Hospital Corporation of America (HCA)

The optimization of eMAR & Bar Coding allows the creation of a uniform data set to address concerns in the medication continuum within HCA hospitals. Optimization efforts address the 2nd and 4th HCA Patient Safety goals: move from blaming people to improving processes, and use data to identify and measure improvements.

Situation

Patient Safety is a vital concern for all healthcare providers. The 1999 report from the “Institute of Medicine: To err is Human,” (which states that between 44,000-98,000 people die annually from medical errors) triggered significant action at HCA.

In February of 2000, HCA began an in-depth analysis of opportunities to enhance patient safety within its hospitals. This analysis led to a company-wide commitment to assure patient safety practices were implemented in every HCA hospital.

The goals for the HCA Patient Safety Initiative are:

1. Establish patient safety as a visible commitment to our "putting patients first" philosophy
2. Move from blaming people to improving processes
3. Improve use of technology to prevent and detect error
4. Use data to identify and measure improvements

Solution

The original planning group (doctors, nurses, pharmacists, etc) for improving medication practices identified a need for two new technologies that would reduce medication errors through improved communication, decision support and documentation.

The planning group defined design specifications for each technology that included; the ability to intercept errors; integrate with existing information systems; the ability to integrate with a variety of workflow pat

terns; ease of use; and speed.

One strategy to meet the third Patient Safety Goal, was to deploy a specific safety technology referred to as electronic Medication Administration Record (IT- eMAR) and bar code verification in 174 of our 182 facilities. The technology requires the user to confirm the 5 rights of Medication Administration:

• Right Medication
• Right Dose
• Right Patient
• Right Route
• Right Time

and provide warnings when one of these is violated.

Additionally, decision support imbedded within the system alerts physicians, pharmacists, and nurses to potential allergy or interaction issues. eMAR & Bar coding also provides all caregivers with a shared view of each patient’s medication record that is always current, eliminating most communication errors.

The end result yields a comprehensive record of the medications administered to HCA patients, excluding surgical suites, and embeds a structure that, when monitored through a performance improvement (PI) plan, provides data for meaningful process improvement throughout the medication use processes within the hospitals.

Better Health & Lower Costs

The optimization of eMAR & Bar Coding allows the creation of a uniform data set to address concerns in the medication continuum within HCA hospitals. Optimization efforts address the 2nd and 4th HCA Patient Safety goals: move from blaming people to improving processes, and use data to identify and measure improvements.

Health Care Indemnity, Inc’s preliminary report shows medical malpractice claims, as it pertains to medication administration, have reduced by 30 – 35% in the first six months of 2005. Survey of nursing, pharmacy, and respiratory staff shows 100% feel eMAR & Bar Coding has prevented errors indicating a belief that the patient care environment is safer. Please see the below chart for specific data on averted errors.

Corporate data as of December 31, 2005:

*These are errors that violate any of the 5 rights of Medication Administration: right patient, right dose, right route, right time, and right meds are administered.

Patient ID (armband scanned): 97.9 %
Medications Scanned: 93.4%