Besides providing a safety net for nurses and patients, this system helps automate medication procedures. Learn how one hospital uses it to catch mistakes before they happen.

By Julie Miller

Shelly Germain, RN, has a fast-paced job as a medical/surgical nurse at Northern Michigan Hospital, Petoskey, MI. Although she takes precautions to avoid making medication errors that put her patients at risk, she knows mistakes can happen. "In nursing, we sometimes get rushed. Anything that makes me stop and take a second look when I'm giving medications is a good thing," Germain says.

To eliminate medication errors, the 199-bed hospital is installing a computer networking and bar code scanning system that double-checks medications at the bedside before they're given. The cornerstone of the Bridge Medication Management System, developed by Bridge Medical Inc. (Solana Beach, CA), is a bedside computer mounted on a rolling stand or a wall. The computer is equipped with a color touchscreen, a keyboard, and a bar code reader.

Nurses scan the drug to be administered, the patient's identification bracelet, and their own identification badge. The system verifies the "five rights" - right patient, right drug, right dose, right time, and right route - and a prominent message on the computer screen alerts nurses of errors. The system also checks for safe dosing levels and potential hazards with medications that look and sound alike, according to the company.
The bedside computer interacts with a communication system wired into the hospital ceiling. Changes in medications, dosage, and other data can be instantly communicated from hospital information systems to the bedside unit, keeping nurses on the floor up to date. When a patient is transferred to another unit, all information is transferred from the network to the patient's new location.

The first phase of the program at Northern Michigan started in December 1998, when 36 rooms on the hospital's medical/surgical floor were equipped with bedside computers, according to Bridge. The second phase, now underway, involves introducing and testing improved hardware and software. Automation of medication administration records (MARs), the third phase, will take place in June. The hospital expects to have the system installed on all inpatient floors by the end of this year, according to Donna DuLong, vice president of marketing at Bridge.

But the program is already producing good results, says the coordinator, Jim Douglas, RN. "We're documenting 'near misses' and errors that were happening before but were never documented."

Automated recordkeeping
When installation of the Bridge system at Northern Michigan is complete, it will eliminate a lot of manual recordkeeping. At the beginning of a shift, for example, a nurse will receive a printed list from the pharmacy information system of all medications to be delivered to assigned patients.

The list will be organized according to the times medications are scheduled. In addition, a display of medication orders on the bedside computer will be organized by the time due. As new orders are taken from the chart and entered into the pharmacy information system, they'll be available for the nurse to verify on the Bridge system. A message on the computer screen will notify the nurse of the doses due or late and potentially missed.

After the nurse obtains the medication to be given to the patient, the Bridge system will act as a final checkpoint by verifying the "five rights" and other possible sources of error, including maximum daily dose exceeded or potential for allergic reaction. With pre-administration verification, Bridge will automatically document all medication activities, eliminating manual transfer of information to the MAR. The automated MAR can be used alone or in conjunction with a clinical information system to eliminate manual documentation. The clinical information system includes the actual time medications are given and allows up-to-the-minute display of medication records at nursing stations.

Opportunities to improve
Besides providing a safety net at the bedside, the Bridge system allows Northern Michigan to track medication trends, determine where errors nearly occurred, and build safeguards against recurring mistakes.

Trudy Day, RN, clinical nurse manager of Northern Michigan's medical/surgical unit, says reports produced by the system help managers identify opportunities to improve procedures. "We can examine the information closely for factors that contribute to errors. Is it a process change that we need to make? Or is it a clinician we need to look at? Chances are, it's a systems issue."

Nurses may be reluctant at first to adopt changes in medication procedures, relying instead on practices that have worked for them i  n the past. But once they experience the advantages of an automated process that offers a safer environment for their patients, they'll accept the changes, Douglas says.

"First line of defense"
The Bridge system has prevented Germain from making medication errors on a number of occasions, she says. "I do several checks before giving medication to a patient. But Bridge is my first line of defense. It makes me feel confident. If I have only one pill in my hand when I scan a medication, and the order calls for two, the information comes up on the computer screen that I'm supposed to give the patient two pills. I can't tell you how important that is to me. There isn't enough I can do to be safe."

Julie Barton Miller, who lives in North Stonington, CT, is a freelance writer with extensive experience covering health and medical topics. Reprinted with permission from Nurses.com.