Patient Safety and Savings in Las Vegas

By Mitch Work, MPA, FHIMSS; and Chuck Appleby

As one of the country's fastest-growing cities in the early 21st century, Las Vegas, Nevada, has had to shoulder all the demographic challenges that distinction entails. Through it all, University Medical Center (UMC) has steadfastly maintained its role as the safety net for the sickest and neediest patients in this metro area of nearly two million people. UMC, a 565-bed facility affiliated with the University of Nevada School of Medicine, combines the role of county hospital with that of Nevada's only Level 1 Trauma Center, only burn-care unit, and a world-class children's hospital.

Founded in 1931 to serve workers building nearby Hoover Dam and operated by Clark County, non-profit UMC has never been deterred from its mission despite red-hot competition from several new for-profit hospitals built during the burgeoning growth of the early 2000s. While 10 large hospitals now compete for the local market, the recession has dramatically curtailed that growth‚Ät least one new hospital stands empty today‚Änd further accentuates UMC's charitable role. Each year it admits about 30,000 inpatients and treats nearly 70,000 adult patients in its emergency department and more than half-a-million ambulatory patients.

In keeping with its mission, UMC has focused its 4,000 employees, including 1,550 nurses and 1,400 physicians, on patient-centered care emphasizing quality and patient safety, including core measures, a "patient safety net" system to report medical errors in a non-punitive manner, as well as aggressive infection-control and medication-safety programs.

A key piece of UMC's patient-care strategy is a closed-loop medication management system that uses automated dispensing cabinets and barcode scanning at nursing stations to ensure accurate medication dispensing. Now UMC is advancing that strategy by becoming the first hospital in the nation to adopt software that integrates clinical data from multiple sources and delivers alerts to nurses at their automated medication dispensing cabinets when potential adverse drug reactions are detected.

Improving Patient Safety

UMC implemented this unique software in December 2009 on its cardiac care unit (CCU) and cardiovascular care unit (CVCU), where 24 beds support patients with some of the highest needs in the hospital. The innovative system assists clinical pharmacists in identifying patients for adverse clinical events and tracks laboratory results for any changes requiring potential intervention.

Previously, the pharmacy or laboratory identified an adverse event (example: potassium levels being too high), and would place a call to the nurses caring for the patient for corrective action. Now with the Pyxis¬Æ Advisor technology, this same information is sent automatically to the automated medication dispensing cabinet on the patient's floor triggering an alert that reports on out-of-range laboratory values. Nurses must respond to each alert before proceeding with medication dispensing for the patient.  Through this connectivity, nurses are now getting the same kind of clinical decision support reported through their automated medication dispensing cabinet and nearer to the point of care where it can help nurses most in caring for their patients.

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