CASE STUDY:
White River Medical Center
Organization
- Serves residents of North Central Arkansas
- Comprised of two hospitals, numerous medical clinics, physician offices, outpatient therapy centers, long term care facilities, two home health agencies, hospice and a home medical equipment company.
Challenge
Integrate technology to allow pharmacists at main facility to provide remote medication order entry and real time review of medication orders at critical access sister hospital.
Solution
Implementation of an innovative computerized prescriber order entry (CPOE) system with an added focus on medication safety.
Benefits
- Increased patient safety through reduced medication errors
- Improvement of inventory management
- Increased emergency preparedness
- Improvement in monitoring of controlled substances
White River Health System is a major employer in North Central Arkansas, with more than 1,300 staff members from throughout the region. The flagship facility of the health system, White River Medical Center (WRMC), is a 199 bed, not-for-profit community hospital located in Batesville. Stone County Medical Center (SCMC), a 25 bed acute care critical access hospital and the second of the two hospitals that comprise the health system, provides healthcare services to the approximately 3,000 residents of Mountain View and its surrounding area.
As a not-for-profit healthcare system, revenues generated over expenses by White River Health System are reinvested into healthcare technology, facility improvements and new clinical services. One such investment and improvement was a project born out of the idea of health system management that the patients in Stone County deserved the same level of pharmacy services delivered by its sister hospital in Batesville. The main goal of the project was to improve medication safety at SCMC, located approximately 35 miles from Batesville, by providing pharmacy services remotely from the WRMC facility.
CHALLENGE
White River Health System believed that this goal could be achieved through the use of automated dispensing machines at SCMC and remote location order entry by the pharmacists at WRMC. In addition to acquiring the financial and staff resources, the process involved securing intradepartmental cooperation and multi-level administrative. The most labor intensive portion of the process was securing approval as a pilot program by the appropriate regulatory bodies, specifically the Arkansas Board of Pharmacy. Through this project, WRMC and SCMS were the first hospitals approved in Arkansas to deploy remote order entry.
After receiving the appropriate approval, the next step of the project involved going live with automated dispensing machines linked to WRMC to enable the pharmacists to provide remote medication order entry. This step allowed for real-time review of medication orders for dosage accuracy as well as screening for medication allergies and drug-drug interactions. The pharmacists at WRMC review the orders and enter them into the pharmacy order entry system, allowing the nurses at SCMC immediate access to the medications in their dispensing machines.
Two important advantages were accomplished through this process. First, the orders for each patient at SCMC were reviewed and verified by a pharmacist, promoting patient safety; second, the nurses had access to the mediations in each nursing unit without the use of an antiquated medication cart fill each day, providing a better service to these SCMC nursing units. Through the technology, SCMC is able to function as a virtual nursing unit.
SOLUTION
To successfully achieve top results in its project, White River Health System turned to the order entry expertise of Floral Park, New York-based Meta, Inc. Meta’s MetaCare CPOE™ provides hospitals such as WRMC and SCMC with an innovative computerized prescriber order entry (CPOE) system with an added focus on medication safety. A highly-functional order entry solution designed to reduce the complexity of order entry, MetaCare CPOE simplifies key processes, increases efficiency and avoids over-reliance on human memory.
RESULTS
In addition to allowing the pharmacist at SCMS to perform order entry and dispensing activities, the connection of SCMC and WRMC also allows her to be able to allocate a more time to the implementation of clinical pharmacy services and direct patient care. This has led to an improvement of inventory management, monitoring of controlled substances and even charge capture.
“Not only did the people in both hospitals work to link up excellent technology, but the technology also worked to link up excellent care givers to improve the lives of their patients,” explained Jody Smotherman, Pharm.D., Co-director of Pharmacy Services at White River Medical Center. “The main goal of this project was an overall improvement in quality care, but we’ve experienced a much greater depth in the improvement of care that we anticipated.”
Although the successful project also resulted in increased patient/medication safety, increased physician and nursing satisfaction and a greater level of clinical communication for SCMC nursing staff and WRMC pharmacists than expected, it also brought about an unexpected benefit – tremendous emergency preparedness. After the project was completed, an F-3 class tornado struck Mountain View and destroyed part of the SCMC facility, including its pharmacy, which had to be closed due to storm damage. Without the implementation of remote order entry and automated dispensing machines, there would not have been any access to mediations after the tornado. With this technology in place, the automated dispensing machines were quickly relocated to another facility, plugged in and pharmacy services were quickly restored.
“Without our remote order entry and automated dispensing machines, there would have been no access to medications after the storm,” remarked Smotherman.
Most importantly, the project has had the most significant impact on patient care through the reduction of medication errors, and, along with that decrease, a reduction in adverse drug reactions and drug-drug interactions. Also, by enabling the continued expansion of the pharmacy services at the critical access facility in Stone County, the project has met its ultimate goal.
“Jody’s unique concept is an excellent example of how ‘thinking outside the box’ can overcome many of the challenges that face today’s healthcare delivery systems,” remarked Sal Barcia, CEO of Meta. “He conceived a way to improve medication dispensing and patient safety using the technology that was available to him. We are pleased that our system has been so effective in reducing medication errors in such an innovative way and improving outcomes in the state.”