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9 Dec 2019, by Amy Sarcevic
St. Stevens hospital in Hervey Bay is Australia’s first fully-integrated digital hospital. It was the first hospital nationally to get level 7 HIMSS EMRAM accreditation, and the third globally, outside of North America, to win the highly prestigious HIMSS Nicholas E Davies Award of Excellence.
How did it get there? Ahead of the eMedication Management Conference, we spoke with Joanne Hayden – Clinical Informatics Pharmacist – and Patricia Liebke – Director of Digital Health – to get some insights.
St. Stevens transitioned from a fully paper-based system to a fully-integrated digital system – complete with unit dose packaging, automatic dispensing cabinets, and closed loop medications – in a single day.
“We felt a big bang integration was doable, providing we were adequately prepared,” said Patricia.
“We set up a mock patient room, where we conducted our design and testing; explored physical operations, how the systems should ‘hang’ together; how we’d administer drugs and find information.
“We explored clinical workflows from a doctor, nurse and pharmacist perspective, looking at the full range of potential scenarios.
“For example, if I’m a nurse and administering an IV antibiotic, where do I get it from in the cupboard; where do I get labelling information; is there a sticker I can use; what’s the safest way to get a barcode?
“It was really important to get this level of detail down-pat to avoid any glitches in our initiation.”
To be eligible for stage 7 HIMSS accreditation, medication barcoding needed to be 90 percent accurate, but this wasn’t the case early into the hospital’s digital transition.
“Initially the barcoding success rates were lower than anticipated,” said Joanne.
“To counter this, we did some ‘time in motion’ studies, where a pharmacist shadowed nurses for several days.
“In doing this we found some really basic reasons as to why the rates were so low. Things like scanners losing their charge, barcodes not existing for IV fluids, and machines being caps lock sensitive.
“By recalibrating the machines, building barcodes for where they were missing and fixing up cradles, we got a bump in our scanning rates to over 90 percent.
“All really simple fixes, but none of them would have been possible if we didn’t take the time to interrogate what was actually happening on a practical level.”
“The greatest challenge in any digital transformation isn’t the technology itself; rather shifting old patterns of behavior and attitudes,” said Patricia.
“Initially, we found there was a tendency for some staff to ‘romanticise’ the past and claim the new systems were costing them more time.
“But, as we expected, this was just a familiarity issue. Once accustomed to the new ways of working, they no doubt found the new systems to be much more efficient than the old method of pulling out hand-written paper records, counting out bags of pills etcetera.”
To foster team buy-in, Patricia found a simple incentive scheme to be really effective.
“We offered departments with the highest barcoding rates a complimentary catered entertainment evening and were really surprised by the level of engagement this helped us achieve,” she said.
Joanne and Patricia’s parting advice to any hospital about to undergo a digital transformation is to work as closely as possible with other departments and ensure joint accountability for the overall process.
“You might imagine that one department or person would take the lead in a transition like this, but this hasn’t been the case for us. Holding all teams equally accountable has helped us achieve the level of buy-in we needed to make the project a success.”
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