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A national shortage of nurses and a reliance on outdated paper-based systems in the nations hospitals lead to thousands of life-threatening medical mistakes each year. In fact, more Americans die each year from medical mistakes in hospitals than from car accidents, breast cancer or AIDS, according to a 1999 study from the National Academies Institute of Medicine, based in Washington.
It was these statistics, and others like them, that helped spur the Washington-based U.S. Food and Drug Administration to mandate earlier this year that all drugs distributed to U.S. hospitals, as well as blood and biological products, have bar codes by April 26, 2006. Bar coding, the mandate said, will, among other things, help ensure that prescribed medicines and dosages are more accurately documented.
The groundswell of attention being paid to the subject pushed Sutter Health, a nonprofit health care organization with more than 20 providers in Northern California, to turn to bar coding sooner rather than later.
In fact, after learning of the IOM study, Sutters CEO, Van Johnson, gave his IT team three years to implement an electronic bar-code system that would help nurses monitor patient medications.
To do it, Sutters IT team turned to its standby, Sacramento, Calif., neighbor Inacomp Computer Centers. The technology reseller, which has worked with Sutter on IT projects since the mid-80s, helped Sutter draft an electronic medication solution built around PCs, notebooks and handhelds from Hewlett-Packard Co., of Palo Alto, Calif.; bar-code scanners from Symbol Technologies Inc., of Holtsville, N.Y.; and bar-code software from Bridge Medical Inc., in Solana Beach, Calif.
With the new system, a bar code is added to a patients wristband, the patients medication and the nurses ID badge. Before administering prescribed medication, a nurse scans each bar code using a Symbol handheld. The information is automatically cross-referenced with a database in an in-room PC to ensure the correct medication and dosage.
Sutter started testing the system more than 18 months ago and has implemented it in 10 of its hospitals. To date, Sutter has delivered more than 2 million doses using the system and expects to reach 3 million by December.
Before the new system, Sutters physicians sent paper prescriptions to the pharmacy, which would interpret the handwritten notes and dispense medications to nurses. Although there were multiple health care workers verifying prescription accuracy, there was still a lot of room for error.
“If you can imagine its 2 in the morning at the end of a four-day shift, and there are two Mr. Smiths in the room; thats where you could run into problems,” said Sutters CIO, John Hummel.
In fact, more than half of adverse drug reactions occur because nurses accidentally give the wrong dose, said Hummel. “There are 17,000 medications in the average lexicon. Theres not a nurse—or a doctor, for that matter—that knows every single drug out there. But the computer does,” he said. The electronic system also helped eliminate half of the nurses paperwork, freeing them to spend more time with patients, he said.
“When we ask our nurses, What do you really hate? they say paperwork—maybe second to doctors. They tell us they want to spend more time with patients and patients families,” said Hummel.
So far, Hummel said Sutters nurses have been receptive to the bar-coding system. “Our nurses not only want it, but they demand it,” said Hummel. “They see it as somebody helping them at the bedside.”
But Sutter had to overcome several technical obstacles in implementing the system. “One of the biggest hurdles was [to] … get the technology to the bedside,” said Hummel.
The cost of wiring an entire hospital was too high, so Sutter opted to go wireless, using networking equipment from Cisco Systems Inc., of San Jose, Calif.
Still, each hospital has a distinct architecture and thus a different technological challenge, which is where Inacomp came in.
“Some of our hospitals have big rooms; some have small rooms. A lot of them have steel girders, which can interfere with the wireless signals,” said Hummel.
“Each hospital is different, and each floor is different,” said Inacomp CEO Steve Arosteguy. “We helped them to get the right configuration.” Another challenge was power management, Arosteguy said. “We had to make sure they could get a shifts worth of power on the bedside PCs,” he said.
Hummel estimated the overall cost of the project is $26 million but added that Sutter will be able to leverage the technology for other opportunities, such as a physician order entry system, patient billing, systems for monitoring patient blood pressure and pulse, and blood banks.
Sutter is also exploring ways to allow patients to use the bedside PCs for e-mail. “With the right security, patients would be able to use the PCs in between nurses,” said Hummel. “There are never-ending things to do with it.”