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Hallmark Health System Magazine / Summer 2015: Hallmark Health's orthopedics team gets Charlene back to her active lifestyle after knee replacement
Hallmark Health System Magazine / Winter 2015: Hallmark Health at the pulse of heart health
Hallmark Health System Magazine / Spring 2014: Nursing excellence: Hallmark Health earns Magnet® recognition
Hallmark Health System Magazine / Fall 2014: The importance of primary care
Hallmark Health System Magazine / Winter 2014: In his own words: Life after a heart attack
Hallmark Health System Magazine / Summer 2013: Nationally recognized homecare in your community
Hallmark Health System Magazine / Fall 2013: Leading the way in women's health care
Hallmark Health System Magazine / Spring 2012: New pet therapy program brings comfort to patients
Hallmark Health System Magazine / Summer 2012: The finest orthopedic care in these parts
Hallmark Health System Magazine / Fall 2012: Hallmark Health System hospitals earn A grade for patient safety
Hallmark Health System Magazine / Winter 2012: Now open -- New Urgent Care Center
Safety Counts! a newsletter highlighting safety at Hallmark Health System
Vol 3, No. 7, July/August 2015
Then: At discharge, patients got many pages of printed information from several caregivers: education materials, instructions from doctors and other caregivers, medications lists – often with handwritten notes – and more. Sometimes the information could be difficult to follow.
Now: Patients are given one concise packet of information, coordinated through all key caregivers. It is written clearly, with instructions about diagnosis, lab work, medications, new prescriptions if needed and follow-up instructions. Plus, discharge information can be sent electronically to a patient’s primary care doctor.
How: A standardized, template-based electronic application has been built into Hallmark Health System’s hospital information system. “We worked with MEDITECH developers to create an electronic discharge system that is robust enough to meet our needs,” said Maureen Jones, senior provider systems analyst. Among the system’s enhancements are medication reconciliation, decision support and integration of information among caregivers to improve communication. “We are one of the first hospitals to go live with this added functionality in MEDITECH,” she added.
Why: Transitions of care, such as from hospital to home, are among the most precarious times for patients. This is particularly true for medication management. “The electronic system addresses this by reconciling the medications patients took before their hospitalization, during hospitalization, and at and after discharge,” said Rishi Likhi, MD, medical director of hospital medicine and medical informatics. “Discharge instructions include clear explanations of what medications should be continued, which are new and which the patient should stop taking.” The system also includes automatic prompts to help physicians and other clinicians remember what kind of specific written instructions patients may need.
“One of our key goals was to standardize discharge information for all inpatients across both hospitals,” said Jones. “But more importantly,” added Dr. Likhi, “we wanted to improve patient safety during the critical transition-of-care phase of a patient’s care.”
Three patients a day, on average, receive blood products in the infusion suite at the Hallmark Health System Hematology and Oncology Center in Stoneham. Most patients register and have lab work done on one day and come back the following day to receive the infusion. This gives the lab time to do an analysis, send the information to the blood bank at Melrose-Wakefield Hospital to prepare the appropriate product, and deliver it to the infusion suite for administration.
As always, that process was in place on a Thursday in June when a patient was seen by her hematologist/oncologist at the center and it was determined that she needed a blood transfusion.
The following day, the patient came back for her transfusion. She was asked her last name and date of birth as part of Hallmark
Health’s standard “two patient identifiers” protocol to ensure patient safety for all procedures. The date of birth the patient gave didn’t match what was on the blood product she was about to receive.
“This initiated a hard stop from a safety point of view,” said Glenn Davis, RTTR, oncology operations manager. “We then verified the patient’s date of birth with her ID.” The patient’s registration information was updated to match her photo ID and new orders were generated for her blood work and transfusion. “It is essential that all patient identifiers match all along the way – from orders to testing to treatment delivery,” said Davis.
None of the members of the treatment team that day had ever experienced a discrepancy with a patient’s date of birth.
“The patient’s transfusion was delayed, but patient safety is always a priority,” he added. “This incident helped reinforce with the team why the ‘two patient identifier’ rule exists and that when the policy and procedure is followed, it works.”
You’ve come to the emergency department with a possible broken wrist. After registering, you are led to a curtained bay where you will be seen by a clinician. You think ‘it would be nice to know who will be taking care of me and let my family know where I am and give them some information.’
This communication is possible in the emergency departments at Melrose-Wakefield Hospital and Lawrence Memorial Hospital of Medford through a decidedly low-tech solution: whiteboards.
One small whiteboard is mounted within each of the 25 ED bays at the hospitals. Each board contains basic information that patients may need – such as which bay they are in and the names of their caregivers. A “notes” section enables staff to post needed information related to patient safety. “For example, a patient may have precautions such as ‘nothing by mouth’ or ‘allergic to penicillin,’” said Pamela Duchene, PhD, APRN-BC, vice president of patient care services and chief nursing officer at Hallmark Health System. Patients and family members can write on the board as well to communicate with one another and staff members.
Clear plastic covers enable the boards to be wiped clean for the next patient. “Whiteboards are pretty standard throughout the hospital, but EDs have been later adopters because, unlike on an inpatient floor, there is so much turnover in the ED. Our bays can be used several times on a busy evening,” she added.
In addition to patient safety, the whiteboards can help improve patient satisfaction. “Patients better understand what is going on, and they can also make a note of who took care of them while they were here,” said Duchene. “We also find that patients appreciate the Wi-Fi information to help them stay connected while in our care.”
"Ticket to Ride” is a song from the Beatles’ 1965 Help! album. It’s also the most important piece of information that accompanies a Hallmark Health System patient seen in emergency and being sent for X-ray, CT scan or other imaging services. A similar system is already in use for inpatients who need radiology or imaging studies.
“It is literally a ‘ticket to ride,’” said Karen Kelleher, RTR, system director of imaging services. “It’s the intake sheet that is completed when a patient comes into one of our EDs. It contains the order for the imaging study with the ED physician’s sign-off plus important clinical information about the patient’s status. Patient transport staff can’t move a patient from the ED to the imaging areas without it.”
Having more detailed information about the patient’s condition helps radiologic technologists and radiologists provide better and safer care. For example, technologists can take additional precautions if they know ahead of time that a patient coming for a test is at risk for a fall or could faint when standing up. If a radiologist knows that an order for a hand X-ray involves the small finger of the left hand and is the result of a home-improvement accident, imaging studies can be more accurate and can lead to a more precise diagnosis. The system also has practical benefits. “There are far fewer calls back and forth between imaging and the ED to gather or clarify information,” said Kelleher.
Rick Westhaver, MSN, RN, system director of emergency services, said “all transitions of care – even moving a patient from one area of the hospital to another – are important for patient safety, as well as for improved quality and efficiency. The ED/radiology ‘ticket to ride’ is one example of how increased communication, by providing additional clinical information, can result in better care.”
Hallmark Health System's employee newsletter, The Insider, highlights the inside story about our workplace and its people. At Hallmark Helath, the important and impacful work we do starts from the inside. These pages are dedicated to sharing news, features and ideas from across the system.