Secret's
Out: Mt. Washington Pediatric Hospital Uses MEDITECH to Drive
Clinical Excellence
(4/3/2008)
We all know the stereotypes conjured up when
one considers a "typical" MEDITECH customer site: a
community hospital, located in a suburban or rural location.
The inpatient bed total probably falls somewhere between 100
and 200. And, it likely provides all types of care, not
specializing in a particular field or concentration.
However, we recently spent time at Mt. Washington Pediatric
Hospital (Baltimore, MD), an unsung hero and one of the
foremost users of MEDITECH's Advanced Clinical Systems. Users
so advanced, in fact, they were chosen as MEDITECH's LIVE
customer site example during our product certification
process with the Certification
Commission for Health Information Technology (CCHIT®). What we found was Mt. Washington
"breaks the mold" of the typical MEDITECH hospital
in several ways: as a teaching hospital affiliated with both
Johns Hopkins and the University of Maryland, it is a 102-bed
facility located in the city of Baltimore. Furthermore, Mt.
Washington is a pediatric care facility with a focus on
rehabilitation. Surprised? We were too, especially when we
realized they have been continually driving clinical
excellence through a commitment to using technology for
almost 15 years.
"MEDITECH's inherent integration plays a crucial role in
our success, and has for some time," explains Tim Brady,
director of information systems at Mt. Washington since 1993.
"The key for us is being able to enter data once, and
having it available everywhere throughout our enterprise.
Having a MEDITECH system has really enabled us to freely
access the data our providers need, to deliver the high level
care that's become our standard."
A Strong
Sense of Mission Leads to I.T. Commitment
Mt. Washington's mission is a highly specialized one,
focusing on inpatient, outpatient, and day programs for
children with rehabilitation and/or complex medical needs.
"We're fairly unique, and as such, it's imperative to
use data to validate the safety, quality, and cost-effectiveness
of the care we deliver," explains Sheldon Stein, CEO of
Mt. Washington. "There is so much information exchange
required just to get our patients in the door. The challenges
of automating data to expedite and streamline the care we
provide to our kids have really helped to shape our
technology vision, and made us more committed to electronic
records."
The vast range of patient conditions found at Mt. Washington,
while challenging, has also served to unify the staff behind
the concept of using I.T. to improve care. "We see all
kinds of kids, from babies to adolescents, and we see all
ranges of illness, from limb lengthening to gunshot wounds,"
explains Heather Dewan, RN, clinical applications manager.
"Serving this particular patient population has given us
a sense of innovation that's really pushed us on the
technology side. Our staff is used to thinking out of the box
in their clinical decision making, and they bring that same
spirit to getting the most out of our information system."
Brady also believes that Mt. Washington's smaller size and
dedicated mission have been assets in getting Mt. Washington
on track with care initiatives that may have stalled other
organizations. "I think the sense of focus which we
bring to patient care also translates to our technology
projects," he says. "What would be considered 'big'
I.T. projects might get done more effectively here, because
they're a bit easier to manage and facilitate, based on our
tight-knit culture. Everyone is on the same page here; we all
do what it takes to achieve our patient care goals."
Beginning
the Journey with Paperless Nursing . . .
One goal the organization found early consensus on was
paperless record-keeping. If you're looking for paper, you
won't find any in the clinical departments at Mt. Washington.
Since the site's initial implementation, executives have
worked directly with clinical leaders and in concert with the
I.T. staff, to ensure the transition to electronic medical
records would be successful.
"We ultimately decided to go LIVE with electronic
documentation on all nursing floors simultaneously,"
explains Brady. "We're big advocates of Big Bang Theory,
of getting many areas LIVE at the same time. We don't do
isolated pilot programs; we'd rather go LIVE with everything
across the board, so there's no looking back." All
nurses at Mt. Washington now record I&Os, vital signs,
and bedside assignments on-line. Likewise, all of them
exclusively use the electronic medication administration
record (eMAR) and Bedside Verification (BV) systems to record,
track, and administer 100% of patient medications. The nurses
also utilize the Nursing Status Board, which facilitates
handoff communications and allows nurses to personalize care
for each patient.
