Case 19: Selection of a Patient Safety Strategy

Langley Mason Health (LMH) is located in North Reno County, the largest public health care district in the state of Nevada, serving an 850-square-mile area encompassing seven distinctly different communities. The health district was founded in 1937 by a registered nurse and dietician who opened a small medical facility on a former poultry farm. Today the health system comprises Langley Medical Center, a 317-bed tertiary medical center and level II trauma center; Mason Hospital, a 107-bed community hospital; and Mason Continuing Care Center and Villa Langley, two part-skilled nursing facilities (SNFs); a home care division; an ambulatory surgery center; and an outpatient behavioral medicine center. In anticipation of expected population growth in North Reno County and to meet the state-mandated seismic requirements, LMH developed an aggressive facilities master plan (FMP) that includes plans to build a state-of-the-art 453-bed replacement hospital for its Langley Medical Center campus, double the size of its Mason Hospital, and build satellite clinics in four of its outlying communities. The cost associated with actualizing this FMP is estimated to be $1 billion. Several years ago, LMH undertook and successfully passed the largest health care bond measure in the state’s history and in so doing secured $496 million in general obligation bonds to help fund its massive facilities expansion project. The remaining funds must come from revenue bonds, growth strategies, philanthropic efforts, and strong operational performance over the next ten years. Additionally, $5 million of routine capital funds will be diverted every fiscal year for the next five years to help offset the huge capital outlay that will be necessary to equip the new facilities. That leaves LMH with only $10 million per year to spend on routine maintenance, equipment, and technology for all its facilities. LMH is committed to patient safety and is building what the leadership team hopes will be one of the safest hospital-of-the-future facilities. The challenge is to provide for patient safety and safe medication practices given the minimal capital dollars available to spend today. LMH developed an IT strategic plan and identified the following ten goals: Empower health consumers and physicians. Transform data into information. Support the expansion of clinical services. Expand e-business opportunities. Realize the benefits of innovation. Maximize the value of IT. Improve project outcomes. Prepare for the unexpected. Deploy a robust and agile technical architecture. Digitally enable new facilities, including the new hospital. Information Systems Challenge LMH has implemented Phase 1—an enterprise-wide EHR system developed by Cerner Corporation at a cost of $20 million. Phase 2 of the project is to implement CPOE with decision-support capabilities. This phase was to have been completed previously, but has been delayed because of the many challenges associated with Phase 1, which still must be stabilized and optimized. LMH does have a fully automated pharmacy information system, albeit older technology, and Pyxis medication-dispensing systems on all units in the acute care hospitals. Computerized discharge prescriptions and instructions are available only for patients seen and discharged from the LMH emergency departments. Currently, the pharmacy and nursing staff members at LMH have been working closely on the selection of a smart IV pump to replace all of the health system’s aging pumps and have put forth a proposal to spend $4.9 million in the next fiscal year. Smart pumps have been shown to significantly reduce medication administration errors, thus reducing patient harm. This expenditure would consume roughly half of all of the available capital dollars for that fiscal year. The CIO, Marilyn Chen, understands the pharmacists’ and nurses’ desire to purchase smart IV pumps but believes the implementation of this technology should not be considered in isolation. She sees the smart pumps as one facet of an overall medication management capital purchase and patient safety strategic plan. Marilyn Chen suggests that the pharmacy and nursing leadership team lead a medication management strategic planning process and evaluate a suite of available technologies that taken together could optimize medication safety (for example, CPOE, electronic medication administration records [e-mar], robots, automated pharmacy systems, bar coding, computerized discharge prescriptions and instructions, and smart IV pumps), the costs associated with implementing these technologies, and the organization’s readiness to embrace these technologies. Paul Robinson, the director of pharmacy, appreciates Marilyn Chen’s suggestion but feels that smart IV pumps are critical to patient safety and that LMH doesn’t have time to go through a long, drawn-out planning process that could take years to implement and the process of gaining board support. Others argue that all new proposals should be placed on hold until CPOE is up and running. They argue there are too many other pressing issues at hand to invest in yet another new technology.

Discussion Questions

Describe the current situation as you see it. What are the major issues in this case?

Marilyn Chen, CIO, and Paul Robinson, director of pharmacy, have different views of how LMH should proceed. What are the pros and cons of their respective approaches? Which approach, if either, seems like an appropriate course of action to you? Explain your rationale.

Assume you are to mediate a discussion on this issue and that participants are to come to consensus on how best to proceed. What would you do?