The direct-observation methodology was used to monitor medication administration before and after the deployment of the EMAR and BCMA systems. A 54% reduction of medication administration errors was observed following implementation of a multidisciplinary, collaborative approach to medication safety.
By integrating two stand-alone technologies, i.v. interoperability was implemented to improve medication administration. Medication errors were reduced, nursing workflow was simplified, and pharmacists became involved in checking infusion rates of i.v. medications.
IntroductionComplete and accurate documentation of opioids administered by patient-controlled analgesia (PCA) pumps is critical for ensuring a high-quality medication record and an accurate conversion of the intravenous (IV) regimen to oral therapy. Incomplete charting of PCA usage through a manual process may be associated with fragmented documentation of delivered therapy affecting the completeness of the medical record and the IV to oral dose conversion. This study is the first to evaluate the association between auto-documentation of opioid administration provided by PCA smart pump—electronic health record (EHR) interoperability and the completion of PCA opioid administration charting tasks.MethodsThis retrospective cohort study was conducted at Lancaster General Hospital, Lancaster, Pennsylvania. Patients were assigned to pre-auto-documentation (n = 55) or post-auto-documentation groups (n = 58) based on whether they received PCA therapy prior to or after PCA-EHR interoperability was implemented. Charting of PCA therapy included documentation of the number of patient attempts, number of doses given, and total volume infused for both pre- and post-auto-documentation groups. In addition, total dose delivered was documented for the post-auto-documentation group. The overall chart-field completion rate was evaluated as the primary outcome. Individual chart completion percentages were assessed by stratified groups as secondary outcomes.ResultsPCA smart pump—EHR interoperability with auto-documentation was associated with an increase in overall chart-field completion rate from 69.9 to 97.0% (p < 0.001). Auto-documentation was also associated with an increase in fully completed charts from 38 to 91% (139.3% increase, p < 0.001) and reductions of incomplete records in each stratified group (p < 0.001).ConclusionsPCA smart pump—EHR interoperability with auto-documentation is associated with significant improvements in the completion of opioid administration chart-fields. Improved documentation of PCA administered opioids may have implications for the safety of opioid administration. Additional studies will be needed to assess the potential clinical impact of these results.FundingICU Medical, Inc.
BackgroundSmart pump–electronic health record (EHR) interoperability has been demonstrated to reduce adverse events and increase documentation and billing accuracy. However, relatively little is known about the impact of interoperability on infusion therapy billing claims and hospital finances.ObjectiveOur objective was to evaluate the association between smart pump–EHR interoperability with auto-documentation and current procedural terminology (CPT®)-coded infusion-therapy billing claims submissions.MethodsAt Penn Medicine Lancaster General Health (Lancaster, PA, USA), infusion-therapy billing data were collected for 158,379 patient days (a visit to the emergency department [ED] or 24 h admission to a non-ED unit) and divided into two groups: 78,241 pre- and 80,138 post-auto-documentation. The count and types of submitted CPT-coded claims were analyzed for ED/non-ED groups, inpatient/outpatient status and non-ED unit where the infusion was administered. Dollar amounts for CPT codes were calculated using Medicare Addendum B 2017. Patient day and CPT code counts were converted to annualized values to facilitate analysis.ResultsPatient days did not increase significantly from pre- to post-auto-documentation, whereas annualized submitted CPT-coded claims increased significantly by 14.5% (p < 0.001). The corresponding billing claim dollar value increased by $US1,147,652 (13.5%). ED patient days increased by 2.0% (p = 0.44), whereas submitted CPT-coded claims increased significantly by 4.0% (p < 0.001) and $US478,980 (7.4%). Non-ED patient days increased by 2.8% (p = 0.2), whereas CPT-coded claims increased significantly by 31.7% (p < 0.001) and $US668,672 (34.0%). The total number of submitted CPT-coded claims increased by 13.4% for inpatients and 12.3% for outpatients.ConclusionOur findings suggest that auto-documentation of infusion-therapy services may have a positive impact on hospital financial performance, which could help drive adoption of this technology.
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