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Industry Focus Article

St. Vincent’s Hospital, Sydney - an electronic medication management pioneer

A paper published this week in the Medical Journal of Australia describes how implementation of the iSOFT MedChart system led to a 50% reduction in prescribing errors.

Medication error is a frequent, harmful and expensive problem in Australian Hospitals, and yet, most hospitals continue to use paper based systems that rely on the vigilance and skill of staff. More than six years ago, St. Vincent’s Hospital, Sydney, began the journey from paper to electronic medication management. A paper published this week in the Medical Journal of Australia describes how collaboration between the hospital and the software vendor resulted in the successful implementation of the MedChart system from iSOFT, a CSC company, leading to a 50% reduction in prescribing errors.

Clinical systems are some of the most difficult to implement. While technical resources and skills are essential foundations, project leadership must come from clinicians. Change management is typically the most challenging aspect of these projects. With most of the change impacting clinical staff, engagement and extensive consultation with clinical teams are required.

Staff at St Vincent’s were initially resistant to the changes brought about by MedChart. At times satisfaction with the project was very low. This feedback, and dealing with it, was a vital part of the eventual success. The project team worked hard to respond to issues rapidly and effectively. Sometimes this required the involvement of clinical champions for further debate and discussion. Sometimes modifications to processes or to the software itself were necessary.

So what is required for a successful electronic medication management (eMM) system implementation? According to the study authors, the most important factors are:

  • An acceptance of the major impact on work practices by all
  • Workplace culture, leadership at all levels, teamwork, clinician ownership
  • The ability to modify the system in a timely manner in response to user feedback
  • Training and support for clinicians
  • Usability – does it ‘look and feel right’ and work well?
  • Decision support – not too much or too little

Today MedChart is implemented across all wards at St. Vincent’s Hospital (public), Sydney. Evidence of improvement includes a 55% reduction in pharmacy interventions and a 50% reduction in the prescribing error rate.

Medication safety is an ongoing focus at St. Vincent’s Hospital. Future plans include the gradual introduction of targeted and sophisticated electronic decision support. Integration with other information systems such as pathology, for better variable dose regimens, is planned, as is new targeted training. Hospital management also intends to enhance the reporting capability for performance analysis and reporting at an organisational level.

Electronic medication management: from conception to maturity at an Australian teaching hospital
Richard O Day, David J Roffe, Katrina L Richardson, Melissa T Baysari, Nicholas J Brennan, Sandy Beveridge, Teresa Melocco, John Ainge and Johanna I Westbrook
MJA 2011; 195 (9): 498-502
doi: 10.5694/mja11.10451

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