Sie sind auf Seite 1von 6

The Role of Technology in the Medication-Use Process

Introduction
Healthcare industry is an inherently error-prone process that is fraught with opportunities for mistakes to occur. This was confirmed in the oft quoted 1999 Institute of Medicine (IOM) report. Err is Human: Building a safer health system where authors extrapolated that between 44,000 and 98,000 patients die each year in the US from preventing medical error.

Technology and Healthcare


Until recently, the majority of technology acquisitions have consisted of basic stand-alone computer systems. These were generally installed in the pharmacy, radiology, laboratory departments and also in the administration and business offices

Influences on the Adoption of Technology


1995, there we television and newspaper accounts that reported the tragic death of a patient from a preventable adverse drug event (ADE). A root cause analysis of the error is that there was no malpractice behavior; caring pharmacists and nurses simply interpreted an ambiguous handwritten chemotherapy order incorrectly. Medication errors related to the misinterpretation of physicians prescriptions were the 2 nd most prevalent claim listed on malpractice cases filed between 1985-1992 It has been estimated in the outpatient setting that unclear orders resulted in more than 150 million telephone calls from pharmacists and nurses to prescribing clarifications. Availability of critical clinical information needed (prescribing, dispensing and administering) improve time management and contribute to cost savings through improved utilization.

Computerized Prescriber Order Entry (CPOE)


a process of electronic entry of medical practitioner instructions for the treatment of patients (particularly hospitalized patients) under his or her care. Can also be defined as 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 (AHA, 2000) CPOE decreases delay in order completion, reduces errors related to handwriting or transcription, allows order entry at point-of-care or off-site, provides error-checking for duplicate or incorrect doses or tests, and simplifies inventory and posting of charges

ADVANTAGES OF CPOE SYSTEM OVER THE TRADITIONAL PAPER-BASED SYSTEM Decrease transcription Increase accuracy and completeness Ability to enter orders in multiple locations

Many studies have demonstrated a reduction in ADEs. One study by Bates et al. showed a serious medication errors were reduced by 55% and preventable ADEs were reduced by 17%. Another has shown that non missed dose medication errors fell from 142/1,000 patient days to 26.6/1,000 patient days Errors of omissions would be reduced Handwriting and interpretation issues would be eliminated

Unsafe possible scribing practices and medication errors are still possible with these systems such as: Errors due to lack of integration between a CPOE system and the organizations pharmacy system. Wrong patient errors Wrong drug errors

Beneficial aspects of these systems for nurses: Nurses may have more time with patients due to enhanced productivity due to a reduced frequency in contacting prescribers to clarify orders Reductions in time wasted in transcribing duplicate orders for the same medication of test Greater standardization of orders, lessening the need to understand and adhere to diverse regimens and schedules Improved efficiency when ordering tests or procedures Reducing time devoted to carrying out redundant orders Less need to enter voice orders into the system as prescribers gain access to the system from other units and remote locations.

Bar Code-Enabled Point-of-Care Technology For more than 20 years bar code technology has clearly demonstrated its power to greatly improve productivity and accuracy in the identification of products Proven to be an effective technology Can improve medication safety through several levels of functionality VA healthcare system pioneer in the use of bar code technology. JCAHO- nonprofit organization that is the nations leading standards-setting and accrediting body in healthcare

Results of 2000 ISMP Medication Safety Self-Assessment (1,435 hospitals) showed that only: - 43% of hospitals had even discussed the possibility of bar code drug administration - 2.5% used this technology in some areas of the hospital - Less than 1% had fully implemented it throughout the organization

PROCESS of BPOC technology: On admission, patients are issued an individualized bar code wristband that uniquely identifies their identity. When patient is to receive a medication, nurses scans their bar coded employee identifier and the patients bar code wristband to confirm their identity. JCAHO has stated that a bar code with 2 unique, patient-specific identifiers Prior to administration, each bar coded package of medication to be administered at the bedside is scanned. System can then verify the dispensing authority of the nurse, confirm the patients identity, match the drug identity with their medication profile in the pharmacy information system and electronically record the administration of the medication in an online MAR. Online MAR is likely to be more accurate than traditional handwritten MARs. The bar code scanner can enable nurses to have greater accuracy in recording the timing of medication administration.

