Throughout her career, Kathy Francis has worked with healthcare professionals who were dedicated to the highest level of service and quality. However, she also saw a serious problem—exposing patients to a high risk of medication errors whenever dose calculation was performed at the bedside.
Even in her early years as a nurse, Francis was concerned about patients’ safety when she and her fellow nurses were forced to quickly calculate medication doses as patients’ conditions worsened rapidly. According to Francis, “point-of-care medication administration processes rely heavily on nurses’ own memories and vigilance to recognize and prevent errors. Any system that relies primarily on human memory and vigilance is susceptible to a high rate of error.” For this reason, she saw the need for a device that could significantly reduce the number of errors made at the point of care, and in turn, prevent patient mortality due to calculation errors. Thus, InformMed was formed to create such a device—the pac2.
From the beginning, Francis said, she was “surrounded by a culture of excellence and innovation” at Evanston Hospital. After earning her nursing diploma, Francis moved up the hospital’s career ladder and eventually earned the position of nurse clinician in neonatal intensive care. As such, she “was able to help shape and share [the] unit’s vision for new standards of care in what was considered a pioneering field of medicine.” Francis became interested in revolutionary medicine and carried that to new roles in post-anesthesia care, pediatric sedation and interventional radiology. While enrolled in additional courses at Northwestern University, Francis “was introduced to the systems approach to organizations and processes,” something she used to launch her second career in healthcare consulting before moving back to her hometown of Peoria.
In 1998, Francis, her husband and two children moved to Peoria because they thought Peoria was “an ideal place for family, community and business opportunities,” and have enjoyed living here ever since. The business community, Francis said, is especially supportive and gave InformMed the chance to be the first company to move into the Peoria NEXT Innovation Center on Main Street.
Francis, co-founder of InformMed with Diane Mathis, “developed the early algorithms for a new system of safe medication delivery. InformMed was founded in 2001 to develop and commercialize that system.” The pac2, short for Pharmaceutical Algorithm Computerized Calculator, is the company’s flagship product. The pac2 is a handheld computer invented to help nurses reduce the risk of medication errors reaching their patients.
The idea for the device came about when Francis was working on a healthcare consulting project. She was creating a database to improve multi-site clinic processes and thought there must be a way to alert nurses of errors in dosage calculations by drawing on a bank of medication information. Francis and Mathis incorporated InformMed and “immediately filed provisional patent documents and began working with a world-class product development firm to manage the turnkey process of product design, human factors engineering and prototyping.” In working with one of the world’s top patent experts here in Peoria, as well as new CEO Gary Conkright, InformMed has already been very successful, according to Francis: “The company’s IP assets, product and business development have grown exponentially.”
The pac2 handheld computer is used by nurses at the bedside when patients’ conditions change rapidly, requiring medication to be administered before the pharmacy could prepare and screen the dose. “In these situations it is up to the nurse, rather than the pharmacist, to perform the mathematical conversions that translate a doctor’s order into a specific volume of medicine and then screen the dose for accuracy.” One of the many great features of the pac2 is that it does not require nurses to recall the mathematical formulas which calculate correct doses. Nurses enter amounts needed and “the pac2 does the math, checks the entries for accuracy, and issues cautions and warnings when the dose is outside of the hospital’s predetermined safe ranges. It also alerts the nurse to important medication administration information. The pac2 guards against preventable adverse drug events by helping nurses calculate and verify accurate doses, detect and prevent unsafe doses and recall safe medication administration information.”
The Pediatric Intensive Care Unit (PICU) at OSF Saint Francis Medical Center has been using the pac2 throughout each shift since the summer of 2007. Researchers at the University of Illinois College of Medicine at Peoria measured and recorded nurses’ opinions and satisfaction with the new device. They were asked to rate the pac2’s usefulness, ease of use, ease of learning and overall satisfaction. “Ratings were extremely favorable across all measures,” Francis said. “Patient safety, peace of mind and ease of use were among the top reasons nurses liked the pac2.”
