The American Society of Health-System Pharmacists (ASHP) Research and Education Foundation announced Evanston Northwestern Healthcare as the recipient of the second annual Award for Excellence in Medication-Use Safety for 2005. The two finalists were St. Francis Hospital and Health Centers in Beech Grove, Indiana, and Sutter Medical Center Sacramento in Sacramento, California.The recipient and finalists were formally recognized at an invitation-only luncheon held during the 2005 ASHP Midyear Clinical Meeting in Las Vegas, Nevada. ENH received a $50,000 award to be used to further promote medication-use safety in its health system. The finalists, St. Francis Hospital and Health Centers and Sutter Medical Center, each received a $10,000 award.
2005 Awardee — Evanston Northwestern Healthcare
This year’s recipient, Evanston Northwestern Healthcare, located in Evanston, Illinois, created a completely electronic health record system for use in an acute care and ambulatory setting. ENH is one of the first integrated healthcare systems to put a totally electronic health record system into an acute care setting. Planning, preparation, and training occurred from August 2001 to December 2002. Implementation occurred from January 2003 to April 2004 in their 3 hospitals and 60-plus physician offices and off-site locations. The significance of this state-of-the-art system — now in use by 100 percent of physicians, nurses, pharmacists, and other medical professionals at ENH — is that all patient-related documentation and orders are now paperless throughout the organization. All practitioners work from a single, integrated source of clinical information that is secure, current, legible, organized and instantly accessible in all ENH locations.
Pharmacists played a key role in all aspects of the implementation of the system. There were many outcomes related to the implementation of this system including an elimination of all transcription-related medication errors, decreases in the delay of medication administration and first-time administration of certain medications such as antibiotics, a reduction in the number of override pulls of medications and integration of the inpatient system with the ambulatory health records of all patients served by the health system.
“With direction and support from both senior leadership and physician leadership, we have completely revised almost every workflow process of every physician, clinician, technician, and support staff to utilize technology to improve the care and safety of our patients,” says Lynn Boecler, Pharm.D., M.S., Senior Director of Pharmacy Services for Evanston Hospital, and the pharmacist who led ENH’s multidisciplinary team in its initiatives. “Being granted this award validates our effort to completely transform how we provide care through the implementation of integrated electronic health records as the right thing to do for our patients. We are pleased that the ASHP Foundation and Cardinal Health Foundation recognize the tremendous amount of work required to accomplish these outcomes.”
Lynn Boecler, Pharm.D., M.S.
Doina Dumitru, Pharm.D.
Jenny Go, Pharm.D.
Stan Kent, R.Ph., M.S.
Peggy King, R.N.
David Lerner, M.D.
Michelle Makowsy, R.N.
Lisa Michener, Pharm.D., M.S.
Jim Renneker, R.N.
Kate Reynolds, R.N.
Janet Ryan, R.N.
Sue Levi, R.N., M.B.A.
Nancy Semerdjian, FACHE
Thomas W. Smith
Kathy Snow, R.N.
Arnold Wagner, Jr., M.D.
Veronica Zaman, R.N.
ENH presented their work entitled "Planning and Teamwork: Keys to Successful Implementation of an Electronic Medical Record with Computerized Prescriber Order Entry" at the ASHP 2006 Summer Meeting in Orlando, Florida. The presentation can be viewed here:
2005 Finalist — St. Francis Hospital and Health Centers
Practitioners at St. Francis Hospital and Health Centers in Beech Grove, Indiana, came together to create the Medication Event Decision Support Team (MEDS) to develop the infrastructure and teamwork to build “a culture of safety” for the medication use process. By 2004, critical components and strategies of safety were implemented and functioning, including adopting a systems approach, implementing care delivery changes and sharing success stories. Building on their medication safety foundation, the MEDS Team embraced technology to expand the patient safety net. The MEDS team vision remained constant to its goal: To proactively prevent adverse medication events. Bar-coded replenishment of automated dispensing cabinets was implemented to increase efficiency and accuracy of medication refills.
