Case In Point
“I think most hospitals are in the same boat we are—we have older buildings built for different times, and all of a sudden the technology is multiplying like rabbits,” says Donna Crompton, R.N., director of nursing for clinical operations and informatics at the Memorial Medical Center, a 500-bed teaching and nurse magnet facility in Springfield, Ill. “Nursing stations were just crammed with different pieces of equipment all doing one function.” All the devices were covered under separate maintenance agreements, making it cumbersome and costly to keep them running and to keep diverse toner cartridges and other consumables stocked.
Memorial’s contemporary, streamlined solution—a Lexmark Clinical Assistant multifunction printer with embedded applications—has enabled the hospital to expand functionality, streamline workflow, cut costs and improve patient safety, Crompton says.
What drove the hospital to look for alternatives was its antiquated, preprinted physician order system, which ran on dot matrix printers. In addition to the noise, the design of the forms raised patient safety issues. “We had these things banging away at the back of the nurses’ stations, and you know what happens if your paper is not lined up right—page two is printing half way through page one,” she says. And because many of the pre-printed forms were several pages thick, accidental stray marks showed up on lower pages or nurses failed to press hard enough to create legible copies.
“Those stray marks were just terrible,” Crompton says. More than once, medication errors could have resulted because errant check marks unseen on the top page lined up perfectly in places on the nurses’ copy. Luckily, nurses questioned those orders and errors were caught.
Consolidated solution
The printer from Lexmark International Inc., Lexington, Ky., scans to electronic medical records, routes physician orders; prints forms and labels on demand and prints both sides of a patient’s identification card on one side of a single sheet of paper. “When IT brought me the Lexmark, we were very excited about it.
It would replace the scanner, so that separate piece of equipment would go away. It would take the place of our unit printer because it was a printer, too, and a high-volume printer. And lo and behold, it had a fax and it also would copy,” she says.
| A CLOSER look | |
| STAT prescription order processing time | |
| Before: Fax machine communication between nurses and pharmacists | Time |
| 1. Physician writes STAT prescription order and gives it to nurse | 5 min. |
| 2. Nurse waits until no busy signal is received to fax order to pharmacy | 6 min. |
| 3. Nurse calls to alert pharmacy of STAT order | 4 min. |
| 4. Pharmacist is alerted of STAT order | 2 min. |
| 5. Pharmacist checks all fax machines to find order | 2 min. |
| 6. Pharmacist calls nurse to clarify order information due to low quality of fax | 10 min. |
| 7. Order is processed | Total: 29 min. |
| After: Electronic communication via Lexmark MFPs and routing software | Time |
| 1. Physician writes STAT prescription order and gives it to nurse | 5 min. |
| 2. Nurse scans order and directs order to pharmacy using Lexmark MFP | 1 min. |
| 3. STAT order prints in a specially designated printer bin at the pharmacy | 1 min. |
| 4. Pharmacist receives STAT order | 1 min. |
| 5. Order is processed | Total: 8 min. |
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The printer integrated seamlessly into the hospital’s existing processes and implementation was simple, says Stephen DePooter, manager of clinical systems at Memorial. “The Lexmark solution allow-ed us to increase patient safety by getting rid of multipart forms, which were prone to stray marks and incorrect information, and to make copies at the point of scanning to pharmacy with the touch of a button.”
Equipping the Level 1 trauma hospital with the printers cost $52,700 for hardware and $23,217 for software, he says. “We were able to save a lot of money based on our current workflow and the ability to get rid of many outdated pieces of hardware and costly multipart forms,” DePooter says.
Memorial is a prime example of the value to be had by streamlining physician pharmacy orders using multifunction technology for printing, copying and faxing, says Ken Woodruff, industry director for Lexmark’s health care printing solutions and services. The printer has replaced 21 different models of various devices obtained from seven different vendors. This has improved productivity and lowered costs.
“If you think about a work task and how they’ve got to go to the fax machine to do this and the printer to do that, it’s a lot of footsteps,” he says. “And then you think about the cost of maintaining all those different devices, all those different consumables—you have no economies of scale if you’ve got all of these unique supply items. We can typically save 20 percent to 40 percent of output spend.”
The vast majority of physician orders nationwide still are handwritten, Woodruff says. With the Lexmark printer, a nurse takes a handwritten order, places it in the printer’s feeder and presses a “scan to pharmacy” button on a 7-inch touch screen. The printer automatically separates urgent orders from routine ones for faster processing and integrates with medication order management systems. In pharmacy, a prompt tells pharmacists if an order is urgent, enabling processing in 10 seconds or less. “Compare that with a fax machine,” he says.
The printer also eliminates preprinted forms and outputs forms on demand. It quickly assembles patient chart form sets and it enures the use of the most current version of a form. In copying patient insurance or identification cards, the printer scans both sides and prints them on one side of a single sheet of paper, saving time and paper. “It can really add up. A busy hospital nursing station could do 3,000 orders in a month, easily,” he says.
As an added benefit, it keeps an audit trail. “Now, they can go back and retrospectively look at metrics on how their pharmacy process is running,” he says. Some hospitals report marked improvement in the turnaround time of orders, with routine orders dropping from 45 minutes to 20 minutes and urgent orders from 20 minutes down to five minutes. “It’s really a huge benefit getting rid of the paper that early in the process.”
Up and running
Implementation time is relatively short, Woodruff says. After a single on-site needs assessment, the system is deployed within 30 to 60 days, depending on scheduling. Hospital resources are needed to implement and maintain the system or these services can be outsourced to Lexmark.
Two of the hospital’s units piloted the printer in September 2006, independent of the preprinted order system because this would have required first typing some 1,600 forms into the system. “We just wheeled it up to unit clerks on a cart, which was just a big piece of equipment in their way. And they still liked it,” Crompton says. “Within less than three weeks, we knew we had a keeper. We found the right technology for the right time. It was able to really transform the unit clerks’ jobs as they do it because they didn’t have to manage or maintain three separate devices and it saved them a ton of work, a ton of steps and added functionality that we didn’t have.” Permission was needed from facilities to retrofit nurses’ stations with the printers, which were adjusted to a height that enabled nurses to see the screens without standing.
It also is no longer necessary to put a patient sticker on all copies of a form. A sticker placed on the original is copied into the system when the original is scanned. “From the nursing perspective, it gives us a more accurate, clearer picture and much more confidence in our orders because we no longer have those stray marks and we can read what’s been checked because we’re getting a true copy of the original.”
The printer has three drawers. One holds plain, white, three-hole paper. The second holds blue paper and is dedicated to receiving notes from pharmacy about patient medications. If shifts change, blue papers are placed in the boxes of the nurses who are taking care of the patients next. The third tray holds labels so that nurses can print their own instead of waiting in line for admissions to do it.
“This allows us to put the control back to the nurses’ station. They push one button, they print out a page of labels and off they go,” Crompton says. “It has really allowed us to improve our workflow. These opportunities may have been there before, but we were never able to capitalize on them because we didn’t have a device that would do the job for us.”
The end result is better workflow and improved patient safety. “If I’ve got a printed label, I’m more likely to label your specimen correctly than if I take a blank label and try to write your name on it,” she says. “And if I try to write your medical record number on it, which is pretty long, being human, it’s easy to transpose numbers. If I transpose numbers, then your ID is all wrong. So, although it sounds like a very simple thing, the trickledown of that is huge.”
Nancy Torner is a freelance writer based in Roseville, MINN.
Memorial Medical Center devices before and after Lexmark solution
Source: Lexmark, 2007