title: A network collaboration implementing technology to improve medication dispensing and administration in critical access hospitals.
abstract: We report how seven independent critical access hospitals collaborated with a rural referral hospital to standardize workflow policies and procedures while jointly implementing the same health information technologies (HITs) to enhance medication care processes. The study hospitals implemented the same electronic health record, computerized provider order entry, pharmacy information systems, automated dispensing cabinets (ADC), and barcode medication administration systems. We conducted interviews and examined project documents to explore factors underlying the successful implementation of ADC and barcode medication administration across the network hospitals. These included a shared culture of collaboration; strategic sequencing of HIT component implementation; interface among HIT components; strategic placement of ADCs; disciplined use and sharing of workflow analyses linked with HIT applications; planning for workflow efficiencies; acquisition of adequate supply of HIT-related devices; and establishing metrics to monitor HIT use and outcomes.
authors.affiliation: Department of Health Management and Informatics, and the MU Informatics Institute, University of Missouri, Columbia, MO, USA. wakefielddo@health.missouri.edu
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Wakefield
authors.forename: Marcia M
authors.initials: MM
authors.lastname: Ward
authors.forename: Jean L
authors.initials: JL
authors.lastname: Loes
authors.forename: John
authors.initials: J
authors.lastname: O'Brien
mesh_terms: D016303:Clinical Pharmacy Information Systems; D003299:Cooperative Behavior; D057286:Electronic Health Records; D006751:Hospital Information Systems / Q000458:organization & administration*; D006780:Hospitals, Rural / Q000458:organization & administration; D006801:Humans; D007484:Iowa; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control*; D008510:Medication Systems, Hospital / Q000458:organization & administration*; D010607:Pharmacy Service, Hospital / Q000458:organization & administration; D057188:Workflow
references.citation: J Am Med Inform Assoc. 2006 Sep-Oct;13(5):557-66
references.pmid: 16799130
references.citation: Healthc Q. 2006;10 Spec No:39
references.pmid: 17163115
references.citation: Am J Health Syst Pharm. 2005 Dec 15;62(24):2619-25
references.pmid: 16333060
references.citation: Am J Health Syst Pharm. 2005 Nov 15;62(22):2413-5
references.pmid: 16278335
references.citation: J Healthc Inf Manag. 2007 Fall;21(4):41-8
references.pmid: 19195280
references.citation: Health Serv Res. 2007 Dec;42(6 Pt 1):2089-108; discussion 2294-323
references.pmid: 17995554
references.citation: Perspect Health Inf Manag. 2008 May 16;5:6
references.pmid: 18504505
references.citation: J Healthc Inf Manag. 2002 Winter;16(1):46-51
references.pmid: 11813523
references.citation: Health Care Manage Rev. 2008 Apr-Jun;33(2):169-77
references.pmid: 18360167
references.citation: Am J Health Syst Pharm. 2007 Feb 1;64(3):315-21
references.pmid: 17244881
references.citation: Clin Lab Med. 1991 Mar;11(1):227-38
references.pmid: 2040145
references.citation: Jt Comm J Qual Saf. 2003 Jul;29(7):345-53
references.pmid: 12856556
references.citation: JAMA. 2008 May 14;299(18):2200-2
references.pmid: 18477788
references.citation: Am J Health Syst Pharm. 2008 Sep 1;65(17):1661-6
references.pmid: 18714114
references.citation: J Med Syst. 2006 Dec;30(6):429-38
references.pmid: 17233155
references.citation: J Am Med Inform Assoc. 2008 Jul-Aug;15(4):554-8
references.pmid: 18436901
references.citation: Am J Health Syst Pharm. 1995 Jun 15;52(12):1305-9
references.pmid: 7656117
references.citation: N Engl J Med. 2010 Aug 5;363(6):501-4
references.pmid: 20647183
references.citation: Am J Health Syst Pharm. 2006 Jan 15;63(2):165-8
references.pmid: 16390931
references.citation: Transfusion. 2003 Sep;43(9):1200-9
references.pmid: 12919421
references.citation: N Engl J Med. 2005 Jul 28;353(4):329-31
references.pmid: 16049205
references.citation: J Healthc Inf Manag. 2008 Spring;22(2):16-22
references.pmid: 19266990
references.citation: Jt Comm J Qual Patient Saf. 2007 May;33(5):293-301, 245
references.pmid: 17503685
references.citation: Ann Intern Med. 2006 Sep 19;145(6):426-34
references.pmid: 16983130
references.citation: Inquiry. 2009 Spring;46(1):46-57
references.pmid: 19489483
references.citation: J Healthc Qual. 2004 Nov-Dec;26(6):5-11
references.pmid: 15603088
references.citation: J Am Med Inform Assoc. 2002 Jan-Feb;9(1):16-24
references.pmid: 11751800
references.citation: Am J Health Syst Pharm. 2007 Mar 1;64(5):536-43
references.pmid: 17322168
references.citation: N Engl J Med. 2009 Apr 16;360(16):1628-38
references.pmid: 19321858
references.citation: Am J Health Syst Pharm. 1996 Mar 15;53(6):651-4
references.pmid: 8800970
references.citation: J Rural Health. 2008 Spring;24(2):101-5
references.pmid: 18397442