Patient Safety at Rhode Island Hospital
Collaborating to Give the Best Care
Lifelinks™ Electronic Health Record
Lifelinks™ is the name of the electronic health record at hospitals in the Lifespan system: Rhode Island Hospital and its Hasbro Children’s Hospital, The Miriam Hospital, Newport Hospital and Bradley Hospital. It has been operational since 2000 and has grown each year. Bradley Hospital was the final hospital to begin using Lifelinks™, which began this year. While all are secure, there is added security for Bradley due to the nature of the care provided.
Lifelinks™ meets all of the qualifications for an electronic health record for inpatients:
- Centralized: it gathers data in a patient-centered (rather than a hospital-centered) way. This enables the system to pull together all of the information available for the patient, no matter which Lifespan-affiliated hospital they choose for care.
- Displayable at the Point of Decision-making: doctors and nurses have access
- Comprehensive: includes all of the information we have about the patient
- Analyzable: the data can be analyzed
- Reportable: to fulfill some public health requirements
Lifelinks™ is our own product which aggregates data from many information systems, including, but not limited to, computerized physician order entry (CPOE), medication safety, the diagnostic imaging picture archiving computer system (PACS). It was built using Siemens tools.
CT Scan Alerts
With growing concern nationally about the amount of radiation that patients receive through repeated CT scans, the diagnostic imaging leaders at our three acute care medical/surgical hospitals worked with our IT staff to develop a way to “flag” a patient’s electronic medical record if they’ve had a certain number of CT scans (amount depends on body part scanned). Since December of 2008, this information is available through Lifelinks™ for any patient who has had the tests at any of our hospitals, and subsequently comes into the emergency department or any other part of the hospital. This information allows the emergency department physician to decide if a different type of diagnostic test could be used. While there is no government limit, we’re a leader in the country in developing this type of capability.
Medication Safety
The Closed Loop of Medication Safety refers to electronic safeguards at each step in the medication process. The process begins with the physician’s access to the patient’s electronic medical record which contains thorough reference data from hospital visits, laboratory and radiographic encounters. The physician’s entry of a medication order triggers decision support, checking for minimum-maximum dose, potential interactions as well as identifying therapeutic and generic duplicates. It is checked against other patient information such as laboratory results to advise if the order is safe and appropriate.
An electronic interface to the pharmacy system places the order onto a pharmacist’s work-list. The pharmacy system also uses a laboratory results interface and its own rules to enhance the safety of certain medications. When the pharmacist completes the order review, the order is electronically transmitted to the electronic medication administration record (e-MAR) and to the appropriate automated dispensing machine. The nurse electronically reviews the medications due for administration and retrieves the patient’s medications from the automated dispensing unit. The nurse uses bar code technology to check the five rights of medication safety: right patient; right drug; right dose; right route; and right time by scanning the nurse’s ID badge, the patient’s wristband and the unit dose of medication. A green light informs the nurse that the medication can be administered. It also electronically charts the drug administration in the e-MAR, which is available to all of the patient’s caregivers.
We have demonstrated improvements in patient safety:
- Physicians electronically enter greater than 90% of all orders.
- The time between the physician ordering the drug and administration to the patient has been cut dramatically, from 90 minutes to 11 minutes.
- Medication administration checking prevents an average of 6 wrong patient errors and 11 wrong drug/strength/route errors every day at all hospitals combined.
- The number of doses withdrawn from the automated dispensing units by nurses using the override function (i.e., prior to pharmacist review, bypassing the safety checks) decreased by 59%. This is a direct result of the decrease in cycle time.
ICU Collaborative
Rhode Island Hospital belongs to the ICU Collaborative, which includes all adult intensive care units in Rhode Island. For the past five years, this group has worked to share best practices to improve outcomes for critically ill patients. The Collaborative has shown a 21 percent reduction in ventilator-associated pneumonia. There have been no central-line associated blood stream infections in any ICU for the past 9 months, and a 62 percent reduction in such infections compared to a 2008 baseline. Sepsis mortality, at 27.6 percent, is lower than the national average of 28.6 percent. RI is the only state to have unanimous voluntary participation in such an initiative.
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