a multidisciplinary committee. We sent
out requests for information, and then I stepped into the background. The
committee--composed of pharmacy, IT, and nursing staff--examined all the
products on the market from three well-known vendors. The group conducted a
thorough analysis of the advantages and disadvantages of each system and
overwhelmingly voted for MedSelect.
Children's Hospital began installing MedSelect
cabinets in February 2004, and AmerisourceBergen was a very helpful partner in
the process. The company helped design the right solution for each floor and
ultimately installed units in 21 locations. A new narcotic vault system was
also installed in the pharmacy that included 10 MedSelect cabinets plus
MedSelect's Centrack software. On average, each nursing station is composed of
about four modules. The normal configuration is a Display Terminal with a
touch screen, bar code reader, and badge scanner for safe access; a Unit-Dose
Module; a Drawer Module; and a Supply Cabinet. Overall, we have more than 100
MedSelect cabinets in our hospital in 21 nursing units and the Central
Pharmacy.
The Features We Need and Then Some
The number one reason we chose MedSelect is that it enhances medication
safety. We are a very patient safety–oriented hospital. That is our primary
focus for investing in technology.
In addition, MedSelect is easy to use. It takes 30
to 60 minutes for a nurse to become familiar with it. It probably takes less
than 30 seconds to get a medication out of the system. We receive daily
reports to streamline the stocking process. Although stocking all the cabinets
is inherently a laborious procedure, we are confident that restocking the
MedSelect units is faster than it would be with other systems.
The ease of use and time saved make MedSelect
popular with our nursing staff. Of great importance is MedSelect's ability to
manage unit-dose medications through the Unit-Dose Module. With this module,
nurses do not need to do counts with each dispense. Medications that are
stocked in the Unit-Dose Module no longer require end-of-shift counts. It used
to take two nurses on every shift at least 30 minutes per person to run counts
at all 21 medication rooms. That added up to plenty of hours, money, and
productivity that we have saved due to using MedSelect.
When Children's Hospital was originally built, the
medication rooms were very small and not standardized across units. On some
nursing floors, the limited space allows only a display terminal and the
minidrawer module cabinets to store medications. But on other floors, there is
more space. We felt MedSelect's modular designs helped address our space
issues much better than the other vendors' systems. Overall, the capability to
design the MedSelect cabinets to suit our size requirements makes MedSelect a
much better choice in terms of utilization of space compared with the other
options we considered.
When MedSelect was installed, AmerisourceBergen
was receptive to our suggestions and made some useful modifications to the
system, as well as other improvements and updates that have had a significant
impact. Most notably, Centrack software has helped us do a good job handling
our controlled substances. In addition, every unit-dose product is bar coded.
The medication must be matched to the storage slot before restocking.
Additionally, dispense verification, a built-in control that prevents errors,
provides another check. Dispense verification was a unique feature to see in
cabinets and is a safe process.
AmerisourceBergen also added biometric access,
which is working well. Nurses can scan their badges and use the biometric
scanner to have almost instant access. This new biometric feature allows each
user to register multiple fingers. All it requires is a badge swipe and a
finger swipe, and the nurse is in and out, usually in less than five seconds.
We have not had any problem integrating and
interfacing MedSelect with any of our information systems. At Children's
Hospital, some of our requirements included limiting access to orders to
create a safer environment. That was already built into the MedSelect MedOrder
interface. Pharmacy can control access to scheduled medications by a due and
late window.
The Examiner data analysis and reporting
functionality (provided with the MedSelect System) is much more robust than
what we had seen from other vendors. When we must produce or analyze data
quickly, we have it all at our fingertips. There are some useful features in
MedSelect's data-collecting, sorting, and filtering, such as the breadth of
reports, the ability to easily learn and master the system without much
training, and the capability to create reports specific to our organization.
Although the canned reports are good, we can also modify any of the more than
100 standard reports available from the extensive report-writing catalogue.
The ability to store the data as a Microsoft Excel file and manipulate it even
further is also a great feature, not to mention that the information is stored
for up to five years. We can track staff members' medication dispensing
history over time and across locations when needed and chart trends and
outliers.
I wasn't surprised that the addition of MedSelect
cabinets has gone so well. I believe I speak for the others who were part of
our original interdisciplinary selection team when I say that the MedSelect
cabinets and software were the right technology to bring onto our nursing
floors.
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