Improving
Medication Administration with Bar Coding
But one of the single biggest safety improvements for Mt.
Washington has come from Bedside Verification, which provides
safety checks throughout the administration process. Upon
scanning a patient's barcoded wristband and scheduled
medications, bar code symbols appear next to each medication's
record, indicating the barcode reader successfully read the
dose. Upon scanning all scheduled doses, the nurse submits
the scanned information to be verified against the patient's
eMAR, ensuring the five rights of medication or transfusion
are met.
"BV has made our medication process much safer, and
medication errors have dramatically decreased," says
Sharon Kelley, RN, vice president of patient care services.
"In my opinion, every hospital in the U.S. should have
barcoded medication administration, for maintaining safe
nursing practices."
Working in conjunction with the on-line Medication
Administration Record and the on-line Transfusion
Administration Record, BV has provided Mt. Washington's
nurses with the clinical decision support they need to
administer medications more safely. Warning messages alert
the nurse to inconsistencies such as the wrong patient or the
wrong medication. In addition, assessment routines prompt the
nurse to collect information (e.g., pulse rate) to help
confirm a medication's clinical appropriateness at the point
of administration. In the eMAR, alerts such as color-coded
data cells indicate to nurses that a medication is past due
or discontinued. Pertinent patient information is readily
available to nurses, including allergies and adverse drug
events, lab results, and vital signs.
"This error flagging system is important for any patient,
but especially for our chronically ill kids, who are on many
different medication cycles," explains Linda Thornton,
RN, director of clinical services. "We're administering
an enormous amount of medications here, with great variances
in doses, despite our relatively small size. And it's
critical to the safety of our patients that we get it right
every single time."
. . . And
Extending I.T. Benefits On to Physicians
After automating the Nursing departments, Mt. Washington
wasted no time in extending the same level of adoption to its
physicians. "There are no verbal or written orders here.
We order 100% of medications, 100% on-line," says Dr.
Richard Katz, medical director and vice president of medicine.
"We had challenges in implementing these changes, but
the key to getting our physicians on board was showing them
the benefits and life-saving error reduction which would
result from going paperless. After that, it didn't take much
convincing."
Katz reports that Mt. Washington's physicians are also seeing
time management and efficiency benefits as well. "The
electronic charts are easier to find and easier to read
because they eliminate redundancy. When physicians can
clearly see the most relevant patient information, they can
administer care more effectively," he says. "Our
physicians have witnessed the benefits of investing time up-front
for training and transitioning to electronic records. They
know they've saved so much more time in the long run."
Non-Typical
Success, Rooted in Reliability
Certainly I.T. in general has made a huge difference in
quality for the staff at Mt. Washington. But when we asked
folks at Mt. Washington, 'why MEDITECH?' their responses were
anything but nonspecific. According to CEO Stein, the answer
was simple: "Reliability. It's the foundation of our
partnership with MEDITECH. Part of my background I spent as a
CIO, and I've had a lot of experience with different systems
and vendors. And the uptime is simply unbelievable with
MEDITECH."
Katz agrees: "While other vendor systems may seem 'sexier,'
they're not as reliable, and they don't have MEDITECH's utter
lack of system downtime. The other huge difference with
MEDITECH is staffing. We have a level of I.T. advancement
comparable to or in excess of many other hospitals, but it's
achieved with far fewer I.T. employees, and that approach
works for us. We'd rather hire more physicians!"
So now, after 15 years of relative anonymity, this non-typical
MEDITECH customer is proudly proclaiming its success moving
to the forefront of Advanced Clinical software usage. As they
say, you always have to watch out for the quiet ones!
MEDITECH
Medical
Information Technology, Inc.
MEDITECH Circle
Westwood, MA 02090
781-821-3000
www.meditech.com