May 2004

Strong Invests in New Medication Pumps to Prevent Errors

Kristen Moulten, R.N., checks one of the new Alaris pumps on the PICU.

As a sign of its continuing commitment to provide high quality patient care, Strong Memorial Hospital recently installed new computer-driven "smart-pumps" to deliver intravenous medication to all hospital patients. The new pumps monitor medication dosages and compare them against established benchmarks to help prevent medication errors before they occur. Strong Memorial is one of the first hospitals in New York State to replace all of its intravenous medication pumps with this "smart-pump" technology.

According to Kate Miller, R.N., B.S.N., director of Value Analysis, Strong made the decision to purchase 739 Medley™ Medication Safety Systems with Guardrails® Safety Software from ALARIS Medical Systems after piloting the technology in two pediatric and five adult intensive care units.

"Staff love these pumps because they work like another set of eyes looking over your shoulder," Miller said. "They let you know if something could be wrong before you administer the medication."

The new pump adds yet another dimension to Strong's medication safety process that extends from the time the prescription is ordered, through its preparation in the pharmacy, to the moment it is given to the patient. Each pump is pre-programmed with dosage, concentration, and rate-of-infusion parameters for each medication, based on hospital protocols that are specific to each patient care unit. If a dose is entered which falls outside of the pre-established limits, the pump will signal an alert on its message screen. The nurse must then make an active choice to override the pump, or change the dosage or infusion rate to conform to the standards.

"There are instances in which the prescribing physician may, in fact, want a higher- or lower-than-normal dose," Miller said. "But this forces us to double-check those exceptions to be absolutely sure."

A Healthy Investment

Strong Memorial's multi-million dollar investment is sure to pay off. In a recent nine-week period, Strong tracked nearly 150,000 medication administrations delivered by the new pumps. About five percent of the time, the pumps signaled an alert. In the vast majority of these instances, staff chose to override the pump's alert since the dosage was intentional. But a small percentage of these alerts signaled "near misses," instances in which a potential error was avoided.

Using data downloaded from the pump's computers, hospital leaders are now able to track the number of times that the pumps signal alerts and whether or not those alerts were deliberately overridden, information useful in assuring quality. Plus, data can be studied by a specific drug or by a particular patient care unit. The computers can also map out what time of day any "near misses" take place so that administrators can spot trends that may relate to staffing patterns or shift changes.

"In most of these 'near miss' instances, staff would have caught the error themselves, but this simply provides yet another barrier between the patient and a potential mistake," Miller said. "Even one mistake averted has enormous human and financial benefits."

Medication errors are one of the most common and expensive medical errors. A recent study published in the Archives of Internal Medicine estimates that as many as one in five doses of medication administered in hospitals is done so erroneously, and The Institute of Medicine's landmark 1999 report, To Err is Human: Building a Safer Health System, suggests that these medication errors account for at least 7,000 patient deaths annually.

Aside from the tragic toll in human suffering, medication errors have a significant impact on national health care costs. Industry experts calculate that America spends between $1.56 and $5.6 billion annually to treat patients who suffer from adverse drug events.

All Staff Urged to Attend HRMS Training

In less than two months, the new Human Resources Management System (HRMS) will be up and running, and along with it, the implementation of many new policies and procedures. For example, how we report and record time, how we receive a paystub, and how we make changes to our personal information all will change.

To help introduce faculty and staff to HRMS, and to better understand the new policy and procedures that will be in place, dozens of general training meetings will occur, with many of them tailored to meet the needs of specific groups of faculty and staff within the Medical Center (see below). In addition, separate meetings for managers/administrators and those responsible for recording and approving time and labor will be held. For these meetings, and much more information on HRMS, please visit www.rochester.edu/hrms.

Medical Center Gains Approval for First New Residency in a Decade

Thomas A. Pearson, M.D., M.P.H., Ph.D., chair of the Department of Public Health Sciences

The Department of Public Health Sciences has received approval from the national Accrediting Council for Graduate Medical Education for the first new residency program at Rochester in nearly a decade. The General Preventive Medicine residency program in the University of Rochester School of Medicine and Dentistry will train physicians in the field of community health.

Preventive medicine as a medical specialty deals with public health, disease prevention and health promotion. Board certification requires three years of residency training: one year of primary care residency training, a year of coursework leading to a Master's degree in Public Health (MPH), and a one-year practicum experience. The Rochester Preventive Medicine Residency Program will represent the second and third years.

Graduates of preventive medicine residency programs typically assume leadership positions in organizations responsible for the health of populations, such as federal, state and municipal health departments; corporate medical offices; HMOs; occupational medicine programs; and academic health centers.

Residents in the new program will complete supervised rotations at the University of Rochester Medical Center, Eastman Kodak Company, the Monroe County Department of Health, and community sites and clinics in the Rochester area. Rotations at the New York State Health Department in Albany and the Onondaga County Department of Health also are options.

"It's gratifying to know that we'll be able to offer such important experience to residents," says Thomas A. Pearson, M.D., M.P.H., Ph.D., chair of the Department of Public Health Sciences. "More and more, people are realizing the crucial role that preventive medicine plays in health care."

The new Rochester program plans to enroll residents in July 2004.

Garage Expansion Project Wrapping Up!

The finishing touches are underway on the garage expansion project at Strong Memorial. The project added 600+ patient and visitor parking spaces, which were available almost two months ahead of schedule.

The next phase of the construction is now focused on finishing the exterior work to the facility and the surrounding grounds. During this time, the East Drive entrance/exit will be closed May 5 - May 22, however, all other entrances and exits will be open according to the regular schedule. We hope all construction on the garage to be completed by June 30, 2004.

We apologize for the inconvenience and delays you may have experienced in the garage during this construction, and thank you for your understanding and patience.

Hands-on Work Experience

Fourth grader Nick Boyd, son of orthopaedic surgeon Allen Boyd, M.D., learns how to attach a plate to the skull. Boyd was one of more than 200 children of Medical Center faculty and staff participating in the annual Take Your Children to Work Day.

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