Delivering world-class healthcare

Business challenge

 

Prescribing, dispensing and administering medications at the right dosage, with the appropriate delivery method and in the correct combination is key to safe and effective hospital treatment. However, implementing safety checks can often be a time consuming and manual process. The clinical team at HIC looked for a more efficient way to check prescriptions for potential dangers and prevent medication-related harm. How could HIC clinicians work more effectively while ensuring excellent patient safety?

 

Enhancing patient safety and workflow efficiency

 

With support from local solution distributor Dot.Lib, HIC integrated clinical evidence from Micromedex® into its Electronic Health Record (EHR) for an automated warning system directly in the workflow for physicians, pharmacists and nurses. Today, the EHR alerts clinicians if a drug, delivery method or combination of medicines could cause issues for patients. By enhancing workflow efficiency, clinical teams at HIC can review more patient cases, helping to avoid medication errors and adverse events, while also enabling clinicians to dedicate more time to complex cases.

 

Results

• Enhanced patient safety: At least 96% of all prescriptions now undergo clinical pharmacy validation, helping to reduce medication errors and associated costs.
• Achieved digital certification: Automating clinical alerts helped HIC to achieve stage 7 certification of the Electronic Medical Record Adoption Model (EMRAM) developed by the Healthcare Information and Management Systems Society (HIMSS) and maintain Joint Commission International compliance.
• Improved workflow efficiency: Streamlined workflows enable clinicians to spend more time with patients, supporting active listening and person-centered care. 

[getModule name="blockquote" quote="We knew that Micromedex was the best fit for HIC because it is used widely by the international medical community and has won prestigious awards and accreditation for its robust editorial process. Plus, many of our clinicians were already familiar with Micromedex solutions from their medical training." author="María Carolina Aguirre Navas, Chief Medical Information Officer, Hospital Internacional de Colombia"]

 

 

Ensuring medication safety

 

Recognized by the Joint Commission International (JCI) as a leader in cardiovascular medicine, Hospital Internacional de Colombia (HIC) provides cutting-edge care to patients with a wide range of complex heath conditions. 

 

Patient safety is a priority for HIC, and clinicians in the medication safety program and across the hospital are acutely aware of the potential harm that could result from medication errors. Dangerous drug interactions, dosing errors and intravenous compatibility issues can cause harmful adverse events. Typically, patients with comorbidities and those who receive multiple medications face a higher risk.

Pharmacists at HIC have always carried out medication reviews to validate prescriptions for the most at-risk patient groups, helping them to maintain an excellent patient safety record. However, clinicians ran this process manually by proactively checking evidence-based resources for potential interactions or compatibility issues. While supporting excellent patient safety, working in this way took a significant amount of time and limited the number of clinical pharmacy validations that pharmacists could perform.

María Carolina Aguirre Navas, chief medical information officer at HIC, explains: “With 700 inpatient beds and many more outpatients, increasing the number of clinical pharmacy reviews that our team could carry out was a challenge. Skilled pharmacists are in short supply, so we looked at the possibility of partially automating clinical pharmacy validations to scale these interventions.” 

 

Harnessing the power of automation

 

To help clinicians work more efficiently, HIC integrated Micromedex® into the Electronic Health Record (EHR), creating automated patient safety alerts directly within clinician workflows. The evidence-based clinical content of Micromedex is now available during prescription, dispensing and medication administration. As a result, clinical teams can evaluate drug interactions, maximum and minimum dosage considerations, and IV compatibility all within the EHR workflow. Moreover, the new solution automatically screens prescriptions for multiple medications as well as a patient’s clinical history and laboratory results to check for possible interactions.

“Finding a database that we could trust to deliver the latest accurate, reliable, clinical decision support was our top priority,” explains Navas. “We knew that Micromedex was the best fit for HIC because it is used widely by the international medical community and has won prestigious awards and accreditation for its robust editorial process. Plus, many of our clinicians were already familiar with Micromedex solutions from their medical training.”

Today, all clinical staff at HIC are guided by clinical evidence from Micromedex when prescribing, reviewing or administering medications. Physicians and specialists use the solution to support prescription workflows, pharmacists harness it to support clinical pharmacy validations, and nursing teams consult guidance from Micromedex to run a final check before administering medications to patients. Initially, HIC rolled out Micromedex in the hospital setting, but the hospital is now also using the tool to support outpatient services.

