Topic 9:

ROLE OF TECHNOLOGY IN MEDICATIONUSE PROCESS

The first rule of the medical profession is supposed to be Do No Harm.

MEDICAL ERRORS
In 1999, the Institute of Medicine published its report To Err is Human: Building a Safer Health System. In doing so, they focused the nations attention on the subject of medical error.

RECORDED FACTS

Fact 1: It is found that 44,000 out of 98,000 hospital American patients die annually as a result of preventable medical errors. Fact 2: It is found that one in five American families (8.1 million households) reported experiencing a serious medication error during hospitalization.

Fact 3: It is found that healthcare facilities are experiencing as many as one error per every five doses administered. Fact 4: It is found that 7 percent of erroneously administered doses were judged to be potential adverse drug events (ADEs).

TECHNOLOGY AND HEALTHCARE

Due to the numerous steps required in the care of patients, the healthcare industry is an inherently error-prone process that is fraught with opportunities for mistakes to occur. Enhancing safety system design through the use of technology is an invaluable tool in the prevention of potentially life-threatening mistakes.

ADOPTION OF TECHNOLOGY

Computerized Prescriber Order Entry (CPOE) Present Setting: Healthcare practitioners still communicate information in the old fashioned way. It has been estimated that handwritten prescriptions are used 99% of the time to communicate orders.

Problems encountered:
Delays

in treatment Duplication of services Illegible handwriting Use of dangerous abbreviations and dose designations

WHAT IS CPOE?

A system used for direct entry of one or more types of medical orders by a prescriber into a system that transmits those orders electronically to the appropriate department

BENEFITS/ADVANTAGES TO NURSES
They may have more time with patients due to a reduced frequency in contacting prescribers to clarify orders. They would be able to execute orders faster and give prompter care to their patients.

Bar Code-Enabled Point-of-Care Technology Present Setting: The administration of medications can be labor-intensive and errorprone process. In addition, nurses are burdened with larger patient loads and are caring for patients with higher degrees of acuity than ever before.

Problems encountered:
Error

in transcribing and dispensing Error in drug administration process

WHAT IS BPOC?
On admission, patients are issued an individualized bar code wristband that uniquely identifies their identity. When a patient is to receive a medication, nurses scan their bar coded employee identifier and the patients bar code wristband to confirm their identity.

BENEFITS/ADVANTAGES TO NURSES
They can spend more time on high-value patient care by capturing vitals and charting treatment information instantaneously with mobile computers. They can improve the quality of care by reducing the possibility of human error through instant access to the most current data about patients and their medications.

Automated Dispensing Cabinet Present Setting: Traditionally, hospital pharmacies provide medications for patients by filling patient-specific bins of unit dose medications, which were then delivered to the nursing unit and stored in medication carts.

Problems encountered:
Less

pharmacy productivity Less nursing productivity

WHAT IS ADC?
This a computerized drug storage device or cabinet designed for hospitals. ADCs allow medications to be stored and dispensed near the point of care while controlling and tracking drug distribution.

BENEFITS/ADVANTAGES TO NURSES
Since automated cabinets can be located on the nursing unit floor, they have speedier access to a patients medications. Decreased wait time for medication can lead to less frustration for nursing staff and prevent conflict between the pharmacy and nursing staff. In addition, nurses can note returned medications using the cabinets computers, enabling direct credits to patients accounts.

Smart Infusion Pump Delivery Systems Present Setting: Infusion pumps can administer fluids in ways that would be impractically expensive or unreliable if performed manually by nursing staff using self-controlled infusion pumps.

Problems encountered:
More

time spent on monitoring Incorrect dose of a medication Error when setting self-controlled infusion pump

WHAT IS SMART INFUSION PUMP?

This infuses fluids, medication or nutrients into a patient's circulatory system. It has the ability to store dosing guidelines in a drug library and to apply those guidelines during pump programming to warn clinicians about potential unsafe drug therapy.

BENEFITS/ADVANTAGES TO NURSES
It would save countless man-hours where nurses and doctors would not have to continuously give shots, personally administer IV's, or do as much monitoring. It would also allow great flexibility in the amount or volume of substance being delivered, thus preventing cases of underand/or over-dose.

ISSUES TO BE ADDRESSED IN THE IMPLEMENTATION OF TECHNOLOGY:

1.

2.

3.

4.

Outlining goals for the type of automation to be implemented. Developing a wish list of desired features and determining which one are practical. Investigating systems that are presently available. Analyzing the current workflow and determining what changes are needed.

5.

6.

7.

Identifying the required capabilities and configuration of the new system. Selling the benefits and objectives of automation to staff. Development of an implementation plan.