Project probes reengineering med management system

Hospitals and health systems are under increasing pressure to reengineer their medication use systems and to make the process safer, more efficient, and more cost-effective. In most instances, these types of reengineering initiatives are proprietary. Hospitals aren't in the habit of sharing the details about such projects with their competitors. But what if the data from such a reengineering project were made public for all to see and to learn from?

The ASHP Research and Education Foundation, along with the Missouri Rehabilitation Center (MRC) in Mt. Vernon, Mo., and Baxter Healthcare Corp., have determined that disclosure of such data could yield tremendous benefits for those involved in similar endeavors. To that end, the three organizations have teamed up in a collaborative effort entitled The Fail-Safe Medication Management System Project & Research Study that will take a comprehensive look at a traditional/manual medication use system and contrast it with a new automated integrated point-of-care (POC) bar-code system at a 135-bed long-term acute care facility. ASHP is funding the project with a grant from Baxter. For its part, Baxter hopes to evaluate its technology's impact on reducing medication errors.

An interdisciplinary research team based at MRC is charged with making improvements to the medication management system and ensuring that drugs will be managed in a safe, efficient, cost-effective manner while at the same time fulfilling legal and regulatory standards and maintaining patient confidentiality.

Among the goals of the study are: to measure the impact of the fail-safe medication management system design on the performance and safety of the medication use system, to apply ideal medication use system design characteristics in a multidisciplinary coordinated technology-driven medication use system, and to identify and implement essential performance standards for health professionals in that system.

In a multiphase project that began in 2002, researchers will review benchmark data from each phase of the medication use process-prescribing, preparation, dispensing, and administration. Project director Barbara White, R.Ph., said that after evaluating several systems, the team selected Baxter's Patient Care System that includes an integrated medication management system and POC bar-code technology. Phase two of the project will begin in November, and data collection will begin in April 2005.

White said that the team is studying the traditional/manual medication administration record (MAR) process, looking at which mistakes were caught, which ones were missed, and whether or not information was documented properly. Then they will evaluate the new electronic MAR process and look for new types of errors that may exist. The biggest challenge so far, she noted, is the culture change regarding technology. "We underestimated what it takes to get every user wanting to use this system and helping them understand why. It's quite a learning curve," she said. What impact will the results of the study ultimately have on pharmacy? "From day one, the goal was to free up pharmacists so they can be on the patient care units with the rest of the team," she said.

Steven Allen, R.Ph., executive VP/CEO of the ASHP Research and Education Foundation, said that among the key objectives of the project is to evaluate the team approach to redesigning the medication use system and sharing the process with other practitioners. "We'd like to share with other practitioners the set of measurements that this team put in place prior to redesigning their system, so that they would then be able to, at a later point in time, determine how effective their redesign process was and what their ongoing measurements of patient safety were for their medication use system," he said.

Allen noted that what makes the project unique is that the vendor was willing to subject its product to the rigors of formal research and allow the outcome to be publicized.

But for Baxter, the potential benefits of participating in the study outweigh the public relations risk. "This project seemed like a perfect fit for ensuring that we get a study that is properly facilitated and independent of our own views of the system," said Tova Manett, director of marketing for Baxter Patient Care System.

Results of the entire study will be published in 2005.