closed loop medication process in a teaching hospital in 9
TRANSCRIPT
![Page 1: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/1.jpg)
1
Closed loop medication process in a teaching hospital in 9 months
LUIS MARTINEZ ESCOTET, MD
e-huca+ project manager
Hospital Universitario Central de Asturias
![Page 2: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/2.jpg)
Where are we located?
We are at the North of SpainOviedo is Principality of Asturias capital city
![Page 3: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/3.jpg)
HEALTHCARE GEOGRAPHIC DISTRIBUTION
1,075,948 citizens
![Page 4: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/4.jpg)
HEALTHCARE GEOGRAPHIC DISTRIBUTION
![Page 5: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/5.jpg)
HEALTHCARE GEOGRAPHIC DISTRIBUTION
![Page 6: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/6.jpg)
989
2,700 beds
HEALTHCARE GEOGRAPHIC DISTRIBUTION
![Page 7: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/7.jpg)
Hospital Universitario Central de Asturias
(HUCA).
Oviedo, Spain
Tertiary care teaching hospital. 989 beds
7 adult intensive care units (ICU), 1
neonatal ICU, 1 pediatric ICU
![Page 8: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/8.jpg)
GESTION DEL CAMBIO WWW: ayuda de los sistemas de información
WEB 1.0
Data recorder
Not interface
WEB 2.0
P2P
Virtual communities
Information share
WEB 3.0
semantic web
Using metadata and tags
Natural Language
SNOMED y Semantic Search
TIC’S EVOLUTION
![Page 9: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/9.jpg)
• Paper medical records
• Handwritten medication orders
JUNE 2014: hospital move and model change
• Electronic medical records
(EMR)
• Computerized prescriber order
entry (CPOE)
• Clinical decision support
systems (CDSS)
From To
![Page 10: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/10.jpg)
• Illegible handwriting
• Transcription errors
• Lack of traceability
• No access to the full medical history
Advantages & disadvantages
• Real-time access to patient records
• Avoid transcription errors and illegible
issues
• Improve workflow efficiency
• Help prescribers with decision
support systems
• New type of medication errors
![Page 11: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/11.jpg)
11 / XX
GESTION DEL CAMBIO: AJUSTE DE PROCESOS
Adverse events, which represent
between 3% and 5% of all hospital
admissions in the UK, costing the
NHS around 500 million GBP
Hospital errors leading to
preventable adverse events,
typically occur in:
34%4%56%
The cost of care based on memory
Medication management during the
entire cycle
CVLab
Rad
•Computerized
prescriber order
entry (CPOE)
Indications
managemet
Pharmacy
Management
Electronic
medication
administration
In Spain, adverse events accounted for 3.47% of
admissions in large hospitals (ENEA). According to
AHQR (Agency for Healthcare Research and
Quality's) each adverse event linked to medication
costs about € 3,200.
In UE, make a mistake until 60 million in non-electronic
prescriptions per year, (3% of all prescriptions issued)
With a 40% adoption of electronic prescribing, 40% of the errors
could be avoided
British Journal of General Practice.
![Page 12: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/12.jpg)
CPOE+CDSS reduce prescribing errors. However, they have no
effect on medication administration errors. ‘Closed loop’
medication management systems, which combine CPOE+CDSS
with other proven technologies to prevent errors at each step
of the medication pathway, show great promise for preventing
clinical adverse events.
Ranji SR, Rennke S, Wachter RM. Computerised provider order entry combined with clinical
decision support systems to improve medication safety: a narrative review. BMJ Qual Saf
2014;23:773–780.
![Page 13: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/13.jpg)
Closed loop medication process
![Page 14: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/14.jpg)
Pharmacy Inpatient Formulary: 2,070 products
CPOE
![Page 15: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/15.jpg)
2,254 Inpatient Medication Orders (Indications)
CPOE
![Page 16: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/16.jpg)
4,765 Inpatient Medication Order Sentences
CPOE
![Page 17: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/17.jpg)
Search options:
• Drug name
• Brand name
CPOE
![Page 18: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/18.jpg)
Using Tall Man Letters for look-alike drug names to reduce confusion
between similar drug names (following ISMP recommendation)
CPOE
![Page 19: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/19.jpg)
IV Sets: 1,015- Continuous infusion: 752- Intermittent infusion: 263
CPOE
![Page 20: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/20.jpg)
IV sets
• Standardization in critical drugs (amiodarone, dobutamine,…).
• Standardization in IV sets preparation (instructions for nurses).
