Medication management goes electronic at an Ohio hospital pharmacy

Key Points

In an effort to improve technology and security in its pharmacy operations, Ashtabula County Medical Center in Ohio recently began using QuadraMed's Pharmacy Integrated Medication Management (IMM) system.

The IMM system provides real-time wireless and point-of-care medication scanning. It also allows nurses to verify a patient's identity, validate medications against active orders, and document medication administration online. The technology is designed to reduce medication errors and improve overall patient care.

A key selling point for Ashtabula was "definitely the integration piece," according to Wendy Nagy, RPh, a staff pharmacist and clinical coordinator at Ashtabula. IMM "has the nursing component along with the electronic medication administration record (MAR), physician order entry, and an electronic medical record," she said. The facility is hoping to implement all the components eventually, providing a single fully integrated solution. Ashtabula went live with the pharmacy component in May, replacing a much older Cerner system. So far, the biggest advantage Nagy has experienced is reduced paper in the pharmacy. "There is definitely less paper involved and less duplicate stickers. We are able to record electronically who checks the identifications," she said. "Our goal is to eventually go to bar-code medicine and online MARs."

Once fully implemented, the unified database will provide seamless medication management and close the loop from order entry to medication administration. Nursing and pharmacy staff will gain instant access to patient status records and clinical information, which will further assist in reducing medication administration errors and streamlining workflow.

Ashtabula is the first pharmacy to implement the system since QuadraMed purchased it from Misys in 2007. Once the purchase was complete, QuadraMed immediately began working on product enhancements. At that time, October 2007, Ashtabula was already in the beginning stages of implementation. The implementation team then worked for another eight months to get the facility ready to meet its live deadline.

"Because the system is a total pharmacy system, the pharmacists played a pivotal primary role in the whole process, because they are the gatekeepers for the medication dispensing process and for patient safety," Carol Boehmer, QuadraMed's manager of client services and Ashtabula's IMM project manager, said.

"The entire implementation was accomplished by the director of pharmacy, the pharmacists, and pharmacy techs. Vendor and hospital had to work together to meet the Ohio State Board of Pharmacy IT requirements - some of the strictest in the nation. Many of the requirements were new and unfamiliar to the staff. Among the mandates was a requirement for a specific sign-on to identify the staff member entering the orders and performing the key strokes.

To meet that criterion, QuadraMed collaborated with a third-party vendor (Maxim Integrated Products), which manufactures plastic keys, called iButtons, that enhance system security. This security measure ensures that the person interacting with the application and entering the orders is the person to whom the unique log-on and password have been assigned. If the key is removed from the computer without proper log-on or log-off procedures, the application shuts down immediately.

Although a fairly smooth implementation was accomplished, there were some challenges along the way, particularly working with a small IT department and a pharmacy staff that had to continue with daily operational responsibilities while performing a major IT system overhaul.

LEAH PERRY is a writer based in Atlanta.