Lancaster General Takes Patient Care to the Next Level

Lancaster General Hospital's (LGH) wireless bedside point of care (BPOC) system is fully operational at the 630-bed hospital in Pennsylvania. The final phase of the implementation was completed in October 2007.

Registered Pharmacist Richard Paoletti, MBA, director of pharmacy services at LGH, said that the wireless BPOC system helps to gain compliance with the 5 rights of medication administration, alerts nurses to various potential medication errors in real time, prevents medication errors, and gives accurate documentation of medication- administration time.

"All orders are now profiled by pharmacy and concurrently reviewed" throughout the hospital. "This is a new process and has resulted in about a 30% increase in pharmacist workload."

When LGH began looking into a BPOC system in 2001, the hospital needed to find a system to fit its specific needs. The hospital implemented the Cerner Bridge Medical bar-code solution supported in part by MILT packaging software from Medi-Dose Inc.

Paoletti said they use Medi-Dose packaging and software to package unit-dose solids that are specialized, such as hazardous/chemotherapy substances, chalky products, and controlled substances: "items we would not put in our robotic system due to cross contamination and other risks."

"MILT is simple to use and has provided unique packaging/bar-coding solutions for products requiring manipulation after purchase," explained Paoletti. For example, the company's mini labels have been helpful for products that are difficult to bar code, such as small vials. Cerner Bridge Medical "has been instrumental in patient safety efforts and has dramatically changed the pharmacist role in our hospital to a more proactive clinical practitioner," he said.

The hospital recently began using the newest version of the MILT software. MILT 3.0 now is available with a variety of innovative features designed to evolve with the ever-changing practice of pharmacy packaging. The formatting options now include bar codes, graphics, special fonts, and "tall man" lettering. The software supports various types of bar codes, including 2- dimensional, reduced-space symbiology, and multipart codes.

In addition, MILT 3.0 supports the company's newest line of thermal printers—for both direct-thermal and thermal-transfer printers.

Medi-Dose configured MILT 3.0 to manage the processes LGH had designed for labeling and maintaining its pumps.

• When a new pump is purchased, the pump's bar code is scanned, and MILT creates the information for each of the channel bar codes and helps the clinician print the new labels
• Each print job prompts a clinician to verify that the label belongs to a specific pump
• At any time, a member of the health care team can verify that the channel bar code belongs to a specific pump
• MILT was configured to allow only upper-level supervisors to edit channel information, label design, the log reports, and the rules for channel creation
• LGH uses Thermal Mini-LiquiDose Labels (1/2 in by 11/4 in) because they meet the tight space constraints on the hospital's pumps and have a strong adhesive that stands up to repeated cleanings
• Step-by-step on-screen instructions are available for health care team members who do not participate in the process often

In an effort to meet LGH needs, Medi-Dose further enhanced the capabilities of MILT 3.0. As a component of the wireless BPOC system, LGH wanted the capability to label each smart-pump intravenous (IV) channel with a unique bar code.

Robert Braverman, president of Medi-Dose Inc, said the hospital's 900+ smart IV pumps have at least 2 channels per pump. The company worked with LGH to produce about 1800 unique bar codes.

"They helped us achieve a way to bar code our Hospira Plum A+ SMART wireless infusion pump channels so that we may be able to link our pumps with our BPOC system," commented Paoletti. "This linkage would allow for our BPOC system to auto program the patient's infusion pump and dramatically reduce the nursing steps in the process. This project, if successful, should prove to further reduce medication events and incorporate another technology into a closed loop process for medication administration," he concluded.