Ongoing Update – Cochrane Report – March 17, 2017

The following was sent on behalf of Damian Lange, Director Clinical Operations, NRGH, and Dr. Ben Williams, Medical Director, Oceanside, to all Nanaimo Regional General Hospital, Oceanside Health Centre and Dufferin Place physicians and staff

Dear Colleagues,

As outlined previously, Island Health President and CEO, Dr. Brendan Carr has asked that we provide you with regular updates.

NRGH Local Quality and Operations Committee Meeting

The NRGH Local Quality and Operations Committee had its third meeting on March 16th. This Committee includes NRGH clinical and medical leaders, representation from the Medical Staff Association (MSA), as well as multiple guests including regional and local representatives impacted by CPOE suspension. The following are highlights:

1. New Options to Support Physicians and other EHR Users

As the Committee has learned about the implications of suspending CPOE and other advanced EHR functionality, committee members asked if there were other options available to support physicians and other users while maintaining advanced EHR functionality including CPOE.

Over the last two meetings, and in informal discussions between committee members, individual physicians, the medical staff association, and others, new options have arisen.

The Island Health Executive indicated to the committee during the meeting that the Executive and the Board support the exploration of these options.

The committee heard a presentation from Dr. Fyfe outlining possible options that could be rapidly deployed to support physicians and other users.

The Committee has asked that technical and operational teams that had been focused on work to suspend CPOE also focus this next week on providing further details on these new options to support physicians and other users.

2. Survey Results

The NRGH Local Quality and Operations Committee conducted a survey in order to understand staff and physician perspectives related CPOE suspension.

In total, 836 staff and physicians participated in the survey. The survey results demonstrate a close to 50-50 split in perceptions of the electronic health record.

Qualitative data will be reviewed by the committee at its next meeting.

Thank-you to all staff and physicians who participated in the survey.

3. Medication Processes From Ordering To Administration before and after CPOE

In response to the Committee’s request for a better understanding of medication error management, the Committee received a multidisciplinary presentation on the steps involved from the time a medication is ordered through until the time it is delivered to the patient.

Multiple stages of Transcription

  • Prior to CPOE, medications were transcribed by the NUA to the paper MAR, verified by the patient’s nurse and faxed to pharmacy. In the pharmacy, medication orders were then entered by a pharmacy technician into the Electronic Health Record and then reviewed by a pharmacist. Once verified, a new computer generated MAR was printed every evening.
  • There is no transcription of medications using CPOE.

Redeployment of Pharmacy Technician Resources

  • Pharmacy Technicians Previously transcribing physician orders have been redeployed to other projects including taking the patient’s Best Possible Medication History (BPMH).

Reduction in turn-Around Time

  • Because all steps involving transcription have been removed, the time between when a medication is ordered and when it can be dispatched to the floor by pharmacy has been significantly reduced.

4. Dufferin Place

The Committee had previously determined that CPOE would continue at Dufferin Place as long as this could be done safely. The committee heard that medical imaging, lab, pharmacy and nursing staff could support the continued use of CPOE at Dufferin Place. It was agreed that there would be no suspension of CPOE at Dufferin Place.

Yours Sincerely,

Damian Lange
Director, Clinical Operations, NRGH

Dr. Ben Williams
Medical Director Oceanside