Because the testing at the PICU was so successful, the Children’s Hospital of Illinois, also at OSF Saint Francis Medical Center, has become the first facility in the United States to purchase InformMed’s pac2 system. It will initially be used in the Pediatric Intensive Care Unit of the Children’s Hospital, as Dr. Al Torres, medical director of the unit, explained. “We are focusing first on our pediatric patients, because they are the least able to tolerate even small dose errors.”
“It only takes 20 to 30 minutes to prepare nurses to use the pac2 effectively in patient care,” Francis noted. “Nurse Champions—pac2 ‘experts’ who help train other nurses—are fully trained in about two hours.” 97 percent of nurses have said the device is easy to use.
The pac2 is sold as a system, complete with the Data Manager—“the brains of the system that allows the hospital to monitor and enforce safe drug dosing guidelines.” Each individual pac2 device is connected with the Data Manager via wireless or cable connections, with data constantly being exchanged between the two.
The software “stores and manages the formulary data that gets downloaded into each pac2 device,” Francis explained. “The system extends the reach of the pharmacist to the point of care by providing a means for the pharmacist to control the drug information and dosing parameters for each care area and then monitor how that information is used at the point of care.” Francis credits VP of Development Todd Gage with the “functionality of the Data Manager system and its intuitive user interface.” Gage came to InformMed with over 21 years of enterprise software experience.
Not only does the pac2 help nurses accurately administer medication at the point of care, it also helps reach Joint Commission Medication Management Standards. Francis said “the Joint Commission is a powerful credentialing body that evaluates hospitals against core standards. JCAHO accreditation is an important seal of approval that indicates whether high-performance standards are met.” The JCAHO standards require that before medication is administered to any patient, it must be checked for appropriateness of the drug, dose and route. The pac2 helps nurses meet these standards by “facilitating this review in the same time it would normally take the nurse to simply calculate the dose with a regular math calculator. At the same time, it issues a warning to the nurse if the dose is unsafe,” Francis said.
A study performed by the Rutgers University School of Nursing shows that errors were made in identifying the appropriateness of orders 85 percent of the time, 45 percent of the time when calculating medication doses and 76 percent of the time when recalling essential drug information. Francis attributes these errors to the reliance on nurses to correctly and quickly recall medication information and calculate correct doses. The constant introduction of new drugs and the changing doses and protocols makes it difficult for nurses to remember all of the necessary information.
Francis noted that a study similar to the one at Rutgers was recently conducted by the University of Illinois College of Medicine at the Rager Clinical Simulation Lab in Peoria. The results of this study in terms of point-of-care medication administration were very similar to the Rutger findings. According to Francis, “both studies demonstrate more than 90 percent reduction in those errors when nurses use the pac2.”
Francis also noted that these high percentages of error reflect the risks brought on by point-of-care dose calculation and preparation. She said that improving the clinical mathematical skills of nurses, physicians and pharmacists has been a concern in the field for decades, and one which is being addressed through spreadsheets and unit dose dispensing—when medications are prepared by a pharmacist in the exact dose a nurse needs to administer to a patient. However, 20 percent of all medication given in hospitals is at the point of care, and there is no time to have unit doses prepared by pharmacists.
As its first tenant, “the spirit of collaboration that is embodied in the Peoria NEXT Innovation Center is truly exemplified in InformMed,” said Francis. “Nearly every one of the anchor organizations has come alongside our company to help InformMed’s business incubate, grow and thrive.” She noted that Peoria NEXT was instrumental in getting InformMed’s pac2 off the ground by giving the company access to some of the nation’s foremost authorities in medical science, technology, intellectual property, business and finance. This community support also allowed InformMed to have the vision and set goals for the pac2 and its commercialization and utilization in the medical field.
Francis said InformMed plans to stay at the Innovation Center for the full three years a start-up company is allowed to lease, and after that, continue elsewhere within Peoria. “We anticipate raising two more rounds of capital to complete a full market launch.” Each of those rounds of funding, according to Francis, will require adding employees to the company—something InformMed looks forward to doing. IBI