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Safety Counts August 2014 - Download entire PDF by clicking
Think about the last time you rented a car. An employee with a hand-held device probably checked you out and back in again, even printing a receipt. A similar technology is at work with MobiLab, a wireless specimen collection system that’s been used at Hallmark Health System (HHS) since 2012.
MobiLab uses bar code scanning and bedside label printing to ensure correct patient identification and accurate labeling of blood, urine and other samples. More than 150 staff at HHS – primarily phlebotomists, nurses, clinical associates and nursing assistants – have been trained to use MobiLab on the inpatient floors and in the Emergency Departments and Urgent Care Centers. The devices – both hand-held and laptop versions – are used to collect specimens from more than 100,000 patients annually.
How does MobiLab help protect patient safety? “When MobiLab is in use, we have no labeling errors,” said System Director of Laboratory Services Michael Biskup. “The phlebotomist or nurse takes the device to the bedside and scans the patient’s wristband ID. Orders pop up for what specimens need to be collected and labels for the collection vessels print out. There is no question of mislabeling.”
The system has a number of checks and balances, including the need to re-scan the patient’s wristband ID after the specimens have been collected. MobiLab also interfaces with HHS’s Meditech hospital information system so the labs can upload and download information as needed. “Besides improving positive patient identification, MobiLab gives us accurate data compared to our previous manual process,” said Biskup. “This has helped us with workflow and productivity.”
Comparing a hospitalized patient’s home medications with those to be given in the hospital – called medication reconciliation – is an important patient safety measure. It’s also important in the doctor’s office. Why? The main reason is that there are so many more physician office visits (an estimated 1 billion) compared to hospitalizations (an estimated 35 million), according to the Centers for Disease Control and Prevention.
There are other reasons, too: patients often are prescribed medications by specialists they see in addition to their primary care physician, and they sometimes misunderstand how and when to take their medications or how their medications can interact.To improve medication safety for outpatients, Hallmark Health Medical Associates (HHMA) participated this year in the “PROMISES Project” through the Massachusetts Department of Public Health and the Massachusetts Coalition for the Prevention of Medical Errors. Jadien Walter, BSN, RN, ambulatory risk manager, is working with the HHMA primary care practice of Regine Tillmanns, MD, in Melrose as a “PROMISES” coach to teach improvement skills.
“Most of our practices have some system to ask patients about their medications, but there is room for improvement of the process,” said Walter. “We hope to devise a simple system that will work for all practices and we’re using Dr. Tillmanns’s practice as our pilot.” In the pilot, patients are asked to review a printed list of their medications while they are waiting to see the doctor. A medical assistant then inputs any changes into the patient’s record and the updated list is then available for a doctor-patient conversation during the appointment. Patients with complicated medication regimens are asked to bring in all their medications to the visit.
“Most patients do this and find it helpful to review medication bottles together with their provider,” said Tillmanns. “This gives us a chance to detect errors, simplify the medication regimen and educate patients on their medications. It has been very eye-opening to see how the simple method of reviewing a patient’s actual medicine bottles can eliminate detrimental medication errors.”