 

 

Preventing alert fatigue

 

Doctors, pharmacists and nurses work in fast-paced environments and HIC was keen to avoid adding further pressure with the new alert system. To achieve this, the hospital worked closely with local Micromedex distributor Dot.Lib to tailor alerts to the needs of different clinical roles. Micromedex also allows clinicians to filter alerts by severity, or strength of documentation, helping them to triage warnings appropriately.

“If clinicians receive multiple notifications every time they prescribe or administer a drug, they’ll quickly get overwhelmed,” explains Navas. “Too many alerts can be counter-productive and could cause clinicians to miss important warnings. Using Micromedex, we can design a system that warns clinicians of potential dangers without distracting them. With the customized approach, we can help the right clinicians receive the appropriate alerts at the right time.”

During the implementation, HIC and Dot.Lib tailored the medication alerts to three distinct user groups. “Doctors, pharmacists and nurses perform very different roles in clinical settings,” comments Navas. “Some alerts are relevant to doctors when prescribing, while others are more relevant to nurses administering drugs intravenously. The Micromedex team at Dot.Lib helped us to design a warning system to match the unique needs of each user profile.” 

 

Boosting clinician and system efficiency

 

With automated alerts for potential medicine-related harm built into its EHR, HIC can ensure that clinicians have immediate access to the latest information when prescribing, dispensing and administering medications. As a result, clinicians no longer need to manually check reference materials for potential dosing errors, drug interactions or IV compatibility issues — helping them to work much more efficiently.

“After integrating Micromedex into our EHR, we are now able to review 96 percent of the prescriptions that we issue,” says Navas. “By reviewing almost all prescriptions, we are enabling better pharmacological treatment. We also expect to see significant improvements in pharmacokinetics and pharmacodynamics, as well as a reduction in medication errors. Most importantly, clinicians can now spend more time with patients instead of checking reference materials.”

Micromedex also helps nurses to work more productively while strengthening patient safety. Navas explains: “Previously, our nurses would call the clinical pharmacy team for confirmation if they had concerns about medication mixtures. Now nurses automatically receive warnings via our EHR if a medication or dosage could be problematic, so they can take the appropriate next step much faster. With nurses treating hundreds of patients each day, this saves a lot of time across all of our wards.” Additionally, since physicians now also receive compatibility alerts at the moment of prescribing, these patient safety issues can be avoided much earlier in the clinical journey.

As well as alerts on drug interactions, contraindications and IV compatibility, clinicians at HIC also receive the latest guidance on dosages for different patient populations. Navas comments: “Physicians used to check reference materials manually if they had any queries on dosing for more complex cases. Now clinicians receive automated alerts on patient-specific dosing and can use their own expertise, together with the clinical context of the patient, to assess the most appropriate treatment options. This helps physicians to work more productively and prescribe with greater confidence.”

Many patients at HIC have complex conditions and receive multiple medications as part of their treatment. With more efficient medication validation activities driven by Micromedex, HIC can prevent the wastage of valuable medication resources — reducing costs and helping the organization to build an even more sustainable medication cycle. 

 

Achieving international recognition and certification

 

Integrating trusted clinical decision support from Micromedex into its EHR formed a key part of HIC’s strategic plan for digital transformation. As well as supporting continued compliance with the Joint Commission International accreditation, the project helped HIC to achieve stage seven of the Electronic Medical Record Adoption Model (EMRAM) developed by the Healthcare Information and Management Systems Society (HIMSS). Currently, only 6.4 percent of US hospitals have gained such a high level of certification1 and HIC is the first in the country to meet stage seven criteria.

Navas concludes: “Achieving HIMSS EMRAM stage 7 certification is a huge milestone that we are incredibly proud of. We are committed to excellence, and by selecting award-winning solutions like Micromedex, we’re well placed to support continuous innovation and ensure that we always provide patients with the best possible care.” 

[getModule name="blockquote" quote="Achieving HIMSS EMRAM stage 7 certification is a huge milestone that we are incredibly proud of. We are committed to excellence, and by selecting award-winning solutions like Micromedex, we’re well placed to support continuous innovation and ensure that we always provide patients with the best possible care." author="María Carolina Aguirre Navas, Chief Medical Information Officer, Hospital Internacional de Colombia"]

References

1.  Jessica Kim Cohen, “How many hospitals are on each stage of HIMSS Analytics’ EMR Adoption Model?”, Beckers Health IT, April 2018.
https://www.beckershospitalreview.com/healthcare-information-technology/ehrs/how-many-hospitals-are-on-each-stage-of-himss-analytics-emr-adoption-model/