UH Cardiothoracic Unit uses Fostering Innovation Grant to reduce medication errors

In 2010, Clinical Nurse Specialist Regi Freeman, RN, MSN, CNS, began noticing a higher rate of medication errors – incorrect dose, time and route – on the UH 4C Cardiac & Thoracic Surgery unit.

Freeman works with Quality Improvement to enhance patient and family experience as well as nursing practice. The unit she oversees cares for lung and heart transplant patients including those with open heart, valve replacement surgery and ventricular assist devices.

“We started looking into the causes of medication errors and realized our unit administers more medication doses in a one-month period than any other unit in the Health System,” says Freeman. “Patients on 4C often need more than 20 medications per day during their hospital stay.”

Sarah Comstock, BSN, RN gets medicine for a patient in UH 4C's No Interruption Zone.

After interviewing and shadowing staff as well as reviewing the timing and frequency of medication errors, Freeman found that the 70 nurses in 4C were being interrupted multiple times as they counted, prepared and administered medication.

“Interruptions included everything from pages and phone calls from staff, to patients, family members and colleagues stopping nurses in the hallway to ask questions,” Freeman says

Once the cause was clear, Freeman and her team sprang into action to find a solution.

They applied for a Fostering Innovations Grant from the U-M Health System and used funding to create a “No Interruption Zone” in the unit’s medication room. Read the rest of this entry »

When U-M patient Michelle Johnson decided to have infusion therapy in her home instead of in the hospital or by going back to clinic, she joined a group of nearly 1,900 patients who receive HomeMed services.

“I can still work when I’m able,” says Johnson, a young graphic designer, whose fanny pack filled with infusion therapy has helped her avoid trips to U-M two or three times every week. “I’ve even been able to travel. It’s been wonderful.”

“We’re a pharmacy,” says Chris Maksym, director of Pharmacy and Home Care Operations, “yet, because of the nature of our work, we have nurses, pharmacists and dieticians involved in patient care.”

HomeMed enables patient Michelle Johnson to receive chemotherapy infusion in the comfort of her own home.

U-M’s home infusion services began more than 30 years ago when pediatric surgeon John Wesley, M.D., went to alternate revenue administrator Raymond Haggerty with a special request.  A 16-year-old girl with a twisted intestine needed total parenteral nutrition (TPN)—a catheter or needle that drips nutritional fluid into the patient’s vein for 10 or 12 hours a day—and she would probably need this for the rest of her life. Wesley wanted to find a way for her to go home and avoid daily trips to the hospital. Wesley and others knew that there was a greater need for home infusion pharmacy services for other patients.

U-M initially contracted with an outside vendor to provide pharmacy products, distribution and reimbursement services. Then in 1992, in collaboration with Abbott Laboratories, the University ventured out on its own as the full-service provider known as HomeMed.

“In 90 days, we were up and running,” says Haggerty, who, although retired, is still very much involved with U-M through his membership on the Pediatric Ethics Board. “We started with 100 patients. HomeMed was created through a lot of hard work and luck. We did the right things at the right time.”

Today, HomeMed has more than 100 employees and provides infusion and care management services throughout Michigan. Patients receive antibiotics, chemotherapy, pain medications, parenteral nutrition, inhalation therapies, and specialty drugs compounded in their state-of-the-art clean room. Read the rest of this entry »