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By Kevin Trimble, COO/CNO
Saint Luke's Northland Hospital
Saint Luke's Health System
Kansas City, Mo.
Keys to Success
With healthcare's growing focus on medical errors and patient safety, more and more hospitals are applying information technology (IT) solutions to make the patient care environment safer. Saint Luke's Health System – a faith-based, not-for-profit, aligned system of 11 hospitals serving Missouri and Kansas – is no exception. But simply deploying these technologies does not guarantee success. Establishing a culture of patient safety and directly engaging employees in the change process are keys to adoption and compliance.
Engaging Front-line Stakeholders
When Saint Luke's launched a strategic initiative to reduce medication errors in our hospitals, we used the Baldrige Business Model to drive strategic planning and set expectations. We began by defining and aligning our goals: to improve clinical quality, reduce medical errors and improve patient safety. Once we established safety as a cultural standard, we developed a tactical plan to implement the technology.
Engaging our front-line stakeholders was paramount. We assembled a multidisciplinary team of nurses, pharmacists, physicians and IT employees to design the optimum medication distribution process that would meet our measures of success. These were our experts, and we listened closely to what they had to say. Then we performed meticulous market research to identify and correct potential problems in advance.
Once we had everyone's buy-in, we created a design to meet the requirements — one that was as lean and pristine for employees as possible.
Exceeding Strategic Goals
In September 2008, Saint Luke's Northland Hospital deployed McKesson's point-of-care, bar-code scanning for medication administration at its two campuses. Nurses use a handheld device to scan and verify the "five rights" of medication administration: right patient, right drug, right dose, right route and right time.
In the 18 months since we went live, the hospital has achieved some dramatic results. We've not only exceeded our strategic goals, but eclipsed several best practice benchmarks as well.
Compliance is outstanding. Nurses readily embraced the technology, and their scan rate is now upwards of 95%. Our distribution process – from physician order to point of administration – is so efficient that pharmacists are able to review medication orders for appropriateness more than 99% of the time. Most significantly, errors with severity of D or greater have been reduced by 35%, and "wrong patient" medication errors have been reduced by 75%. Our team is now working to reduce the errors that may occur in other segments of the medication delivery process, outside of the IT solution.
With our continually improving metrics, we are the model for Saint Luke's Health System, where two more hospitals recently went live with the same technology.
Measuring Compliance
To promote adoption and continued compliance, we link success to individual performance. Delivering safe, high-quality patient care is an expected behavior at Saint Luke's Health System, and compliance is part of each employee's performance plan. We use analytics to track how frequently nurses are scanning medications and continually share those results via monthly balanced scorecards.
Lessons Learned
Thoughtful preparation helped our employees embrace the change. Here's what we learned along the way:
Establish Clear Expectations
Determine strategic goals and objectives, and clearly communicate them to everyone. Employees should know "What's in it for me?"
Engage Your Stakeholders
Everyone is more receptive to change when they've helped craft that change from the start. By involving employees in the medication administration design and rollout, they felt they were heard every step of the way.
Create a Design to Meet Requirements
Your stakeholder experts are your best resource. Our nurses, pharmacists and physicians understood the medication administration flow and helped map out a new process that met their mutual needs.
Review Process and Procedures Before Implementing Technology
Be sure employees understand their roles and responsibilities before you flip the switch. At Saint Luke's, this helped ensure that everyone worked well together for a smooth rollout and beyond.
Do Your Homework
Before going live, call at least 15 other hospitals already using the technology and talk to the person managing the process. This took us extra time, but the feedback helped us anticipate problems and make the technology even more user-friendly.
Mandate Compliance
It's critical to link success to individual performance. We defined a culture of patient safety as a standard and expected certain behaviors to support that culture. Once the new technology was in place, we made compliance a part of each nurse's performance plan, and we continually measure and report results.
In healthcare, we often try to solve a problem by laying technology atop an existing process, then wonder why it doesn't work the way it should. Here, we did the reverse. We directly engaged critical stakeholders from the beginning, then worked with McKesson to execute a new process that was as painless as possible for everyone involved. As a result, employees are entirely invested in its success.
Kevin Trimble is the Chief Operations/Chief Nursing Officer at Saint Luke's Northland Hospital in Kansas City, one of 11 hospitals within Saint Luke's Health System. He holds a Masters Degree in Business Administration from Rockhurst University, and a Bachelor of Science in Nursing from Saint Luke's School of Nursing. He is an active member and certified Fellow of the American College of Healthcare Executives (ACHE).
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