Electronic alerts were developed for high-risk or problem-prone medications vended from automated dispensing cabinets. Alerts, rules and decision support interventions were designed for the Pharmacy Information System to prevent or detect errors. Implementation of an intravenous (IV) medication safety system added a new level of safety to IV infusions. As these system-wide initiatives were implemented, medication events that reached the patient decreased, communication regarding orders improved, and patient harm was mitigated. The use of technology is an ongoing strategy at St. Francis. Additional information technology projects that involve medication safety are in early phases of project management or implementation, including bedside barcode for medication administration and document imaging. St. Francis collaborates with medication safety efforts at the corporate and regional levels, standardizing quality initiatives and sharing success stories.
Susan Brown, R.Ph., M.S., MBA
Charles Kinsella, M.D.
Marianne Benjamin, R.N., M.S.N., CNA-BC
Mischelle Frank, R.N., M.B.A.
Ronda Freije, R.Ph.
Alan Gillespie, M.D.
Barbara Harvey, R.N.
Tammy Haslar, R.N., APRN BC
Gary Head, R.Ph.
Douglas Johnstone, M.D., J.D.
Donald Kerner, M.D.
George Long, R.Ph.
Melissa Lowder, R.N., M.S.N., CCRN, CNS
Jo May, R.N.
Lee Ann McGinley-Wright, R.Ph.
Susan McRoberts, R.N., M.S.N., CPHQ
Deb Orange, R.N.
Mechelle Peck, R.N., B.S.N., RCIS
Cathy Rittenhouse, R.N.
Dawn Scott, R.N.
Paula Stanfill, R.N., M.S.N., R.N.,CPNP
Therese Staublin, Pharm.D.
Theresa Weisenbach, R.N.
2005 Finalist — Sutter Medical Center, Sacramento
The initiative undertaken at Sutter Medical Center, Sacramento, in California, focused on the use of vasoactive medications in emergency settings. A new comprehensive system for the use of these drugs included standardized concentrations for all patients, a new software program that produced emergency drug sheets according to an approved protocol and associated smart pump technology incorporating the standardized concentrations and protocol. The protocol applies to the use of vasoactive medications for all patients regardless of patient age, size or location in the hospitals.
The protocol was developed in a comprehensive manner gaining full support of many practitioners by meeting the dosing ranges, fluid needs and pump rates of each patient. The implementation team was led by the pediatric pharmacist and pediatric clinical nurse specialist. All clinicians use the system in the main hospital, two sister hospitals and is requested by area facilities. The most important aspect of the project that was cited by the selection panel was the extent to which the implementation team gained consensus from all groups at the main hospital and sister hospitals. Sutter also concentrated on spreading their success story by developing a tool kit for others to use in implementation of similar projects.
Kevin Brown, Pharm.D.
Siobhan Geary, R.N., M.S., CNS
Kay Jelten, R.N., M.B.A.
Mark Larrabee, R.Ph.
Kristin Niemi, Pharm.D.
“It is remarkable to see the systems improvement and the advances for patients’ medication safety that were achieved by the team of practitioners at each of these sites. Pharmacist leadership was instrumental in every case and there are tremendously valuable and transferable lessons to be learned. The ASHP Foundation celebrates the successes of these practitioners and looks forward to helping them disseminate key aspects of their success stories with other practitioners,” said Stephen J. Allen, M.S., FASHP, Executive Vice President and Chief Executive Officer of the ASHP Foundation.
The three sites were chosen by an interdisciplinary panel of judges, who evaluated 19applications. Finalists were chosen based on criteria focusing on achievements in medication-use system initative/scope, planning and implementation, measurable outcomes and impact, and innovation and applicability. Judges visited each finalist site before selecting a recipient.
The recipients were also highlighted in articles that appeared in Drug Topics, Pharmacy Practice News, Drug Formulary Review, Hospital Pharmacy, and American Journal of Health-System Pharmacy.