By Doris R. Mulder, RNC, BSN, MBA

BELOIT MEMORIAL HOSPITAL (BMH) IS A 177-BED FACILITY SERVING MORE than 175,000 people in southern Wisconsin and northern Illinois. This not-forprofit, independent hospital also operates four offsite primary care clinics. Our reputation of excellence has been supported by our uncompromising pledge to combine technology with the highest quality of care and compassion.

In 1997, BMH leadership formed an interdisciplinary team to look at our medication-use process. The team created a flow chart for the medication process, from the time a medication was ordered, to the point of administration and documentation at the bedside. Through this exercise, we identified steps that could be removed from the process to reduce the opportunities for errors – one of our first medication error-reduction initiatives. At that time we also implemented a nonpunitive, anonymous error-reporting policy. Anyone who found a medication error or a near-miss could report it without fear of retaliation. The new reporting policy was a success in allowing us to see the real picture of medication errors at our hospital. As expected, the number of reported errors and near-misses jumped dramatically. We then began to look at technology as a tool to assist us in making strides to improve patient safety.

We first considered CPOE as a potential error-reduction tool, but we did not feel that the commercially available solutions fit our specific needs. We then turned to where most medication errors occur: at the point of administration. By 2002, bar coding surfaced as a technology worth investigating, and we invited several vendors to demonstrate their bedside bar coding technologies.

System Selection
After several vendor demonstrations, we decided that it would be in our patients’ best interests if we did not limit ourselves to just a medication verification system. Instead, we wanted to find a technology that could also verify lab specimen collection, blood transfusions, and other procedures. This strategic decision narrowed our potential vendor list to two finalists with similar technology. One platform was a computer on wheels (COW), and the other was a handheld device about the size of a PDA. The handheld portability and expanded capabilities from Cardinal Health’s Care Fusion application became our ultimate choice.

The Care Fusion device provides a variety of patient safety applications. CareMed, the base application, uses bar code scanning to verify that the five-rights check is completed for each administered medication – both oral and IV. The CareCollect feature allows positive patient identification for lab specimen collection. BloodCare provides positive patient identification for all blood products and and can reduce the potential for errors during blood transfusions. CareAssist captures patients’ vital signs, helping to disseminate real-time patient information to other team members. These applications help us ensure that our clinicians are working with the right patient before they provide care to that person. In addition, all of Care Fusion’s medication administration information is transferred into our Meditech EMAR, improving workflow efficiency and accuracy for our staff.

System Benefits
Since the implementation in 2003, Care Fusion has helped Beloit Memorial Hospital attack and control the problem of “wrong patient” errors, and the results have been remarkable. Because of our non-punitive and anonymous error-reporting policy, we feel we have very good data on medication errors at our facility. As we rolled out the Care Fusion device and encouraged our clinicians to use the CareMed application, we saw an immediate decrease in the number of errors being reported.

Since our initial implementation of Care Fusion about three and a half years ago, Beloit Memorial Hospital has documented a consistent 80 to 85% reduction in medication errors. This reduced rate has been sustained for the past three years. We attribute this reduction to Care Fusion, because it is the only change we have made to our medication administration process. In addition, prior to Care Fusion, we were seeing about two to five wrong-patient lab draws per year, but after implementing the CareCollect application, we have had zero wrong-patient errors with lab specimen collection for three years running.

Looking Forward
While we are very happy with these results, we are looking forward to the further expansion of our Care Fusion capabilities. In the very near future, we plan to implement a CareView application that provides a real-time view of the patient information traditionally contained in the paper-based chart process. This will allow our clinicians to have real-time access to patient information from the same device they use to administer medications, labs, and blood, and record vital signs. Longer term, we are considering the use of Care Fusion in surgical pathology applications to ensure that specimens collected through surgery in the OR make it to the lab with no patient-identification errors.

Doris R. Mulder, RNC, BSN, MBA, is the vice president of nursing at Beloit Memorial Hospital, a role she assumed in 1999, after serving as director of BMH’s Family Care Center. She received an associate’s degree in nursing from Calhoun Community College, a BS in nursing from Graceland College, and an MBA from Marquette University. Mulder serves on the board of the Wisconsin OrganizaExecutives, and on the Medical and Professional Affairs Committee of
tion of Nurse the Wisconsin Hospital Association, the Blackhawk Technical College Nursing Advisory Council, and the Rock County Needs Assessment Steering Committee. She is a member of the Association of Women’s Health, Obstetric and Neonatal Nurses, the American Organization of Nurse Executives, and Sigma Theta Tau.