Pharmacy Technology Reduces Medication Errors

Since 2002, Pharmacy Services at St. Luke’s Hospital has been quietly undertaking a technology revolution that has dramatically increased the efficiency and convenience of dispensing patient medications.  The technological improvements also have reduced the risk of medication errors. 

“Medication errors are a matter of great concern, both in California and nationwide,” says Director of Pharmacy Services Keith Yoshizuka, PharmD, MBA, JD.  “In recent years, we’ve implemented several strategies to reduce medication errors. The first step was the installation in 2002 of the Pyxis Profile system, an automated medication dispensing service.” 

The Pyxis system allows the Pharmacy to stock medication vending machines on all nursing units with the most common medications used in each unit.  A pharmacist enters prescriptions into the hospital’s pharmacy computer system, which interfaces with the Pyxis machines.  Nurses then use a fingerprint-scanning keypad to access the dispensing machines.  Because the system uses fingerprint-scanning technology, nurses can access only certain machines and can get medications only for those patients for whom they have authorization.

“The advantages of Pyxis are substantial,” Yoshizuka explains.  “First of all, medication doses are available on the nursing units as soon as the Pharmacy authorizes the prescription.  There is no waiting for the medication to come up from the Pharmacy.  An even greater benefit, though, is the fact that Pyxis has helped us reduce wrong dose and wrong medication errors by 80 percent.”

Yoshizuka notes that the next step, in 2003, was the introduction of computer-generated Medication Administration Records (MAR).  “This advance helped cut down the number of transcription errors, as well as the number of missed doses,” he says.  “MAR shows when each patient should receive various medications, serving as an automatic reminder to the nurses.  Now each nursing shift goes back and reviews medication orders over the past eight hours to make sure everything is document on MAR.  The nurses on the night shift also conduct a 24-hour review of all medication records.”

Shortly after MAR was put in place, Nursing Services changed the way nurses processed new orders from physicians, enabling the bedside nurse who was primarily responsible for a patient’s care to take charge of dispensing all the patient’s medications.  “The bedside nurse knows the patients under her care and is familiar with the doctors’ orders,” Yoshizuka explains. 

The latest enhancement in medication-dispensing technology is the current process of installing computers in each patient room. The nurse retrieves medications from the Pyxis dispenser and then goes to the computer in the patient room, where she scans in the bar codes from her ID badge and the patient’s wristband.  The medications the patient is due to receive come up on the computer screen.

“The medications have bar codes, too,” says Yoshizuka.  “This ensures that the patient gets the right medication, in the right dose, at the right time.  Unless everything is just right, a pop-up window comes up, warning the nurse that one of the drugs does not match the doctor’s orders as recorded in the pharmacy computer system.  The nurse must stop and double-check the medication and dosage.  In emergency situations when a doctor orders administration of a medicine immediately, the nurse can perform an override.”

The new in-room computer system, called Electronic Medication Administration Program – or “e-MAP” – will eventually be installed throughout the hospital.  Roll-out of the new system is expected to begin sometime soon.

The future holds even more technology advances.  “Sometime in 2006 or 2007, the entire medical center will migrate to a single computer platform called EPIC,” Yoshizuka notes.  “The system eventually will allow physicians to enter orders directly onto the computer, which will eliminate transcription errors and problems with doctors’ handwriting.  It also will allow physicians to use standardized order sets approved by the medical staff with the click of a mouse.” 

EPIC will be implemented first at California Pacific Medical Center.  “The intent is to develop the system for all Sutter Health affiliates,” says Yoshizuka.  “This will mean that if a St. Luke’s patient ends up at a Sutter facility elsewhere, the hospital will have immediate access to the patient’s records via the same system.  The benefits for both St. Luke’s and our patients will be impressive.”