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Facebook© and Bedside Medication Administration Systems
Facebook is the premier online social network service that has revolutionized the way in which people connect with friends, family, and peers in this truly electronic era. Universally used by millions of people across the world from South Africa to Australia, Canada boasts the third highest volume of active users in the world. More specifically, the city of Toronto lays claim to the second largest Facebook network numbering over 1M users. Similar to the growth of Facebook in our culture, the healthcare industry in the midst of a similar surge with Bedside Medication Administration System(s) (BMAS). A review of the newly published HIMSS Analytics Canadian database reveals that the number of Canadian healthcare organizations who have installed or have plans to install Electronic Medication Administration Record (EMAR) and “Nurse Bar Coding” is growing exponentially. While it is generally unfitting to compare a social network service to life saving technology, beyond growth statistics there are some underlying functional similarities between Facebook and BMASs.
At their core, Facebook and bedside medication administration systems serve analogous functions: to improve communication among different groups. Similar to the way Facebook users exchange public/private messages or “poke” their peers, health care organizations use BMASs to improve communication between nurses, pharmacists, and ultimately patients. Just as a BMAS provides real time electronic updates of medication history, so to do Facebook users use the “Event” feature to update their current status and whereabouts.
The choice to implement a BMAS comes with a set of inherent risks and challenges. The implementation process is challenging because it requires not only an expenditure of both human and financial capital, but also a fundamental change in the way organizations conduct day-to-day clinical activities. Moreover the complexity of BMAS projects is influenced by the dynamic interdependent relationships between software, hardware, wireless networks, and accurately defined clinical workflows. BMAS adoption and net gains can be dramatically effected when the balance of any one of these core principles is off.
Historically, those organizations who commit time and resources to a BMAS readiness assessment and pre-implementation planning experience successful implementation results. As is the case with any other activity in project management, proper planning ensures that most unforeseen issues can be accounted for and mitigated before they happen. The following paragraphs represent eight critical areas of evaluation that should be considered as part of a BMAS Readiness Assessment. The goal of this document is to introduce a conceptual framework for management level staff to explore the readiness of their respective organizations to implement bedside medication administration systems.
I. Workflow
More than any other component of the BMAS readiness assessment, organizations must be willing to invest time and resources into documenting and examining workflows associated with the medication administration process. By process mapping current paper administration processes with future optimal state administration processes using technology, organizations have a unique opportunity to improve caretaker efficiencies and remove obstacles that impact work cadence and continuity. Although tedious and time consuming, the results of this effort ensure that broken or unconforming processes are not sustained with the introduction of the new technology.
This process is eye opening for many reasons and generally yields interesting results. It is not uncommon to discover that processes for medication administration are different from unit to unit, shift to shift, and of course employee to employee.
II. Team Structure and Resources
Central to the success of a BMAS project is establishing a multi-disciplinary team that has clearly defined roles and a commitment to the project time requirements. In addition to the traditional project core team, BMAS project teams generally benefit from the contributions of supplemental team members including a Clinical Project Sponsor, Organizational Change Leader, Training Specialist, Communication Specialist, Technical Writer, Quality Consultant and Physician Champion. Due to extended BMAS project timeline with pre-implementation, implementation and post –LIVE activities, it is imperative for project managers to proactively address global project time requirements and gauge each team member’s level of commitment. Project staffing disruptions and changes in personnel will have extended downstream project effects.
Beyond the physical resources the project manager’s awareness of team building and conflict resolution tactics and strategies remain important. Team dynamics and building relationships between pharmacy, nursing and information technology is often challenging.
III. Project Structure
Establishing sound project documentation including a BMAS project charter and communication plan is instrumental to project coordination and the unification of project resources. The following key documents should grow and evolve through the course of a BMAS project.
The Project Charter is a tool for obtaining commitment from all affected groups and individuals within the BMAS project. The Project Charter is a single, consolidated source of information about the project in terms of initiation and planning, and provides information about project scope, objectives, deliverables, risks and issues. It also lays the foundation for how the BMAS project will be structured, and how it will be managed in terms of change control, oversight and control, and risk and issue resolution.
