Embleton Care is an accredited aged care facility located in the inner north-east suburb of Embleton, WA. The facility has been owned and operated by the same family for over 30 years. Embleton Care has single and double occupancy rooms for 82 residents who have either low or high care needs and a staff of 105.
To support Embleton Care’s management, quality and care processes, they recognised the need to introduce an electronic system to save time and quickly access clinical data to provide safer and more effective person centred care.
Whilst Embleton Care utilised electronic systems for finance, human resource management and some components of care services for some years, there was a need to introduce a system that maximised communication and integrated all aspects of clinical care, including integrated medication management as well as having the ability to configure certain aspects of the system, specifically forms.
David Cox, Managing Director of Embleton Care said, “iCareHealth’s Clinical, Care and Medication Management software addressed our criteria and took it a step further by having the ability to create the most complete single person electronic health record in aged care.”
“The integration of an electronic medication profile, medication signing sheets, pharmacy records, integrated clinical notes and internal/external communication systems would enhance the accuracy and efficiency of our care delivery and documentation,” he said. “This solution would provide our staff with a clear view of the information required to make informed care decisions and hence provide the highest quality of care to our residents.”
Embleton Care had utilised aspects of an electronic care system for two years prior to the selection of iCareHealth, the new system was introduced after many months of planning and education.
“A small committee involving managers, nurses, the pharmacy, doctors and the facility’s IT support consultants were involved in the selection and implementation of the software. The project manager ensured that the implementation was on time and within budget,” David said.
End users were contacted as soon as the software was chosen and education via posters, memos and staff meetings promoted the benefits of the new software well before staff were required to use it. The new tablet devices were introduced before the software so that staff could familiarise themselves with the touch screen, digital hand writing software, finger scanners and camera.
“The tablet PCs were quickly adopted as staff realised they were easy to use and could enter data at the point of contact with residents,” David said.
Education tailored to the individual needs of staff ensured that the software could be used by all staff before its planned introduction.
David explained, “managers and documentation coordinators received training on all aspects of the software by the iCareHealth educator. General users received internal education on day to day use of the software. The use of a training environment enabled staff to enter mock data without the threat of data corruption.”
Two-stage approach to implementation
“We implemented in two stages to ensure that we didn’t overwhelm our staff, pharmacy and GPs. Staff elected to remove all paper handover sheets, charts, communication diaries and task lists as soon as the clinical and care modules were implemented to ensure that all aspects of the software would be adopted,” David said. Once the clinical and care modules in iCareHealth’s solution were being utilised well by staff the medication management module was introduced.
“Managers initially undertook concurrent paper and electronic medication rounds across all three shifts to ensure data integrity. Registered staff also undertook concurrent rounds for a short period of time to demonstrate the integrity of the software. Staff soon realised the time savings resulting from the new software and requested that the paper software be removed,” said David.
Embleton Care’s pharmacy was engaged in the early stages of the project.
“The pharmacy was involved in initial discussions with IT vendors and contributed in the decision process. By being involved in the vendor selection process the pharmacy was given an opportunity to see the benefits of an electronic software to the facility and the pharmacy well before the implementation phase,” said David.
The pharmacy had analysed Embleton Care’s medication errors and acknowledged that the vast majority were a result of the difficulties of reading messy and cumbersome paper based medication charts.
“The pharmacy was able to see early on that the issues, time and cost of sending medication profiles and signing sheets each time there was a medication change would be eliminated with electronic software as well as many of the errors that were occurring and resident safety would be increased. Regular meetings with pharmacy staff meant that any issues relating to procedural changes, staff training or software enhancements could be appropriately and quickly addressed to ensure a smooth transition to an electronic medication management software.”
Embleton Care’s GPs were surveyed to ascertain the difficulties of operating the current paper based system. They were frustrated that they could not access information on medications and laboratory results on a single system and that they wanted a system that could integrate with their existing medical practice software to avoid duplication of information entry.
“All GPs were contacted personally once iCareHealth had been chosen as the vendor of choice. Our GPs liked the thought of an integrated clinical, care and medication management software. They were thrilled at the fact that they would never have to rewrite a medication profile again and were pleased that the facility was willing to make a commitment to scanning and saving all resident documents in the iCareHealth document database to enable a single source for patient records. GPs were also pleased that iCareHealth had an agreement with Medical Director to share data and had provided a timeline for implementation.”