• Use of low-volume fluids to reduce the % of positive fluid balances.
• Avoid compatibility problems.
CPOE
![Page 21: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/21.jpg)
Medication containing PowerPlans: 362
CPOE
![Page 22: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/22.jpg)
A. Drug powerplans
CPOE
![Page 23: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/23.jpg)
B. Clinical situations powerplans
CPOE
![Page 24: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/24.jpg)
Intravenous fluid therapy powerplans: 27
CPOE
![Page 25: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/25.jpg)
ICU PowerPlans: 77
CPOE
![Page 26: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/26.jpg)
NICU PowerPlans: 69
CPOE
![Page 27: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/27.jpg)
PICU PowerPlans: 29
CPOE
![Page 28: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/28.jpg)
Emergency PowerPlans: 27
CPOE
![Page 29: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/29.jpg)
Anesthesia PowerPlans: 15
CPOE
![Page 30: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/30.jpg)
Cardiology PowerPlans: 23
CPOE
![Page 31: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/31.jpg)
Intoxication management PowerPlans: 13
CPOE & CDSS
![Page 32: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/32.jpg)
Intoxication management PowerPlans
CPOE & CDSS
![Page 33: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/33.jpg)
Therapeutic Interchange Program PowerPlans: 135
Therapeutic alternative for 223 drugs
CPOE & CDSS
![Page 34: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/34.jpg)
Therapeutic Interchange Program PowerPlans
CPOE & CDSS
![Page 35: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/35.jpg)
PowerPlans signed in a week
0
18
35
53
70
Mé
dic
o A
CL
.M
éd
ico
AC
V
.M
éd
ico
AN
R
.M
éd
ico
CA
R
.M
éd
ico
CC
A
.M
éd
ico
CG
D
.M
éd
ico
CM
F .
Mé
dic
o C
PE
.M
éd
ico
CP
L .
Mé
dic
o C
TO
.M
éd
ico
DER
.
Mé
dic
o D
IG
.M
éd
ico
EN
D
.M
éd
ico
GIN
.
Mé
dic
o G
RT
.M
éd
ico
HEM
.
Mé
dic
o M
FC
.M
éd
ico
MIN
.
Mé
dic
o N
EF
.M
éd
ico
NE
O
.M
éd
ico
NFL
.
Mé
dic
o N
ML
.M
éd
ico
NR
C
.M
éd
ico
NR
L .
Mé
dic
o O
FT
.M
éd
ico
ON
C .
Mé
dic
o O
NR
.
Mé
dic
o O
RL
.M
éd
ico
PED
.
Mé
dic
o R
AD
.
Mé
dic
o R
EH
.M
éd
ico
REU
.
Mé
dic
o S
LA
.M
éd
ico
SM
E .
Mé
dic
o T
RA
.
Mé
dic
o U
CI
.M
éd
ico
UP
E .
Mé
dic
o U
RG
.
Mé
dic
o U
RO
.
CPOE & CDSS
![Page 36: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/36.jpg)
Indications included in PowerPlans signed in a week
0
250
500
750
1000
Méd
ico
ACL
.M
édic
o AC
V
.M
édic
o AN
R .
Méd
ico
CAR
.M
édic
o CC
A .
Méd
ico
CGD
.
Méd
ico
CMF
.M
édic
o CP
E .
Méd
ico
CPL
.M
édic
o CT
O
.M
édic
o D
ER
.M
édic
o D
IG
.M
édic
o EN
D .
Méd
ico
GIN
.
Méd
ico
GRT
.
Méd
ico
HEM
.
Méd
ico
MFC
.
Méd
ico
MIN
.
Méd
ico
NEF
.
Méd
ico
NEO
.
Méd
ico
NFL
.
Méd
ico
NM
L .
Méd
ico
NRC
.
Méd
ico
NRL
.
Méd
ico
OFT
.
Méd
ico
ON
C .
Méd
ico
ON
R .
Méd
ico
ORL
.
Méd
ico
PED
.
Méd
ico
RAD
.
Méd
ico
REH
.
Méd
ico
REU
.
Méd
ico
SLA
.M
édic
o SM
E .
Méd
ico
TRA
.
Méd
ico
UCI
.
Méd
ico
UPE
.
Méd
ico
URG
.
Méd
ico
URO
.