A sound communication plan is critical to successful BMAS projects as it facilitates effective and efficient communication from the project team. With a multi-disciplinary BMAS team and varied layers of IT and project experience, effective communication is a strict project requirement that ultimately leads to efficient decision-making. During a BMAS implementation project the flow of communication will need to span many directions, including upward, downward, and horizontal. This should be well defined in the communication strategy. The best strategy is to initially determine “what” communication is necessary and from “what” resources.
IV. Back-up downtime procedures
BMASs support a component of care delivery that is downtime-intolerant. Appropriate technical continuity strategies must be well defined and tested prior to the design and build of the project. Unless already established, during the pre-implementation period it is strongly recommended that organizations develop, document and implement a formal written Disaster Recovery Plan to address both internal IT disasters and force majeure. This includes a thorough review of the requirements for emergency power sources within each technology component of the project.
V. Project Metrics and Goals
Traditional project management metrics of “on time, on budget and meets specifications” are generally irrelevant when talking about BMAS projects. Initially, core metrics for any BMAS project should start with reference to the way new technology will further enhance the core business directives or the defined mission statement (see above). In either case, appropriately aligned project metrics for BMASs should be centered on improving patient safety or minimizing medication errors. Common baseline measures and core metrics might include:
- Number of meds administered
- Number of meds scanned and not scanned
- Number of warnings
- Number of warnings with administration
- Number of warnings without administration
Looking beyond the statistical analysis and more quantifiable metrics, it is also important to establish BMAS project goals among the end-users adopting the technology. Specifically, gaining organizational support and marketing the organizational goals of a BMAS project are difficult as standardized workflows and associated technology will generally increase time required during the medication administration process. The true selling point of BMASs is improved organizational workflow and of course improved patient care and safety.
VI. Change Management Program
Given the magnitude of change associated with BMASs including the (1) redesign of processes and workflow of several departments; and (2) volume of care providers who are affected; a well established institutional change management program will advance the adoption of the new technology. Effective change management requires an understanding of the possible effects of change upon people and how to manage potential barriers or resistance to that change. In the early 20th century psychologist Kurt Lewin identified three stages of change that today represent the cornerstone of many change management programs. Lewin’s “Unfreeze”, “Transition” and “Refreeze” phases are quite relevant and can be directly applied towards moving organizations from traditional manual medication administration procedures to bar coded administration technology.
VII. Hardware Evaluations
For the average inpatient setting the introduction of a BMAS will include the addition of over 100 wireless devices to the system. It can be expected that the number of transactions carried by both the wireless and hardwired network components will substantially increase. The applications utilized are used to administer medications and therefore are intolerant of service interruptions. While it is difficult to project the absolute bandwidth requirements of the new technology, it is prudent to have an understanding of current capacity, scalability and load balancing options. With the assistance of a mobile device vendor or consultant, an assessment of the organizations’ wireless infrastructure is strongly recommended.
VIII. Positive Patient Identification (PPID) Assessment
The Institute for Safe Medication Practices-Canada has recognized that failure to correctly identify patients constitutes one of the most serious risks to patient safety and applies to all sectors of the healthcare practice. PPID processes and technology are being implemented nationwide with the goal of both reducing and eliminating the risk and consequences of ensuring positive patient identification. The importance of safe checking procedures is the foundation of all safe patient identification practices and specifically BMAS functionality.
In the absence of these formal processes and operations, the true benefits of BMASs are difficult to achieve. As part of a traditional BMAS readiness assessment, it is strongly recommended that organization establish a Positive Patient Identification Task Force to either implement this new technology or confirm that existing protocols are established to marry with BMAS functionality. Minimizing project risks and addressing workflow challenges are best managed by investing time in pre-implementation planning and readiness assessments. With time healthcare organizations will acquire improved strategies and lessons learned from implementing BMASs. In the meantime, following the above detailed critical areas of evaluation will lead to positive project results.
The term "Facebook" was acknowledged as Miriam Webster’s Word of the Year 2007 runner up. Based on the above information and similar explosion, don’t be surprised if BMAS is recognized as the 2008 Word (or acronym) of the Year.
About the Author
Chris Kondrat is the Director of Consulting Services, Canada with Beacon Partners. He has coordinated several advanced clinical system readiness assessments and provided high-level consultation for BMAS projects. He can be reached by email.
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