Princeton Baptist Medical Center in Birmingham, Alabama is a 499-bed facility dedicated to persistent patient safety initiatives and eager to develop innovative programs that improve patient care. With this in mind, the nursing IT department was pleased to be approached by representatives of MedMined Data Mining Surveillance Service from CareFusion to be a test site for a new technology, called Pyxis Advisor, that would deliver clinical surveillance alerts to nursing at the point of medication retrieval from an automated dispensing cabinet (ADC).
Collaborating on Process Improvements
In February of 2010, MedMined Service came to Princeton with a new medication surveillance technology and requested our assistance in testing it for market. Both the pharmacy and nursing departments decided to work together on the project, and the ten-month collaboration led to the creation of a comprehensive surveillance software to monitor medications, integrate lab results, and alert caregivers to conflicts; areas that were troublesome to reconcile in the past.
In a facility of our size, there were instances when nursing was not aware of a new lab result for a patient they were actively administering medications to. What appealed to both pharmacy and nursing was that this software would analyze clinical data from multiple sources and immediately deliver relevant information and alerts to our ADCs. This functionality provides the nurse with the most up-to-date patient status prior to medication administration. The governing idea behind Pyxis Advisor is to provide near real-time communication channels to assist in identifying potential medication and other adverse events before they happen, and the surveillance system reviews patient laboratory results to help ensure prescribed medications do not negatively affect the respective laboratory abnormalities.
Involving Key Stakeholders
The Princeton BMC nursing and pharmacy departments began to work with this new system by installing it on two units—in the 12-bed ICU and the 43-bed general surgery department. We saw rather quickly that the system was not only helpful in reducing medication errors in those two departments but its benefits could be applicable throughout the hospital in helping to reduce potential medication and other errors. By empowering nurses with real-time information, that front line staff can review multiple data points and follow up with pharmacy or physicians to adjust patient doses when necessary, helping to avoid costly errors. At present, all nurses use the Pyxis Advisor system, hospital-wide.
Shaping and Using the System
To assist us initially, CareFusion established data parameters that would be compiled and sent to the ADCs, with input from both the pharmacy and nursing departments. We were given customization options throughout, and now have the ability to set and adjust our own data rules. The nursing department provided ongoing feedback from the beginning of the project, and completed two opinion surveys during the course of the pilot. We also have a monthly interdepartmental meeting that serves as a forum for continued feedback and improvement.
When an alert is received at the ADC, the nurse enters a result or comment in our eMAR system, as appropriate. As the system stores all user data, we can produce reports based on the individual ADC units used, what alerts were received, and how those alerts were resolved during the course of any date range. A common example of an alert and response would be if the lab results show an elevated potassium level, possibly related to a patient’s medication. In this case, a text box would appear on the ADC screen notifying the nurse of the situation prior to the removal of medications. Likewise, if a patient’s lab value crosses a pre-defined threshold, such as a patient on warfarin with a high INR, an alert will trigger prior to warfarin being administered so that a clinician’s intervention can be made, if needed. Once the issue is resolved, the nurse will click a button indicating the alert has been reviewed, and it will not show up again for that nurse. If another staff member accesses the same patient record, however, he or she will see the alert and be able to review the status and resolution. As part of the alert resolution, the nurse documents all resolution actions in the eMAR system. Training on the system was fairly simple, as the alerts display automatically depending on the medication or criteria match, and we perform routine reviews of the alerts to ensure they remain pertinent.
In addition to providing nurses with critical laboratory and pharmacological information about their patients, Pyxis Advisor can help clinical pharmacists identify patients for potential adverse clinical events and track laboratory results for any changes that may require potential clinical intervention. Pharmacists can further customize the software by creating drug-specific clinical alerts. These alerts provide pharmacists with additional, real-time clinical information, allowing them to spend more time with patients who may need a medication regimen adjustment.
To focus on patient safety, our physicians, pharmacists, and nurses need timely, coordinated information. Pyxis Advisor gives the nursing department the opportunity to be more active in the medication administration and control process. This reduces the strain on nursing, pharmacy, and physicians and enhances communication between all disciplines. Our intent is to give nurses the tools they need at the point-of-care, and this system is able to quickly alert nurses regarding abnormal lab values and empower them to act accordingly to avert potential medication related problems.
Carol Donaldson, RN, is the nursing systems coordinator at Princeton Baptist Medical Center in Birmingham, Alabama. With over 30 years experience in hospital nursing operations, Carol collaborates with physicians, pharmacists, and clinical staff to address system needs. She received her BS in nursing from the Ida V. Moffett School of Nursing at Samford University in Birmingham, Alabama.