Nurses Help Guide Bedside Verification and eMAR Initiative at Upper Chesapeake Health
(10/8/2009)

When Upper Chesapeake Health (Havre De Grace, MD) chose to implement MEDITECH's Bedside Verification (BV) and the electronic Medication Administration Record (eMAR) products as a key part of its 2009 Operating Plan, the expectation was that the organization's two hospitals would improve the medication administration process and reduce errors. These goals were not only met but exceeded, when on the very first day of go-LIVE this past April, Upper Chesapeake Medical Center was already able to show tangible, positive results on the first unit.

"Our scanning rates were at 90% compliance, and we were able to identify several avoided errors," states Stephen Prouse MS, RN-BC, director of applications at Upper Chesapeake Health. "And that was just the first day. Our compliance numbers have improved even since then. This is, by far, one of the most important patient safety initiatives we've done to date."

Upper Chesapeake's success continued when the medical center rapidly completed its implementation across the rest of its inpatient units by June, followed by a go-LIVE in the Harford Memorial Hospital facility in August, using the same methodology. How did they do so much in so little time? Prouse credits the commitment of Nursing, I.T., and Pharmacy in bringing both hospitals up to speed.

"The Nursing V.P. and the vice president of I.T. worked together a great deal, making some key staffing decisions to pave the way for success," notes Prouse. "Jean Almacy, RN, MSN, and director of nursing support services, was hand-chosen to help lead the implementation initiative and represent the Nursing division. This proved to be a very wise decision."

The project became Almacy's number one priority, and she ensured that her team always kept that attitude. "It's been a collaborative effort," she says. "Throughout this process, all of us have always stayed on track with our singular goal—to ensure every single clinician who administers medication at our facilities is using the MEDITECH BV and eMAR solutions."

Getting BV and eMAR off the Ground
When Almacy began her new role, she immediately started working side-by-side with Prouse and others in the I.T. and clinical departments, to form a new BV core team. This approach fostered good communication from the start, which carried through all the various stages of implementation. For instance, each month, Almacy and Prouse participated in leadership sponsor meetings. Discussions covered all aspects of the implementation project, including detailed plans for moving forward, using resources, and establishing user buy-in strategies.

"One critical choice we made early in the implementation process was to collaborate with a student at the local community college to develop training programs using video," Almacy says. "We created a 20-minute BV video tutorial, featuring a seasoned RN helping a newer nurse get used to the eMAR and BV solutions. They were showing each of the steps involved in scanning medications at the patient's bedside. The video became a very effective tool for training our staff."

Taking the implementation and training efforts yet another step further, the hospital's Education Department created a "dummy kit" which included pills, insulin, and physician notes. "This kit gave end users a tangible way to practice the steps of scanning and administering medication before trying it out with patients," says Almacy.

From a management perspective, the approach also presented a good way to track BV training. "Each nurse had to complete a scanning exercise, and then we'd sign them off the list," Almacy says. "Those nurses then turned around and trained the other nurses and when all was said and done, we trained a total of 270 nurses at Upper Chesapeake. It was an efficient use of resources and a great method which we could then turn around and use at Harford Memorial."

But the education efforts did not end with nurses, though that was a large part of the initiative. Leaders also reached out to all clinicians across the various disciplines, to get them involved in and excited about improving patient safety using BV and eMAR. "The BV core team set up a booth outside the cafeteria during lunchtime, to make the staff aware of our patient safety efforts," says Almacy. "We provided scanning tutorials and demonstrations, and even M&M "medication" as snacks. This fun, hands-on approaach was really engaging, and educational as well."

High Compliance Leads to Improved Patient Safety and Satisfaction
Now that Upper Chesapeake has implemented its MEDITECH solution and trained end users, the facility continues to support its nurses to ensure they are using eMAR and BV to improve care. Several hospital safety committees have undertaken the responsibility of reviewing data to ensure compliance, and so far, they have lots of good news to report.

"After the first month of go-LIVE, we were excited to find that 95% of medications and 97% of patient wrist bracelets were being scanned," says Prouse. "But although we were extremely pleased with these initial results, our objective has always been to achieve 100% compliance. We are continuing to strive for this goal, to take advantage of all the patient safety benefits this software offers."

Prouse adds that nurses themselves have noticed some important improvements since going LIVE. "They have been reporting catching more errors before they occur, communicating more effectively with staff members, and experiencing better workflow in their day-to-day delivery of care," says Prouse. "Nurses are definitely seeing the difference that I.T. tools can make."

And while the positive messages are ringing clear to the clinical staff, the organization has also been keeping patients aware of this important initiative. "For the first seven days of the BV go-LIVE, every patient received a letter explaining what Upper Chesapeake Health was doing and how it would positively impact their care," says Prouse.

"Our patients have been so appreciative of the extra precautions our Nursing staff members are taking to ensure medications are administered properly. We're seeing greater satisfaction in care, particularly with regard to pain management, and patients are rating our organization a 9 out of 10 on our satisfaction surveys. It's been wonderful for them, and for us as well."

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