Planning for pharmacy health information technology in critical access hospitals.

PURPOSE: A plan for the implementation of medication-related health information technology (HIT) in 12 critical access hospitals (CAHs) to improve safety and reduce medication errors is described. SUMMARY: Interviews were conducted to assess the status of HIT in 12 CAHs, including HIT needs and desires and barriers to HIT adoption. Two conferences were held as part of the planning process. It was determined that pharmacy HIT (pHIT) should be implemented in three phases in the CAHs. In phase 1, it was found that the first HIT needed by the CAHs was pharmacy information management systems (PIMS), the cornerstone for the implementation of other HITs. Criteria were developed for the appropriate selection of PIMS for the CAHs. Phase 2 revealed that automated dispensing cabinets (ADCs) should be the next HIT implementation. ADCs are effective in the reduction of medication errors in the dispensing stage. Phase 3 dealt with the implementation of smart infusion pumps. Smart infusion pumps contain a standard data set that includes parameters for infusion fluids and a clinical decision-support system, and they keep a record of rule violations. Barriers to HIT implementation included funding, staff resistance to change, staff adaptation to HIT and workflow changes, time constraints on small sta., facility and building barriers, and lack of information technology support. CONCLUSION: Planning conferences and interviews with hospital representatives helped to identify the HIT needs of 12 CAHs. The planning process resulted in a three-phase plan for pHIT implementation, which will include PIMS, ADCs, and smart infusion pumps.

Medication safety infrastructure in critical-access hospitals in Florida.

PURPOSE: The medication safety infrastructure of critical-access hospitals (CAHs) in Florida was evaluated. METHODS: Qualitative assessments, including a self-administered survey and site visits, were conducted in seven of nine CAHs between January and June 2003. The survey consisted of the Institute for Safe Medication Practices Medication Safety Self-assessment, the 2003 Joint Commission on Accreditation of Healthcare Organizations patient safety goals, health information technology (HIT) questions, and medication-use-process flow charts. On-site visits included interviews of CAH personnel who had safety responsibility and inspections of pharmacy facilities. The findings were compiled into a matrix reflecting structural and procedural components of the CAH medication safety infrastructure. RESULTS: The nine characteristics that emerged as targets for quality improvement (QI) were medication accessibility and storage, sterile product compounding, access to drug information, access to and utilization of patient information in medication order review, advanced safety technology, drug formularies and standardized medication protocols, safety culture, and medication reconciliation. CONCLUSION: Based on weighted importance and feasibility, QI efforts in CAHs should focus on enhancing medication order review systems, standardizing procedures for handling high-risk medications, promoting an appropriate safety culture, involvement in seamless care, and investment in HIT.