Pharmacists
are the Key to Success for Sturdy Memorial Hospital's CPOE
Implementation
(6/12/2009)
Sturdy
Memorial Hospital (Attleboro, MA), a long-time MEDITECH
customer, is one of our first customers to implement and go-LIVE
with Computerized Physician Order Entry (CPOE). The hospital,
which has been LIVE with CPOE for three years, credits their
successful utilization of CPOE to the strong involvement of
their Pharmacy.
As a small, suburban community hospital, the staff at Sturdy
are a close knit group. From the moment the organization
decided to move forward with CPOE, the Pharmacy team took a
central role in preparing for the change, managing and
developing content for CPOE, and getting ready for the
implementation process. The Pharmacy team was crucial in
getting not just the Pharmacy ready for the changes ahead,
but the whole hospital. In addition, they helped ease the
transition from paper to electronic ordering, and made
physicians more comfortable with the system.
"It is essential in a CPOE build to involve your
pharmacists from the beginning," says Jay Silva,
pharmacist for Sturdy Memorial. "One of the main reasons
why CPOE was so well-received in our organization, and why it
has been successful from the start, is because our
pharmacists built the system from day one."
Choosing CPOE
Being one of the first MEDITECH customers to adopt Advanced
Clinical applications, the Sturdy organization has always
viewed technology as a necessary tool to improve patient
safety. CPOE was a natural part of this patient safety
mission, and Sturdy wanted to improve medication safety and
patient outcomes through the technology. The proliferation of
local and national news regarding the rise of medication
errors, with their devastating effects on patients, pushed
the issue even more to the forefront for Sturdy.
"There was never a question of whether we should move
forward with CPOE," says Michele Riviere, HCIS manager
for Sturdy. "Our organization is passionate about
improving medication safety through electronic ordering, so
the only question was when to do it."
Making
it all Happen
Sturdy's pharmacists did a lot of work optimizing their
Pharmacy system to get it ready for CPOE—a process which
is now facilitated by MEDITECH's Advanced Clinical
Implementation Team. Silva went through the system and
dictionaries, cleaning up orders, building order strings and
order sets in the way physicians would write the orders to
make it easier and quicker for them to learn, working best
practices into the sets, and deleting medication strings that
were never used.
"The pharmacist really needs to manage all the
medication orders from the beginning to ensure everything is
built properly and organized in the right way," Silva
says. "It makes it that much easier when you need to
make edits or adjustments later on."
Since Sturdy was one of the first sites to implement CPOE,
the organization also hired a consultant to help them through
the initial stages of preparation. Sturdy's strategy also
included choosing the ICU as their pilot unit, to get the
most challenging area done first. They started with 10
specialists, then added 10 more once those physicians were
LIVE, and so on. This setup worked well for them, and even
had an unexpected payoff.
"We specifically picked this unit because of the
intensivist in the ICU," Riviere explains. "We knew
he'd give honest feedback on the system and tell us if our
roll-out strategy wasn't working. But he learned the system
very quickly, and became such a strong proponent for it that
within one week he was asking to have CPOE implemented
throughout the rest of the hospital!"
Although Sturdy did appoint a physician champion for the CPOE
project, in retrospect they wish they would have made more of
an effort to involve additional clinicians in the process and
work closer with them during the implementation, according to
Riviere. "Eventually the ICU intensivist informally took
on this role, touting the system's ease of use and efficiency
to the rest of the physician community, and even offering to
train other physicians during their respective go-LIVEs,"
she explains.
Tailoring
Processes
"Because Sturdy is a small, unique hospital, Jay Silva
was the one who trained the entire Pharmacy and physician
staff on CPOE," says Riviere. "His hands-on
approach helped the physicians learn the system much more
quickly."
Additionally, the pre-built medication content ensured all
order sets and strings were safe from the start, even during
the training process. As a result, Sturdy experienced no
adverse drug events during the initial learning curve.
In another attempt to help ease the transition from paper to
electronic ordering, pharmacists built physicians their
favorite order sets in the system to make them more
comfortable during the training and go LIVE. "Even
though this helped so much in the beginning, three years
later both our department and I.S. are still maintaining
these order sets," says Andrew Metters, director of
Pharmacy. "We can't take them away from the physicians
now, since they are comfortable with them and it's been so
long, but for us this was a lesson learned that we should
have standardized across the board from the very start."
An important sensitivity Sturdy had to learn during the
process was how much to alert physicians. "Originally,
we flagged physicians for numerous interactions, but through
trial and error we figured out a balance of system alerts
that worked for our physicians. Currently, we flag only for
duplicate orders and allergies, and our department handles
the rest of the interaction checking," says Metters.
"Jay is still the point person for all medication
content, and regularly edits and maintains the order sets and
strings for their physicians."
"The pharmacist's involvement doesn't end when you go
LIVE," agrees Silva. "Medication management is a
continual process in our Pharmacy, and years later we still
work closely with the physicians to improve efficiency."
CPOE
Positions Sturdy for Success
All the Pharmacy's preparation and training paid off when
Sturdy brought the system LIVE throughout their organization.
The pre-built content ensured patient safety was not
compromised during the initial go LIVEs, and allowed Sturdy
to start experiencing the benefits of CPOE immediately.
"CPOE has greatly improved efficiency in our department,"
says Metters. "We no longer have to deal with faxed
orders being sent to the wrong place, or trying to decipher
illegible hand-written orders. And most importantly, our
number of medication errors has dropped since implementing
electronic ordering."
Beyond improving Pharmacy efficiency and
patient safety at Sturdy, CPOE has also led to better inter-departmental
communication among staff. "Our Pharmacy and I.S.
departments have an extremely close, mutually effective
relationship since CPOE," says Brian Churchill, I.S.
director for Sturdy. "I.S. is very involved with the
pharmacists, and that has helped out our department a great
deal."
But perhaps the most unexpected and exciting benefit of
adopting MEDITECH's Advanced Clinical applications is the way
it has positioned Sturdy ahead of the curve to meet future
health care I.T. government mandates.
"The fact that we're successfully LIVE with CPOE means
we don't have to worry about government initiatives to the
degree some other organizations do, such as the
Massachusetts CPOE Mandate for 2012, says Churchill. "The MEDITECH system
not only helps us deliver safer patient care, but it has also
prepared us for whatever health I.T. legislation comes around
the corner."
MEDITECH
Medical
Information Technology, Inc.
MEDITECH Circle
Westwood, MA 02090
781-821-3000
www.meditech.com