CPOE & CDSS
![Page 37: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/37.jpg)
Flowsheets and quick indications
CPOE & CDSS
![Page 38: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/38.jpg)
Flowsheets and quick indicationsCPOE & CDSS
![Page 39: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/39.jpg)
Drug alerts: Interactions
CPOE & CDSS
![Page 40: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/40.jpg)
Drug alerts: Therapeutic Duplications
CPOE & CDSS
![Page 41: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/41.jpg)
Drug alerts: Allergies
CPOE & CDSS
![Page 42: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/42.jpg)
Drug alerts
Fatigue
To avoid alert fatigue:
• Inactivation of non clinically significant drug-drug interactions.
• Daily review of alerts to eliminate non significant ones.
Autovalidation increase
CPOE & CDSS
![Page 43: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/43.jpg)
Other alerts: Dose Range Checking
CPOE & CDSS
![Page 44: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/44.jpg)
Other alerts: using Rules
Intravenous to oral therapy conversion
CPOE & CDSS
![Page 45: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/45.jpg)
Other alerts: using Rules
Intravenous to oral therapy conversion
CPOE & CDSS
![Page 46: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/46.jpg)
Pharmacist Interventions: clinical interventions
CPOE & CDSS
![Page 47: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/47.jpg)
Pharmacist Interventions: reporting Adverse Drug Reactions
CPOE & CDSS
![Page 48: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/48.jpg)
Pharmacist Interventions: compassionate-use
CPOE & CDSS
![Page 49: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/49.jpg)
• Implemented in May 2015
• Developed and used in hematology: conditioning regimens and
GVHD prophylaxis.
• Will be used for Ambulatory Treatment Center indication and
administration: not only chemotherapy.
• Need of onco-hematology treatments standardization.
Oncology CPOE
![Page 50: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/50.jpg)
Oncology CPOE
![Page 51: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/51.jpg)
Oncology CPOE
![Page 52: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/52.jpg)
Oncology CPOE
![Page 53: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/53.jpg)
CERNER integrations at Pharmacy Department
Indication Pharmacist Validation
Dispensing
Inventory management
![Page 54: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/54.jpg)
Safe drug administration: BCMA
Bar-code medication administration
(BCMA)
![Page 55: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/55.jpg)
• Implemented in Child and Adolescent Inpatient
Psychiatric Unit.
• All medications dispensed from Pharmacy
Department with bar-code identification.
• Nurses trained in bar-coding.
• Reduces administration errors.
Safe drug administration: BCMA
![Page 56: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/56.jpg)
HiMSS Analytics Stage 6 - April 2015
![Page 57: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/57.jpg)
Outpatient Pharmacy - Retail
Pharmacy Outpatient Formulary: 432 products
![Page 58: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/58.jpg)
432 Outpatient Medication Prescriptions
Outpatient Pharmacy - Retail
![Page 59: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/59.jpg)
464 Outpatient Medication Prescriptions Sentences
Outpatient Pharmacy - Retail
![Page 60: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/60.jpg)
• Implemented in July 2014.
• 5,000 patients per year (HIV, HCV, HBV, Multiple Esclerosis, Cancer patients).
• Retail integrated with a robotic dispensing system.
Outpatient Pharmacy - Retail
![Page 61: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/61.jpg)
![Page 62: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/62.jpg)
✓ Smart infusion pumps
• Infusion pumps with software that can alert users
to potential errors.
• Library of drugs that provides medication dosing
guidelines, by establishing concentrations, dose
limits, and clinical advisories.
• Indications ready to use the new pumps.
![Page 63: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/63.jpg)
✓ PowerChart Oncology integration with LUG technology
• Drug preparation work sheets on screens
inside biosafety cabinets.
• Voice commands.
• Bar-code technology.
• Computer-assisted gravimetric production
control.
![Page 64: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/64.jpg)
✓ Implement BCMA in the rest of units.
✓ Specific order sentences for weight and age ranges.
✓ Increase dose range checking alerts: new drugs.
![Page 65: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/65.jpg)
✓ Include new alerts, new rules: e.g. antibiotic treatment
duration.
✓ Develop Discern Analytics 2 reports to link indications with
clinical parameters: e.g. erythropoietin and hemoglobin levels.
![Page 66: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/66.jpg)
Conclusions
1. Closed loop medication process improve
patient safety reducing medication errors.
2. Development of the tools we have will lead
our institution to increase patient safety
and reach a high-quality care.
![Page 68: Closed loop medication process in a teaching hospital in 9](https://reader031.vdocuments.us/reader031/viewer/2022011908/61d73da2f7b42d689a3a48bd/html5/thumbnails/68.jpg)
68Thank you for your attention