Newsletter Spring 2010

Ontario Nursing Informatics Group invites you to celebrate our 30th anniversary with us.  Keep visiting the website in the next few months for more details.

Message from the President

In our winter newsletter I committed to facilitating recognition of our milestone anniversary, enabling strategic planning, and ensuring ONIG is well positioned to be recognized as a well informed and influential expert body. The commitment of the current executive has made this an incredibly easy promise to keep. Over the last four months, we have begun to plan the celebration of our important milestone, made substantial progress in our strategic planning efforts and have established formalized relationships with RNAO and Canada Health Infoway Peer to Peer Initiatives.

Canadian Nursing Informatics Association (CNIA)

Join the voice of Informatics Canada.  Consider the Canadian Nursing Informatics Association (CNIA)

CNIA is an active and growing group of Nursing Informatics Specialists that are endeavoring to advance eHealth across Canada. Consider becoming a member! Membership renewal is from June 1st to May 31st.  You will be a part of some new and exciting initiatives including the online Canadian Nursing Informatics Journal. Watch for the call for submissions and showcase your work!

Upcoming Events

June 14, 2010   June Education Day - Peterborough Regional Health Centre

Registration and Agenda

Presentation Topics

• The Status Board - Bev Reid, Judita Szilagyi
• Medication Reconciliation - Christina Porcellato, Dawn Ellis, Sarah Hickey, Anne Martin, Judita Szilagyi
• Automated Dispensing Units - ADUs - Tracey Ferguson, Jude Handley and Anne Martin
• Emergency Department Management System (EDM)

Please join us in person or by videoconferencing.  Details in the agenda.

September 20, 2010   September Education Day - William Osler Health System - Brampton Civic Hospital

Details will be posted later in the Summer.

News from our Members

From Credit Valley Hospital

Electronic Medication Administration Record and Bedside Medication Verification:  Implementation at a Canadian Community Hospital:  Neontal Bar-coding

Sent by Lina Ranieri, RN, Nursing Informatics Coordinator and Jimmy Fung, BscPhm, MBA, Pharmacy Clinical Manager at Credit Valley Hospital.

Credit Valley Hospital is a 2009 recipient of the OHA Leading Practices Award.  See the award winning Neonatal Bar-coding PowerPoint.  Credit Valley was awarded first prize for their digital display submission "Neonatal Bar-coding" in the category of technology innovation.

The Credit Valley Hospital (CVH) is a 381 bed community hospital located in Mississauga, Ontario.  CVH was the first hospital in Ontario to implement Bar-coded Medication Administration (BCMA) within a neonatal special care unit (SCN) and one of the first in Canada to implement BCMA in any unit.  CVH decided to implement the Meditech Bedside Medication Verification (BMV) module as the BPOC system.  The hardware devices we selected are the C5 Motion Computing Tablet, Symbol 2D scanner and AMT Datasouth Direct Thermal Printers.  We mounted the C5 Tablets on Neo Flex Ergotron carts or Rubbermaid mini-medication carts.

Relevance

Medication errors are a leading case of preventable adverse drug events and a major threat to patient safety.  Studies estimate that 38% of medication errors occur at the point of administration.  Virtually all of these errors will get through to the patient since there is no double check between the nurse and the patient.  A closed-loop medication process is the gold standard for patient safety.  The final step in this process is Bar-Coded Medication Administration (BCMA).

Multiple obstacles were encountered due to the unique nature of dealing with neonates.  Rates of potential adverse drug events (ADE) were three times higher in pediatric populations than in adult ones.  34% of these ADE were a result of medication administration errors.

CVH implemented the Meditech BCMA system.  BCMA has allowed CVH to virtually eliminate deviation from our positive patient identification policy, and creates an objective double check of the medication and patient.

Implications

In the month of April 2009, there were a total of 15 error warnings (total doses administered was 1302) which resulted in the medication not being administered to the patient (1.15%).  If this data were extrapolated to the rest of the hospital, there would be 57 medication administration error warnings daily, and 20,987 medication errors averted annually.

Patient identification rates have increased significantly (56.4% to 98.3%) and the data related to near miss counts are now objective rather than dependant on self-reporting by care providers.

The Special Care Nursery was our pilot site and has been live since October 2008.

Conclusions

BPOC systems are a worthwhile investment for Canadian hospitals to increase patient safety.

Further implementation of eMAR BMV at CVH includes adult pilot patient care areas; Mental Health Inpatient and Eating Disorders Unit.  Both units have been live since January 2010.

From the University Health Network Nursing

Can eTransfer Notes Provide Patient Safety Benefits in the Hybrid Environment?

Submitted by Mary Muhic RN BScN, Nursing Informatics, University Health Network

UHN has undertaken multiple innovative projects incorporating new technologies and devices. However, extensively clinical documentation remains on paper. Nursing documents an initial assessment on line, often printing a copy for the paper chart so that other care providers may access the information. Similarly the Emergency Triage nurse completes an eTriage note in the clinical enterprise system, then prints it for admission to the emergency department. Workflow and Patient Safety benefits were realized with the introduction of an eTriage note. One example evident on random audits is the greater than 95% allergy documentation capture and or update prior to medication administration.   Nursing asked could an eTransfer note improve efficiency, quality and patient safety in which the content reflects clinician needs, both provincial and organizational standards during patient transfers?   The pilot involved collaboration of nursing leadership, staff nurses, and IT resources. It began with the two Emergency departments and the 4 inpatient General Internal Medicine areas.

Goals:

•         Opened dialogue between Ed and Inpatient areas for further patient flow improvements