joe ketcherside sr. v.p. and cmio methodist le bonheur healthcare
TRANSCRIPT
What is ?
• Comprehensive command of your patient’s care– All your patient information in one place– Direct control over patient orders– Accessible any time, anywhere
• Why do we need it? – Volume and velocity of information exceeds our ability to
manage by memory and on paper– Decreases many errors found in loosely-coupled paper
systems– Automated tools can improve physician efficiency– Supports patient safety initiatives
Individual orders can be pre-selected IF there is
agreement that they arerequired as the minimum
core orders within an order set.
Minimizes Typing
Check box to select additional orders
OR un-check selected orders which are
not required.Some orders can always
be required/included.
Order Sets
Sub-folders
Order sets
Complete orders
Partially complete orders
Standardized infusions
Favorites Folders
Benefits:– Quick, Accurate Orders (48%)– Reduce Errors/Enhance Patient Safety (41%)– Reduced Turnaround Time (31%)
The largest hurdles to overcome are:– Clinician Acceptance (40%)– Workflow Changes (19%)
Lessons learned:– Clinician Buy-in/Involvement - “Ownership” (43%)– The need for having Champions (Physicians/Nurse) (23%) – Mandating CPOE was again at the bottom of the list (2%)
CPOE Benefits and Hurdles (KLAS® 2006)
Go back to
Order is written on order sheet in pts.
chart
Copy of order is handed to/or
placed on Unit Pharmacist desk
Order transcribed on Paper MAR
Chart is placed "Sideways" in rack for Nurse review
Chart placed on counter, or dropped in
rack "Standing Up"
Takes "Standing Up" chart from rack
Is medication in SureMed?
Medication is received from
SureMed/Tube
Is verified order in the system?
Can nurse override?
Pharmacy is contacted
Pharmacist is contacted and an
order copy is tubed
Medication is verified/signed on MAR
Yes
No
Yes
No
NoOrder is reviewed in MSMeds and OCRR(lab) and
verified by Pharmacist
Is medication in SureMed?
Verification updates SureMed
Order is placed on counter to be filled
Yes
No
Is decentralized pharmacist on
floor?
NoCopy of order is
tubed to Pharmacy
Yes
Order is entered into MSMeds (not
reviewed with OCRR (lab)) and
then verified
Lab is verified on an on-going basis
for all patients from an early
morning printout
Medication is administered to
patient
Order is entered into MSMeds by
Technician
Order copy is dropped in
'Wooden Box' for Pharmacist review
Order is filled and tubed to floor
MAR and orders verified on late
shift
A
"Sideways" placed chart. Nurse compares transcribed
order in paper MAR and looks for verification. Nurse
signs off.
A
Go back to A
Order copy is filed in Pharmacy
Verification updates SureMed
Yes
Takes chart from counter
Current Medication Order Process
(7 min avg.)
(5 min avg.)
(7 min avg.)
(2.5 hrs/day)
(45 min avg.)
Total (60 min)Total (7 min)Total (2 min) Total (7 min)
Total (50 min)
PhysicianPhysician Unit SecretaryUnit Secretary PharmacyPharmacy Unit Unit PharmacistPharmacist
KeyKey'Standing Up' Placed Chart'Standing Up' Placed Chart: States that physician has written order and it is waiting to be transcribed.: States that physician has written order and it is waiting to be transcribed.
• 'Sidways' Placed Chart'Sidways' Placed Chart: States that unit secretary has transcribed physicians order and it is waiting to be : States that unit secretary has transcribed physicians order and it is waiting to be verified by nurse.verified by nurse.
• AA: The standard process that pharmacy goes through for order verification.: The standard process that pharmacy goes through for order verification.
1,2 3
45 6
30 Major Process Steps
Elapsed Time 2.1 Hours
Like pushing
a rope!
Future State Medication Order Process
(7 min avg.)
(5 min avg.)
(7 min avg.)
(2.5 hrs/day)
(45 min avg.)
Total (15 min)Total (0 min) Total (2 min)
Total (20 min)
PhysicianPhysician Unit SecretaryUnit Secretary PharmacyPharmacy Unit Unit PharmacistPharmacist
NurseNurse
12 Major Steps Removed
Elapsed Time 39 Minutes
Decision Support
MAR and orders verified on late
shift
Go back to
Copy of order is handed to/or
placed on Unit Pharmacist desk
Order transcribed on Paper MAR
Chart is placed "Sideways" in rack for Nurse review
Chart placed on counter, or dropped in
rack "Standing Up"
Takes "Standing Up" chart from rack
Is medication in SureMed?
Medication is received from
SureMed/Tube
Is verified order in the system?
Can nurse override?
Pharmacy is contacted
Yes
No
Yes
No
No
Is medication in SureMed?
Verification updates SureMed
Order is placed on counter to be filled
Yes
No
Is decentralized pharmacist on
floor?
NoCopy of order is
tubed to Pharmacy
Yes
Lab is verified on an on-going basis
for all patients from an early
morning printout
Order is entered into MSMeds by
Technician
Order copy is dropped in
'Wooden Box' for Pharmacist review
Order is filled and tubed to floor
A
"Sideways" placed chart. Nurse compares transcribed
order in paper MAR and looks for verification. Nurse
signs off.
A
Go back to A
Order copy is filed in Pharmacy
Verification updates SureMed
Yes
Order is placed online
Open order list is populated
Yes
Knowledge based rules alert
physician
Modify or discontinue order
Does physician
wish to continue with
order?
Yes
Physician is contacted
Medication administration is documented on online
MAR
Order is verified
Order is verified
Takes chart from counter
Medication is administered to
patient
BeatthePizza
How will this impact me?
• Training one-on-one before go-live– Support at the elbow during go-live– Super-users and analysts available 24/7– Focused on future workflow changes not feature
and function• Impact on rounding time
– Slower at first – like any new skill– Faster with mastery of new tools– Efficiencies gained with better data presentation,
automated documentation tools, order sets, shared data such as Problem List and Medication Profile, electronic MAR, and clinical decision support tools