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Closed Loop Medication Management –A Preferred Way To Go Forward For Providers

16 August, 2017 | Author: Prachi Naik, Manager- Consulting

CitiusTech Thought

Leadership

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Overview of Closed Loop Medication Management

What is Closed Loop Medication Management (CLMM)?

Closed Loop Medication Management (CLMM) system is a fully electronic medication management process that integrates automated and intelligent systems to completely close the inpatientmedication management and administration loop, and seamlessly document all the relevant information.

Why is CLMM needed?

CLMM improves paper centric medication management workflow by standardizing the process, reducing variation, identifying and eliminating unnecessary steps and reducing opportunity for errors among the care team members. The closed-loop process provides access to a consistent and real-time patient clinical information at the point of care.

If an EHR system has to certify to EMR Adoption Model (EMRAM) Stage 6 or Meaningful Use (MU2) Stage 2, CLMM implementation becomes mandatory.

This document provides an overview of CLMM system, which is an end-to-end automation from medication prescription to medication administration. This document provides insights to physicians, nurses and pharmacists who intend to reduce medication errors by automating medication management workflow.

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Agenda

CLMM Highlights

Eight Rights of Medication Administration

IT Systems involved in CLMM

CLMM Workflow

CLMM Benefits

Recommendations to implement CLMM

References

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CLMM: Highlights

Stages in Medication Process Ordering/ Prescribing Transcribing and Verifying Dispensing and Delivering Administering Monitoring and Reporting

Components of CLMM An active medication order An electronically identified provider (nurse) A bar-coded drug An electronically identified patient

Impact on Medication Process Enhance patient safety Improve efficiency Reduce medication errors Increase patient identity confirmation

before medication administration

Addressing Medication Errors Automating emergency department care

processes Automating bedside care processes Automating perioperative care processes Preventing medication errors at patient

discharge

Impact on Medication Process Computerized Provider Order Entry Bedside Verification e-Prescribing Medication Reconciliation

Technologies Used Computerized Provider Order Entry (CPOE) Clinical Data Repository (CDR) Drug information systems / databases E-Pharmacy, pharmacy ordering and

information systems Barcode technologies Radio Frequency Identification (RFID)

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Eight Rights of Medication Administration

The “8 Rights of Medication Administration” are a set of 8 standards that ensure safe nursing practice and reduce medication errors:

Right PatientThe medication is administered to the intended patient for whom it is meant.

Right MedicationThe medication to be administered matches the medication order for the patient.

Right DoseThe dose of the medication to be administered matches the dose of the medication ordered for the patient.

Right RouteThe route of medication delivery matches the route specified in the medication order.

Right TimeThe medication is administered as per the time schedule in the medication order.

Right Documentation

The documentation should clearly reflect all of the above attributes

along with electronically recorded time and date as per the synchronized system clock

Right Reason Confirming the rationale for the ordered medication, what is it treating?

Right ResponseDocument monitoring of the patient whether drug has desired effect

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CLMM IT Systems: Computerized Provider Order Entry

Computerized Provider Order Entry (CPOE) is a system that enables healthcare providers to electronically enter, modify and cancel orders in inpatient and ambulatory settings

CPOE orders include medication, laboratory, admission, radiology, referral, procedure and dietary orders

Advantages of CPOE

Prevents errors by ensuring standardized, legible, and complete orders

Improves compliance with guidelines and efficiency of hospital workflow

Provides faster transmission to ancillaries (laboratory, radiology, pharmacy and others)

Combining CPOE with Clinical Decision Support System (CDSS)

Assists providers in timely and efficient decision making

Provides recommendations and warnings such as contraindications, IV incompatibilities, duplicate therapies etc.

Prevents clinical errors such as drug-drug interactions, drug-allergies, etc. through interaction checks

Prevents potential conflicts involving lab results, diet or disease

Saves cost, improves quality of care and enhances patient safety

Examples

1) Patient allergic to Erythromycin

Warning: The use of ERYTHROMYCIN BASE may result in an allergic reaction based on a reported history of allergy to ERYTHROMYCIN BASE

2) Patient with lab test result indicating presence of Clostridium difficile

Recommendation: Vancomycin is used to treat an infection of the intestines caused by Clostridium difficile, which can cause watery or bloody diarrhea

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CLMM IT Systems: Bar Code Medication Administration

Bar code medication administration (BCMA) is a barcode system designed to:

• Prevent medication errors

• Improve the quality and safety of medication administration

• Generate online patient medication records

It consists of a barcode printer, a barcode reader, a mobile computer (with Wi-Fi) server and software

BCMA Workflow

Each medication is labeled with a unique barcode

Administration

Nurse scans barcode on the patient’s wristband and then the medication barcode

Ensure electronic verification that the right patient gets the right dose of the right medication at the right time and by the right route

Barcoded Medication

Order Entry and Verification

Dispensing

Documentation

Physician electronically enters medication order

Order is sent to pharmacy for verification

Pharmacist dispenses barcoded unit dose of the medication to the patient's floor

Automatically document administration if scanned dose matches to a pharmacist-approved medication order & patient is due for current dose

If the dose does not match with valid order, the application issues a warning

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CLMM IT Systems: Other Automation Technologies

Biometrics

Fingerprint Scanning Scan and compare digitized fingerprint image with image data stored in database

Iris Scanning Scan and compare iris of the eye, patterns of blood vessels and flecks on the iris

