New clinical support software improves efficiency

BOSTON- People undergoing surgery are at risk of harm due to medication errors. A new approach to managing and documenting how medications are administered in the operating room improves patient safety and workflow efficiency, according to a new study by researchers at Massachusetts General Hospital (MGH). work of clinicians. the results of this surveythe first of its kind, appear in the Journal of the American Medical Informatics Association (JAMIE) and could lay the groundwork for sweeping changes in the way anesthesia and other medications are administered in the operating room.

In recent years, there have been widespread efforts to reduce the incidence of medication errors in hospitals. However, while a drug given to a patient in a hospital ward goes through multiple levels of electronic and human checks to confirm it’s safe and appropriate, that’s usually not possible in the operating theatre, explains the doctor. MGH anesthesiologist Karen C. Nanji, MD, MPH, a clinician-scientist who studies drug safety.

“Most of the protective measures to prevent medication errors that exist in other areas of the hospital are not available in the operating room,” says Nanji. During surgery, the pace of action is often rapid and a patient’s condition can change rapidly. Most surgical patients receive many drugs, around 10 to 13 per operation, Nanji says. A 2016 study by Nanji and colleagues found that about one in 20 surgery-related medication administration contained an error. With the high volume of medication these patients receive, this means that at least one medication error can occur in over 40% of operations.

To solve this problem, Nanji and his colleagues developed a new clinical decision support software (CDS) platform designed to reduce harm from medication errors in the operating room by more than 95%. The CDS software has several key features. It is fully integrated with electronic health records and vital signs monitors, and it works in real time on operating room computers. Barcodes on syringe labels are scanned immediately prior to administration, providing real-time, patient-specific information on the physician’s computer screen, including allergy alerts, dosages suggestions based on the patient’s medication history and reminders for important medications or tests that may have been missed. The software can also determine if a medication is compatible with a patient’s current heart rate or blood pressure.

For the JAMIE study, Nanji and his team recruited 40 anesthesia clinicians to participate in simulated surgical procedures using a training manikin (or a realistic simulated patient). Half used existing standard protocols for medication administration and documentation, while the other participants used the new CDS software during sham surgeries. All groups were asked to perform basic tasks, such as administering and documenting medications commonly used in the operating room and responding to a drop in blood pressure. The simulated procedures were recorded on audio and video.

A comparison of the two groups revealed that clinicians using the CDS software worked with significantly greater efficiency. They spent 20% less time documenting their work, which required 50% fewer mouse clicks and half as much screen scrolling. Clinicians who used the CDS software also provided better care: simulated patients in the CDS group had more tightly controlled blood pressure, which reduced the risk of heart and kidney damage during and after surgery. Clinicians in the CDS group were also more likely to correctly adjust analgesic doses in sham patients with underlying kidney disease. Importantly, they also rated the system as easier to use; the CDS software achieved a “usability score” that was twice that of electronic health record software.

Nanji hopes the call for greater efficiency in the operating room will further motivate clinicians to use the new CDS software, leading to better patient safety. Nanji is working with the Mass General Brigham Hospital System to bring the software to hospitals across the United States. “Our goal,” Nanji says, “is to make surgery and anesthesia safer for all patients.”

Nanji is also an Assistant Professor of Anesthesia at Harvard Medical School.

This work was supported by grants from the Doris Duke Charitable Foundation and the Agency for Healthcare Research and Quality.

About Massachusetts General Hospital
Massachusetts General Hospital, founded in 1811, is Harvard Medical School’s first and largest teaching hospital. the Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and includes more than 9,500 researchers working in more than 30 institutes, centers and departments. In August 2021, Mass General was named #5 in the US News and World Report list of “America’s Best Hospitals”. MGH is a founding member of the Mass General Brigham Health Care System.

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