Samarinda Lodge uses Microsoft technology

Situation

Samarinda Aged Care Services (Samarinda) is a not-for-profit aged care organisation with a 40-place residential facility -Samarinda Lodge – located in the Melbourne suburb of Ashburton. Eighty staff, including nurses, provide round-the-clock onsite care for residents. The facility also maintains and staffs a dementia day care centre.

Samarinda is a leader in using technology to improve healthcare delivery. In 2007, the Aged Care Association of Australia awarded Samarinda the Implementation of the Year award for Information Technology in Aged Care. In the same year, the lodge also won the association’s Facility of the Year award.

These accolades were in part due to a Microsoft SQL-based electronic health records system that manages the clinical and care aspects of Samarinda’s services. Created by health systems specialist iCare Solutions, it consolidates residents’ health records and care needs, helping staff as well as visiting doctors, because all patient information is on one place.

However, a huge proportion of staff and management time was still absorbed in paperwork – specifically the process of prescribing and administering medication. Doctors would prescribe drugs using paper prescriptions, which were then sent to pharmacies, sometimes by fax. When administering the drugs, staff must complete a complex cross-check between medication instructions and patient records.

“Our nurses work seven-hour shifts,” says Tanya Gilchrist, Chief Executive Officer, Samarinda Lodge. “They have to sign for 600–800 drugs per day: that alone occupied about two and a half hours of their time – over a quarter of their shift.”

Better time management was not Samarinda’s only concern with the complex process of administering drugs process. Managing the risk of errors is a huge concern for the healthcare industry, because the implications are so serious.

“Legibility was a problem,” says Gilchrist. “Doctors don’t have the greatest handwriting, but to be frank nurses don’t either. If the medication instructions were not crystal clear, then we had to sort it out by going back through a complex paper trail.”

There were approximately 40 medication incidents instances per month – typically involving signature omissions and occasional administration errors. These had to be reviewed and managed by going back through a complex paper trail. On average, this took 20 minutes per incident.

Solution

Samarinda wanted a digital medication management system that would free staff from complex paper cross-checking procedures, and the frustrations of illegible instructions. However, any new application had to conform to a tight set of criteria.

Foremost, it had to integrate with the existing electronic health records system, as well as the Intel Motion C5 tablet PCs that staff used to access the system. It would also help if the solution was compatible with Samarinda’s desktop applications, so the company was predisposed towards a Windows® platform. However, Samarinda definitely did not want to risk anything that was over-complicated.

“We needed something that was simple to use,” says Gilchrist. “It had to be easy for replacement staff to pick up and it had to be very straightforward for the doctors, who only spend a few hours here each week.”

There were two other design criteria. If the system required patient details to be stored offsite, then it had to be secure. Lastly, it needed to encapsulate a quick but foolproof mechanism for checking medication details against patient details at the moment when drugs were administered. Otherwise it would not save time and reduce risk.

iCare had been contemplating how to develop a medication management module to add to its clinical care system, and decided to scope the market for a strategic acquisition. The first issue to decide on was the technology platform.

“The health industry is always strapped for cash,” says Christopher Gray, Managing Director, iCare Solutions Pty Ltd. “Customers don’t want expensive bespoke systems in each facility, they want systems to be efficient and scalable.

“It is much easier to scale licensing and hardware requirements once you have SQL, so from a customer point of view, SQL provides very good total cost of ownership. With a single SQL server, you can support 40–1000 users.”

In 2008, iCare Solutions acquired a software solution based on Microsoft® SQL Server® 2005 with a web interface. iCare has merged the two application, with object of creating a single electronic health record, accessible from a single logon. iCare Solutions developed a Windows Mobile® Web interface using the Microsoft .NET framework and a suite of other Microsoft development tools.

The result – a single Clinical, Care and Medication Management system – receives prescription requests from pharmacies via a web-based application called HealthPoint. When rounds are conducted, the Medication Management application takes dosage instructions from each patient’s electronic health record, so that they appear next to the patient’s name and photo, alongside a photo of the medication. Once the medication has been given, the electronic record is updated.

“This was not a technically difficult thing to do,” says Gray, “but it did take a lot of time. Obviously there was an awful lot of testing required to make sure that both the module and its interaction with patients’ health records was flawless.”

Benefits

The Microsoft SQL-based medication management system became operational in November 2008. It creates operational efficiencies by delivering one of the critical needs in healthcare information technology – the automatic transfer of patient data between different staff, facilities and systems. As a result, staff are less likely to commit errors, and can devote far more time to patient care.

Reduced risks

Medication incidents – any error or omission in signing, administration or dispensing – have been reduced from 40 per month to zero.

“It’s made a massive difference,” says Gilchrist. “The application provides a picture of the patient next to the dosing instructions, as well as a photo of the drug that is to be administered, so the chances of error are minimal. Plus there is no chance of forgetting the medication, because if it’s not administered, the application requests a reason and one has to be entered.”

The fact that there are no legibility issues on prescriptions, notes and other patient records has also removed irritation and cause for error. Signature omissions – where the required signature required to administer a drug is missing – have been reduced from 18 per week to zero.

“It’s the sheer transparency of the system that’s impressive,” adds Gilchrist. “The information is at people’s fingertips.”

More time with patients

The reduced number of incidents saves staff approximately 13 hours of time each month, but for Samarinda Lodge the biggest benefit is the speed at which medication rounds can now be completed. Since cross-checking is now primarily a visual exercise, it is simply much faster to execute safely.

“Our nursing staff have an extra two hours a day each, which is the time not spent scanning hundreds of sheets of paper,” says Gilchrist. “Whether the drugs are generic or brand, they appear on the system exactly as they appear on the packet. Administering medication now is very quick and reliable.”

Besides automating the process of receiving prescriptions, the Medication Management application has also automated stock reordering for non-prescription drugs, such as aspirins and paracetemols.

In total, the system cut the amount of administration time required for dealing with pharmacies by two-thirds, from 15 minutes to five.

Future security

Making sure that accidents don’t happen occupies a very large proportion of time and therefore costs in the healthcare system. By dramatically reducing the chance of wrongly administering drugs, Samarinda has improved its finances as well as its ability to deliver care to residents.

Says Gilchrist: “If you reduce the risk of accidents in the healthcare system, you dramatically reduce the cost.”