Advantages Use of unique measurable characteristics of human beings

Provide automatic authentication of patient using biometric devices with embedded software

Enhance patient safety by using identity verification systems

RFID

RFID Radio Frequency Identification uses radio waves for collecting and transferring patient data

RFID technology is used by nursing services to improve the efficiency of operations such as patient identification, nurse identification, medication identification, and closed loop medication administration processes that improve patient safety

Advantages Enhances patient safety

Eliminates medication errors and adverse events related to patient misidentification

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CLMM IT Systems: Automated Dispensing Cabinets

An Automated Dispensing Cabinet (ADC) is a computerized drug storage cabinet designed for hospital pharmacy that dispenses medications near the point-of-care

ADCs are also called unit-based cabinets (UBCs), automated dispensing devices (ADDs), automated distribution cabinets or automated dispensing machines (ADMs)

ADCs incorporate sophisticated software and electronic interfaces to synthesize high-risk steps in the medication use process

Advantages

• Provide computer controlled storage, dispensation, tracking, and documentation of medication distribution on the resident care unit

• Saves significant time in the daily workflow of nurses

• Control and track drug distribution

• Provide secure lockbox storage for controlled substances until needed

• Prevent waste and drug diversion through multi-factor authentication (Using the 8 rights as authentication parameters) to the secure vault and audit trails

• Improve patient safety by providing drug-allergy, drug-drug interactions, advising on high risk medication (heparin, insulin) and avoiding confusion with "sound alike" medications

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1. Monitor patientand documentcorrectly

2. Make informedcare decisions

3. Computerized provider orderentry

4. Review andverifyorder

5. Dispensebar codedunit dose medication

6. Store medicationsecurely

7. Assess patient prior to administeringmedication

8. Scan patient& med barcodeprior to administration

9. Administermedication topatient

CLMM Workflow: Using Pharmacy Automated System

CLMM Clinical decision support tools

Legible, complete order goes to pharmacy

Secure storage in ADCs and medication carts or workstation on wheels

Check the 8 rights of medication administration

Medication administration recorded electronically

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CLMM Workflow: Using Pharmacy Automated System

1. Physician monitors the patient, appropriately documents clinical details and makes informed care decisions

2. Physician enters medication orders through Computerized Physician Order Entry System (CPOE)

3. Clinical Decision Support System (CDSS) prompts physician with information to avoid drug interactions, allergies and adverse drug events

4. Pharmacists verify medication orders, which are then sent automatically to Inpatient Pharmacy Automation System

5. The unit dose barcoded drug sachets from pharmacy are stored at the ward’s Automated Dispensing Cabinets (ADCs) or medication carts or workstation on wheels

6. Nurse scans patient’s RFID/ bar coded wrist tag which unlocks the assigned automated medication cabinet

7. Nurse then scans unit dose bar coded drug sachet(s), before administering the medicines to ensure 8 rights

8. Details are recorded electronically once medication is administered

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CLMM Benefits

Integration

Integrate physician, nurse and pharmacist workflows

Achieve connectivity and reporting from the point of prescription to bedside medication administration

Eliminate all manual order transmission & transcription activities

Real-Time Information

Provide consistent real-time patient and clinical information to all caregivers

Flag real-time medication variations on Electronic Medication Administration Record (EMAR)

Compliance Improve adherence and compliance to medication procedures and

policies

Safety

Prevent Medication Errors (ME) and Adverse Drug Events (ADEs)

Maintain medication history

Improve patient safety and quality of care

Scheduling Schedule tasks and reminders for medical staff

Eliminate shift and 24-hour chart checks

Others Simplified processes

Time savings and reduction in cost

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Recommendations to Implement CLMM

Application Development

For implementing CLMM, a provider will require existing applications or new apps to be developed to support end-to-end user based workflow

For storing clinical data effectively, clinical data model is required

Additionally, Medication Administration Record module would be required for effective medication management workflow

Integration Services

In order to achieve CLMM, if a provider has existing Pharmacy, EHRs/ Nursing Information systems and Medication Administration records in place, the above systems should be integrated at the point of care

This will pull medication schedules into task manager and uniquely identify medications with the help of drug databases like First Databank, Medi-Span

RFID Implementation

For effective CLMM working, a provider would require to implement RFID technology by setting up an interface between barcode scanner and clinical systems used

UI/UX Development

Medication administration record app would require intuitive and user-friendly, workflow/ role-based usability UX focused designs

Implementing CLMM effectively will increase the Medication Management Workflow efficiency

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References

https://www.ihis.com.sg/Project_Showcase/Healthcare_Systems/Pages/CLMM.aspx

http://www.rncentral.com/blog/2012/the-rights-of-medication-administration/

http://www.nursingcenter.com/ncblog/may-2011/8-rights-of-medication-administration

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Stage2_HospitalCore_16_ElectronicMedicationAdminRec_eMAR.pdf

http://www.himssanalytics.org/emram

http://cstproject.ca/news/closed-loop-medication-management-safety-win

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4765644/

https://www.ijirset.com/upload/2015/september/154_IJIRSET-15-394-%20proof.pdf

https://www.eiseverywhere.com/file_uploads/30dbeb4d0631fded7390e49858f04575_HIMSS16NordicLasVegasPresentationJonH.Fridriksson.pdf

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Thank You

Author:

Prachi Naik

Manager - Consulting

thoughtleaders@citiustech.com

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