Additional levels of functionality can include some of the following features: Increased accountability and capture of charges for items such as unit-stock medications. Up-to-date drug reference information from online medication reference libraries. Customizable comments or alerts and reminders of important clinical actions. Monitoring the pharmacy and the nurses response to predetermined rules or standards in the rules engine. Reconciliation for pending or STAT orders . Capturing data for the purpose of retrospective analysis of aggregate data to monitor trends. Verify blood transfusion and laboratory specimen collection identification.

Negative effects that occurred during the implementation of BPOC system includes: Nurses were sometimes caught off guard by the programmed automated actions taken by the BPOC software. The BPOC seemed to inhibit the coordination of patient information between prescribers and burses when compared to a traditional paper based system. Nurses fount it more difficult to deviate from the routine medication administration sequence with the BPOC system. Nurses felt that their main priority was the timeliness of medication administration because BPOC required nurses to type in an explanation when medication were given even a few minutes late. Nurses used strategies to increase efficiency that circumvented the intended use of BPOC.

National drug Code- a medical code set that identifies prescription drugs and some over the counter products. -FDA established a new rule that requires a bar code on most products that meets the Uniform Code Council (UCC) or Health Industry Business Communication Council (HIBCC) standards. This bar code must not only contain the products NDC number , but the expiration date and lot number are optional. Some types of errors that can occur: Omissions Extra Dose Wrong Drug Wrong Dose Unauthorized drug Charting Errors Wrong Dosage form

Automated Dispensing Cabinets A computerized point of use medication management system that is designed to replace or support the traditional unit-dose drug delivery system. The devices require staff to enter a unique logon and password to access the system using a touch screen monitor or by using finger print identification Can also be used to comply with regulatory requirements by tracking the storage, dispensing and use of controlled substances.

Institute for Safe Medication Practices (ISMP)


-nonprofit organization devoted entirely to medication error prevention and safe medication use. Rationales behind the wide acceptance of this technology are the following: Improving pharmacy productivity Improving nursing productivity Reducing costs Improving charge capture Enhancing patient quality and safety

Improving pharmacy productivity


- streamlining of the dispensing process due to the reduced number of steps from filling each patients individual medications bins to filling a centralized station.

Improving nursing productivity


- the time spent gathering or obtaining missing medications can be reduced.

Reducing costs
- increased pharmacist and nursing productivity, which fees them from time consuming processes and allowing more time for patient and clinical interactions.

Improving charge capture


- ADCs that are interfaced with the accounting department allow for the capture of all patient charges associated with administered medications

Enhancing patient quality and safety


- ADCs that have built-in decision support systems that warn users on drug-drug interactions, drugallergy interactions, drug-lab interactions, drug-drug duplications, and so forth.

Some documented unsafe practices with the use of ADCs: Lack of pharmacy screening of medication order prior to administration Choosing of the wrong medication from an alphabetic pick list High alert medications placed, stored and returned to ADCs Storage of medications with look-alike names and/or packaging The development of workarounds

Issues to be considered to ensure safe medication practices: Consider purchasing a system that allow for patient profiling so pharmacists can enter and screen drug orders prior to their removal and administered. Carefully select the drugs that will be stocked in the cabinets. Place drugs that cannot be accessed without pharmacy order entry and screening in individual matrix bins. Use individual cabinets to separate pediatric and adult medications. Periodically reassess the drugs stocked in each unit-based cabinet. Remove only a single dose of the medication ordered. Develop a check system to assure accurate stocking of the cabinets. Place allergy reminders for specific drugs. Routinely run and analyze override reports to help track and identify problems. Smart Infusion Pump Delivery Systems Infusion pumps are primarily used to deliver parenteral medication through IV or epidural lines.

ECRI a non profit organization that evaluates medical device safety.


Changed the paradigm of infusion therapy by removing reliance on memory and human input of calculated values to a software-enabled filter to prevent keystroke errors in programming infusion devices for delivery of parenteral medications

Implementation of technology
Persons who may interact directly with the technology: Chief information officer (CIO) Information technology (IT) Risk managers Medical staff Front-line practitioners Other support staff

Multidisciplinary implementation team will need to address the following issues: Outlining goals for the type of automation to be implemented. Developing a wish list of desired features and determining which one, given budgetary constraints, are practical. Investigating systems that are presently available. Analyzing the current workflow and determining what changes are needed. Identifying the required capabilities and configuration of the new system. Sell the benefits and objectives of automation to staff. Development of an implementation plan.