Deep vein thrombosis, the formation of blood clots, is a common risk factor for hospitalized patients, particularly those immobilized in bed or undergoing surgery.
To better prevent the condition, 67-bed Riverside Walter Reed Hospital in Gloucester, Va., has programmed a workflow process in its Soarian clinical information system from Siemens Medical Solutions, Malvern, Pa.
Six hours after admission of a patient, the program checks the pharmacy information system to see if blood-thinning drugs have been ordered. If so, the program does nothing else. If not, it checks the clinical system to see if compression stockings were ordered for the patient. If so, the program does nothing else. If not, an alert — with a hypertext link to an order sheet—is sent to the appropriate nurses’ worklists so they can ask the attending physician if any preventive measures should be taken.
Riverside Walter Reed, part of Newport News, Va.-based Riverside Health System, worked with the vendor to develop the deep vein thrombosis workflow program, which operates in sync with the Soarian rules engine. The workflow program went live in late 2005, and it now is one of the “model” workflow programs offered with the Soarian product.
Riverside Walter Reed launched the deep vein thrombosis workflow program “because we wanted to get information in front of the doctor,” recalls Charles Frazier, M.D., director of medical informatics at Riverside Health System. Since the program started, the percentage of patients who get preventive treatment has risen 30%, he adds. As the Soarian system is implemented at the delivery system’s two larger acute care hospitals, clinicians there also will adopt the patient safety tool.
Beyond Medication Safety
Eliminating errors during the medication administration process gets the lion’s share of attention in the patient safety arena. Many information technologies are marketed specifically to help prevent medication errors.
But a growing number of organizations, like Riverside Walter Reed, are applying information technologies beyond the realm of medication administration to improve patient safety.
Some are using radio frequency and infrared technologies not just to track equipment and supplies, but also to track patients to prevent wandering and identify those who need immediate help. Others are using specialized software to improve the safety of blood transfusions and to identify patients who might be developing an infection.
Some clinicians even offer a convincing argument that software designed to automate the patient consent process also serves as a patient safety tool.
The University of Miami Hospital, for instance, is rolling out the English and Spanish-language iMedConsent application from Atlanta-based Dialog Medical to standardize and document communication with patients during the informed consent process.
“It’s a tool that supports consent and provides a double-check that the patient and family are informed and that we’re really doing the right procedure on the patient,” says David Arnold, M.D., a head and neck cancer surgeon and assistant professor at the Leonard M. Miller School of Medicine.
Arnold particularly likes the Spanish version because of the region’s large Hispanic population. But he’d also like to see the vendor devise a Creole-language model to serve that sizable population in South Florida. “Anything that helps me practice better is a safety tool,” he adds.
Nursing Home Innovation
At long-term care facilities, a huge patient safety issue involves patients wandering the facility and risking a fall. One organization has discovered that specialized wireless technology can play an important role in addressing this challenge.
Sprucedale Care Center, a skilled nursing facility in Strathroy, Ontario, implemented wireless technology to track both patients and equipment.
The InSites Enterprise Visibility Platform, from Fargo, N.D.-based Intelligent InSites, has significantly improved s taff efficiency and patient safety and comfort, says Darren Micallef, administrator of the 96-bed center.
“This is a technology I believe should be in every long-term care facility,” he adds. “It’s a timesaver—the time for my staff to give to patients is crucial. If you are paying $30 an hour, you want that money to go as far as possible. You don’t want people spending time looking for things, but to emphasize the care.”
Sprucedale uses the wireless network to track patient lift equipment, walkers, wheelchairs and a scheduling book. The staffer who most used the book asked Micallef why a $3 binder was being tracked. “I said, ‘You’re the one constantly looking for this book.’”
But the real value of the network, which uses both infrared and radio frequency technology, is its support for safety, he adds. Equipment is tracked using attached tags. Patients and staff wear pendants.
Staff members, who access the network via PDAs, can locate a patient’s walker almost immediately because its location is pinpointed on a map. “If a patient really needs a walker and is attempting to walk on her own, that’s a safety risk,” Micallef says.
The iPAQ PDA from Palo Alto, Calif.-based Hewlett-Packard Co. also enables voice communication between staff members by transmitting WAV sound files via the Internet. Micallef recalls a patient who fell in the enclosed courtyard. The staff member who found the patient notified others via PDAs, staying to comfort the patient while help was coming.
Infrared technology is used for tracking, but an alarm system, which staff or patients can activate with a button on the pendant, uses radio frequency technology. When the button is pushed, the location of the person in need is sent to staff members via PDAs.
Sensors at every door also can trigger locks as an unauthorized person approaches, which prevents patient wandering. The wireless network also has helped boost staff morale because when incidents happen, they can be better investigated, Micallef says.
A patient recently complained of poor care, telling his family that he had to press his pendant button 10 times before a staff member came to assist him.
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