Making the Case for Computerized Medication Carts


October 2008 - Vol. 5 No. 10

At Ellis Hospital, a 455-bed community facility in Schenectady, New York, patient safety is our highest priority and computerized medica- tion carts go a long way toward helping us achieve that goal. Ellis provides a full range of quality health care service across three campuses including medical and surgical, emergency, psychiatric, and obstetric/gynecological care, primary care, long-term care and outpatient services. Specialty services include a stroke center, a bariatric care center, and a heart center.

Siemens’ Med Administration Check (MAK) bar-code technology, along with the medication carts, helps us accomplish our ongoing initiative to ensure the safety and quality of care for our patients. The advanced system was implemented nearly two years ago and has since helped Ellis provide the safest environment possible for patient care while improving nursing and pharmacy workflow and increasing efficiency. 

Our computerized medication carts feature an on-board computer with secure patient-specific drawers. By using the on-board bar code scanner, caregivers verify that they are administering the right dose of the right medication to the right patient at the right time, via the right route. The system alerts caregivers when the “rights” don’t match up, enhancing patient safety. 

 

Committee Review
We began to consider investing in this technology after moving to a nursing model where the primary nurse assigned to the patient was responsible for administering medication to that patient, instead of using medication nurses. We needed to eliminate the paper-based administration method that allowed potential errors to occur. We also needed to ensure the “five rights” as well as the security of the medication to the bedside. Computerized medication carts met all these needs.

The process of selecting the right system and medication carts for our facility began with a special multi-disciplinary committee, consisting of the director and manager of pharmacy, medical director of informatics, the director of nursing, nurse managers, staff nurses, the director of professional practice, a pharmacy analyst and IT. Everyone’s input was crucial to the selection process.

Before we began examining the carts, we developed specific criteria, including having enough individualized patient drawers in each cart. We also wanted automatic locks so the cart would secure itself within a programmed number of minutes if someone forgot to lock it. In addition, we wanted nurses to be able to simply push a button and lock it down without a key.

 

The Right Choice
While patient safety is worth the additional investment required for computerized medication carts when compared to basic and automatic-locking carts, there are many other sound reasons to select computerized medication carts for your facility.  They are more mobile than traditional medication carts and allow nurses to stock medication in drawers and put them into the cart. In addition, the computer adds the ability to access reports such as lab and radiology results. The system streamlines workflow, allowing nurses to administer a patient’s medications and document it at the bedside instead of leaving the room to use the older paper documentation system. The computerized carts also provide a tracking mechanism and allow for quality assurance.

Additional criteria to consider when selecting a cart include height adjustment capabilities and knee space for sitting, overall ease of use and mobility, lockable wheels, an ample work surface, overall weight, and how easy it is to clean for infection control purposes. From a hardware perspective, we wanted at least a 17-inch monitor with a keyboard and a bar-code scanner attached to every cart. And we wanted at least eight hours of battery runtime. It is also important to survey all floors of your facility with your nurse managers in order to decide on the best place to store the carts when they are not in use. The nursing staff was specific about their needs during the selection process and was hands-on in testing carts from three different vendors. This ultimately led to their supporting the move to automated computerized carts.

Once the decision has been reached to purchase and implement computerized medication carts in your facility, you need to put the cart to everyday use to determine if it fulfills your needs. We brought in carts from three different vendors that we believed met our criteria. We had our nurses use the carts on two units for 30 to 40 days. From there, they were able to make the final decision on which carts they would like us to purchase. 

Currently, we have about 72 carts in our facility with plans to add more. In addition, we worked closely with our nurse managers and evaluated staffing to ensure that nursing had sufficient carts available at all times.  To allow for cart maintenance, it is important to purchase spare carts so that others can be taken off the unit for maintenance without impacting patient care.

 

Return on Investment        

Engendering support and a commitment from your organization across the board is also key. At Ellis, the selection of computerized medication carts was viewed as a significant and necessary piece to further improve and support care. Our board of trustees and senior leadership were fully supportive of the change in technology and process as part of their steadfast commitment to patient safety. 

Conclusion
Computerized medication carts enhance patient safety while improving nursing and pharmacy workflow efficiency. Additional benefits include real-time documentation, reminders for nurses about assessments, eliminated need for hand-written medication administration records, and the ability for nurses to call up medication information at the bedside. This fosters greater peace of mind for staff and patients alike.

Kevin Ryan, RN, BS, is director of clinical systems transformation and Donna Jennings, RN, CCRN, BS, is director of nursing resources at Ellis Hospital in Schenectady, New York.

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