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North York General

North York General Hospital reduces medication errors with closed-loop administration

At Toronto-based North York General Hospital (NYGH), one simple phrase resonates across the organization’s 5,000+ staff, physicians and volunteers: “Our patients come first in everything we do.” With that mentality, the three-facility academic medical center embarked on a multi-year clinical transformation, including a complete redesign of its medication administration process.

In 2010, NYGH implemented a closed-loop medication administration (CLMA) process, which allows clinicians to use Cerner’s fully integrated electronic health record (EHR) to ensure the right dose of the right medication is given to the right patient at the right time. By leveraging information technology solutions, like Cerner’s PowerChart®, WorkFlowMonitor, PharmNet® and CareMobile®, at every step in the process, CLMA eliminates manual entry and fires an alert if a medication does not match the active orders in the EHR. From 2010-2015, NYGH detected and avoided more than 11,000 potential medication errors using CLMA.

“The Canadian Adverse Events study identified that 23.6 percent of adverse events in hospitals are related to medications, and that many of these events are preventable.” said Chief Medical Information Officer Dr. Jeremy Theal. “CLMA is a prime example of how health information technology can reduce the risk of medication errors and make it easier for clinicians to deliver high quality care.”

CLMA was implemented throughout the organization in phases, and with each implementation the clinical process and patient outcomes further improved. CLMA requires clinicians to use barcode scanners to scan each patient’s wrist band and then scan his or her medications to make sure each matches the doctor’s orders in the EHR. One of the keys to success is clinician acceptance and adoption of the new technology and processes. From 2010-2015, scanning compliance among the clinical staff grew from 73 percent to over 95 percent.

“To increase adoption, we distributed monthly compliance reports,” Theal said. “These created a friendly competition among the staff as well as helped managers identify which clinicians needed additional training and education.”

Because CLMA eliminated the need for manual data entry and transcription, the new process also shortened the STAT medication turnaround time by 83 percent, which means patients are now getting their STAT medications more than four hours faster. In addition to improving safety and efficiency, NYGH estimates that CLMA has helped avoid more than $5.7 million in costs from adverse drug events over five years.

“We’re proud of the steps we’ve taken towards improving patient safety,” Theal said. “NYGH will continue to invest in IT-enabled, patient-centric solutions that help our clinicians achieve the best clinical outcomes for our patients, families, and communities."

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Client outcomes were achieved in respective settings and are not representative of benefits realized by all clients due to many variables, including solution scope, client capabilities and business and implementation models.