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Safety in your hands

Dr Lo Wing Kee was the winner of the annual MPS/Hong Kong Academy of Medicine patient safety award in 2012. Here he explains what inspired him to study the effects of digital technology on patient safety

The PDA – personal digital assistant – is the ancestor of the smartphone. I started with Palm OS myself and, since then, I haven’t stopped using them.

Today, billions of people are using them everyday. A few years ago, I asked myself why the medical industry did not introduce these devices for bedside care of patients when even small restaurants had already been using them.

Thanks to the support from the management team of the hospital I work for, I had a chance to visit a hospital in China, which started to deploy these devices for bedside care.

Kickstarting the project

The functions they had at that time were very primitive and were not suitable for the local use in my hospital in Hong Kong. Therefore we co-operated with the responsible software firm to jointly run a project in our hospital.

We provided the clinical and local IT support while they wrote the necessary app on an industrial grade smartphone. All the data were transferred through a wireless network. After one year of hard work, the system was deployed for use.

The functions we built into the system include: taking photos of patients, scanning of 2D barcodes, recording of vital signs and graph plotting, printing of specimen labels at the bedside, retrieval of investigation results and, most important of all, tracking of drug administration, setting different alerts to remind medical personnel when there is any suspected error during the dispensing of medication, including wrong patient, wrong time, drug overdose and overdue drugs.

What we wanted to achieve through the system was mainly patient safety and the minimisation of human errors
What we wanted to achieve through the system was mainly patient safety and the minimisation of human errors. Of these, the most common ones are drug administration errors, which can be catastrophic.

Assessing the results

We analysed the medication errors in the year before the launch of the system in 2009 and those errors that occurred in the subsequent two years after its launch.

The total numbers of medication errors were reduced from nine incidents per year to three in the first year, and to only one in the second year of implementation. Particularly, the six cases of dose omission and drugs given to the wrong patient had been completely eliminated by the new system.

On reflection

It is encouraging to know that our study won the MPS/HKAM patient safety award last year. Looking back, there were many hurdles that we had to overcome in order to make the project a success.

The other obstacle is the inertia from clinical staff who are reluctant to change
Security is always a hindrance to adopting new information technology into the industry. The other obstacle is the inertia from clinical staff who are reluctant to change. This difficulty can be solved by involving the users in designing the software and choice of hardwares so that they can perceive the new invents as trendy toys that give enjoyment.
The need is ever-evolving; therefore continuous feedback from the frontline users is vital to upgrade the system every now and then.

Future shock?

There are still medication errors involving miscommunication between doctors, nurses and pharmacists. These can only be solved by electronic prescriptions at the bedside.

Notebooks, desktops on trolleys, smartphones and tablets have been tried by different institutes including us. We have been working on the iPad lately. It seems to be a better device for this purpose, although there are still many hurdles to overcome before it can be widely accepted by physicians, who are used to writing on paper at the bedside.

Use of technology to help improve clinical care has been and will be an irresistible trend in the healthcare industry

Use of technology to help improve clinical care has been and will be an irresistible trend in the healthcare industry. We, as clinicians, should take up a more proactive role in initiating, co-ordinating and implementing IT reforms, instead of being passively asked to use whatever systems and devices that are designed by someone.

In my hospital, we have regular meetings between clinicians and our IT colleagues every two to three months to discuss issues relating to existing systems and ideas about developing new functions or systems. Usually free lunch is provided to attract more colleagues to participate and save time in their busy schedule! Many are really enthusiastic. After all, every clinician dreams of a perfect IT system at the workplace to improve efficiency and safety of patient care. However, rewards will come only after due effort.

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