To automate the medication ordering process, a health care system used multiple levels of governance to ensure all stakeholders had a voice.
|
|
| Scott Samples | Janet McCrossen, R.N. |
Editor’s note: This is the first installment in a two-part series on improving efficiency in the hospital pharmacy. This week, the authors explain how Christiana Care Health System used multilevel governance to guide the adoption of an electronic medication ordering system. Next week, they discuss the technology’s impact and lessons learned.
For pharmacists, Christiana Care Health System’s plan to implement an electronic medication administration record was both good and bad news. The new system would lead to greater involvement in medication administration by pharmacists, which would improve patient safety and quality. However, it would also demand more of the busy pharmacists’ time. To improve pharmacy efficiency and gain back some of the additional time the eMAR would require, the two-hospital system in Wilmington, Del., decided to replace its manual, paper-based order method with an electronic medication ordering system.
Essentially a document management system designed for capturing and submitting prescriptions, the system was intended to improve medication delivery times, order processing efficiency, order accuracy and priority assignment for stat prescriptions.
In the past, physicians wrote prescriptions, which nurses or unit clerks placed in designated locations for scheduled pick up by pharmacy technicians throughout the day. While stat orders were faxed directly to pharmacies, routine orders were sorted and processed on a first-in, first-out basis.
With the new system, written orders would be scanned, routed to the appropriate central or satellite pharmacy instantly and processed based on priority and pharmacist assignment. While pharmacists could eliminate substantial time spent reviewing and sorting orders, nurses and unit clerks would gain the ability to track the status of prescriptions. For both parties, the system would automate a portion of the process and minimize telephone calls.
In implementing the ordering system, Christiana Care was prepared to confront challenges related to clinical workflow changes and end-user adoption. And as with any project, there would be unanticipated obstacles as well as opportunities to leverage the technology for added benefit.
Prepared for Change
Christiana Care took a structured approach to managing the project for maximum value, establishing separate technology and business groups working within a tiered framework. The technology team completed vendor evaluation in summer 2006, shifting to readiness assessment and project planning by September of that same year.
The initial pilot and testing phases continued from October through January 2007. On the pharmacy side, the technology team developed and refined a dual-monitor technique. The pharmacists would receive and manage orders on one monitor and process them on another screen through the core pharmacy information system.
In the patient care units and procedural areas during this phase, the rollout work groups anticipated changes to the clinical workflow and identified needed adjustments. One question, for example, was how the order system would identify the patient associated with each order. Though the unit or floor location would be apparent based on the source of the order capture, the team devised a solution using preprinted bar-code labels to represent the patient’s identification number.
Governance Structure Empowers at All Levels
Approaching the rollout, Christiana Care focused on change management by refining and enhancing its governance structure for the project. This process granted to the extended team—the combined leadership and business process teams—the necessary organization to systematically collect feedback, accommodate changes and foster accountability. By tightly integrating project leaders with rollout work groups, work group leaders were empowered to represent their groups and act with real decision-making authority.
A well-managed, multilevel governance structure was essential for constructively involving pharmacists, nurses and unit clerks, securing buy-in, gaining agreement on new processes and hitting go-live target dates. Four groups at the system level set goals, made major decisions and led software deployment. An additional three teams at each hospital worked with end users.
The sponsor group’s role was to guide and approve key decisions. A senior vice president who was the project’s champion, the nursing director, the administrative director of pharmacy, a pharmacy manager and the project manager made up this group.
The leadership team was responsible for making tactical-level decisions, providing guidance for issue resolution and ensuring overall progress. This team included the pharmacy, nursing and IT directors, and the project manager.
A business process team focused on approving work group deliverables and integrating work group efforts, working unit-by-unit during rollout, assessing the process, and addressing concerns, such as nurses’ system access or hardware issues. This broad-based team included a pharmacist from each hospital, nursing super users, a nursing informatics representative, a pharmacy technician representative, a nursing unit clerk staff representative and managers from pharmacy, IT and nursing. Also at this level, a technology team oversaw production stability, vendor management, IT issue resolution and overall software and hardware deployment. Though primarily an IT departmental group, the technology team worked with liaisons from pharmacy and nursing informatics.
At the two hospitals, Christiana Care brought in additional project management resources to coordinate the efforts of a rollout work group. These groups involved nursing, pharmacy and IT staff, who collaborated to introduce the new system to end users, identify problems, communicate recommendations and update the business process team on project status at the unit level. An additional nursing work group at each hospital focused on ensuring nurses’ and unit clerks’ understanding of the new clinical workflow requirements as well as addressing their concerns. An existing pharmacy staff group focused on similar issues. Though not created for the ordering system implementation, this group focused much of its attention on assessing the new system and gathering recommendations.
Next week: How small process changes had a big impact in Christiana Care’s pharmacies.
Scott Samples, Pharm.D., is director of pharmacy operations, Christiana Care Health System, Wilmington, Del., and Janet McCrossen, R.N., is a clinical management consultant, Greencastle Associates Consulting, Malvern, Pa.
GIVE US YOUR COMMENTS!
HHNMostWired welcomes your comment on this article. E-mail your comments to hhn@healthforum.com, fax them to Most Wired Magazine Editor at (312) 422-4500, or mail them to Editor, Most Wired Magazine, Health Forum, One North Franklin, Chicago, IL 60606.