100 Most Wired

Progress on Managing Meds

Hospitals are making slow, steady progress in adopting clinical information technology to improve the safety of medication ordering and administration. Results from the 2009 Most Wired Survey and Benchmarking Study show an overall increase in both provider order entry of medications and electronic bedside matching at the time medications are administered. Electronic medication management is considered one of the fundamentals of using IT to improve care.

Of the organizations completing the survey this year, 38 hospitals and health systems—6.8 percent of the sample—have effectively deployed information technology at both ends of the medication administration process (see figure 1). This compares with 23 hospitals and health systems in 2008, or 4.1 percent of the sample (see figure 2).

At the typical hospital responding to the survey, 26 percent of medications are entered electronically by physicians, compared with 19 percent in 2008. The typical respondent has 40 percent of medication doses matched to the order, the drug and the patient at the bedside, compared with 30 percent in 2008.

Military hospitals—Veterans Affairs, Army and Navy—appear to be the most advanced with 77 percent of medications entered electronically by physicians. Military hospitals have 78 percent of medications matched at the bedside.

Children's hospitals and academic medical centers are ahead of the typical respondent in implementing physician order entry, but are behind the curve in implementing bedside medication matching.

Both children's hospitals and academic medical centers made significant advances in physician order entry between 2008 and 2009, while critical access and rural hospitals appear to have been focusing on increasing the use of bedside medication matching during that period.

Survey respondents were asked to estimate the percentage of medications electronically ordered by physicians, nurses, pharmacists and nonclinicians and the percentage that never became electronic orders. For this analysis, full adoption of electronic order entry is defined as at least 80 percent of orders entered electronically by physicians. Using this definition, 99 hospitals and health systems achieved full adoption of physician order entry compared with 68 hospitals in 2008, an increase of more than 45 percent.

In another question, respondents were asked to estimate the percentage of total medication doses administered that are electronically matched to the order, patient and nurse. Full adoption of medication matching is defined as at least 80 percent of administered doses matched to the order, the drug and the patient at the bedside using bar coding or RFID. With this definition, 201 hospitals and health systems achieved full adoption of electronic bedside medication matching.

The typical hospital respondent had 26 percent of medication orders entered electronically by physicians in 2009, compared with 12 percent in 2004 (see figure 3). The least wired still lag significantly behind, with only 4 percent of orders entered electronically by physicians. Bedside medication matching has increased nearly three times among the typical respondent since 2005, representing 40 percent of the doses administered in 2009. (see figure 4).

Medication Safety - The following charts show the use of physician order entry of medications and medication matching at the bedside based on the 2009 and 2008 Most Wired Survey and Benchmarking Studies, with 80 percent usage defined as full adoption. Both charts show the number of survey respondents falling into each of the resulting four quadrants. The averages for eight benchmark groups are also plotted on the charts

Pharmacists remain the primary clinical team member entering medication orders among most survey respondents, accounting for 58 percent of medication orders in 2009. That's down from 66 percent in 2004. Nurses still account for roughly 10 percent of medications ordered electronically for all three key benchmark groups. Among the 2009 least wired, 9 percent of medication orders never make it into the electronic system.

Results at the other end of the spectrum have also improved. Slightly more than one-quarter of the survey participants—150 respondents—report that they have no activity on either front: no physician order entry and no bedside medication management. That is an improvement from 2008 when 212 hospitals, or more than one-third of participants, had none of these activities automated.

This article 1st appeared in the July 2009 issue of HHN Magazine.

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