“Non-signing medication errors fell from 205 to one in the first month of implementation and have remained low in the months since the introduction of the software.”
99% reduction in medication errors
iCareHealth’s Medication Management software has enabled the accurate delivery and tracking of medications at Embleton Care.
“Non-signing medication errors fell from 205 to 1 in the first month of implementation and have remained low in the months since the introduction of the software. Medications can no longer be missed as the software prompts you to provide a reason before you log out of a medication round as to why a medication was not administered,” David said.
Monthly medication audits completed in less than an hour
“Monthly medication audits used to take over two days to conduct with the paper charts at Embleton Care,” said David. “They now take less than one hour to complete each month. Staff are now able to accurately track medications to medication profiles and can search medication change histories giving an accurate reflection of medical treatments.”
A fail-safe for ensuring administered PRNs are evaluated
If staff at Embleton Care administered a PRN, an automatic progress note entry is created electronically and highlighted in yellow along with the reason why it was given. There is also an automatic handover alert prompting staff on the next shift to evaluate the effectiveness of the PRN administered in the previous shift and document it accordingly.
“Monitoring the effectiveness of PRN medications administered was extremely difficult when using a paper based software. It relied on staff remembering that they had administered a PRN and if there was a shift change ensuring they communicated it to the next staff member. This prompt is fail-safe for ensuring administered PRNs are evaluated,” said David.
Faster and easier medication rounds
Nurses report that medication rounds are faster, easier and more fun since using iCareHealth’s Medication Management Software as they only need to sign once to log onto the software rather than signing each drug administered. In comparison to our previous paper based system, our medication rounds are now 40% faster using iCareHealth’s software.
Improved care decision making resulting from more precise and detailed documentation
“The use of the tablet devices have enabled staff to access and enter information at the bedside. Tablet devices are used when undertaking wound care rounds to ensure that wound dressings are completed and wound evaluations are documented appropriately. Assessment forms are specifically relevant to our facility with staff more diligent in completing them as they revel in the data collected. Assessments and care planning have also been enhanced by enabling staff to conduct assessments in the residents’ own room. Residents and family members now have the opportunity to contribute to the care planning process in a non-threatening environment.”
“In regards to medication management, medications withheld or refused during a medication round are automatically documented in progress notes to provide a clear view of a resident’s history. Staff now record why analgesia is being given and have a quick and easy system of recording pain evaluations that are generated into progress note entries. Pain evaluations have doubled since the introduction of the software.”
“The use of the scanned document ability has enabled the improved treatment of residents post admission, hospital transfer and medical review as staff are easily able to access laboratory results and medical orders and respond to changes,” said David.
Reduction in ACFI Appraisal rejections and submissions done in the click of a button
“The integration of a resident’s clinical, care and medication management information has improved the supporting evidence available to be linked to an ACFI Appraisal. Tags are used in the collection of data for ACFI submissions. This has had a positive impact on our funding as data is immediately available and clearly visible in order to maximise funding and reduce submission errors,” he said.
“Whilst funding submissions used to take many hours to complete, submissions can now be collated with the click of a button and sent electronically to MediCareHealth saving many hours of paperwork on each submission.” David also estimates that ACFI submissions are now 50% faster than the manual collation and submission of data.
Increased efficiency and improved communication with pharmacy
“The electronic messaging functionality for medication changes and orders has reduced the time staff spend phoning and faxing our pharmacy by 30 minutes a day following up changed medications and orders. There is also an automated stock reordering for non-prescription medications so staff don’t have to do it manually.”
“Resident medication profiles are updated in the facility’s software as the pharmacist dispenses the medication and there is less chance for communication and medication errors because our GPs, staff and our Pharmacist are all looking at the same profile mitigating risks associated with medication administration.” David said.
Transparency of the software has improved staff communication
“Communication between staff members has been enhanced with the use of the daily message board and the use of scheduled tasks that prompt staff to undertake specific care or administrative tasks during each shift ensuring resident care needs are always met.”