A safe practice standard for barcode technology

Barcode and radio frequency identification utilization varied across Korean hospitals

Barcodes and radio frequency identification (RFID) are increasingly used in health care to improve patient safety. However, studies on their utilization in clinical settings are limited. This study aimed to comprehensively examine the utilization status of barcodes and RFID in Korean hospitals, recognize the effects and obstacles associated with utilization, and explore the measures to expand the applications of barcodes and RFID. A self-reported online survey was conducted in tertiary hospitals, general hospitals, hospitals, and nursing hospitals in the Republic of Korea. The survey questionnaire comprised questions on barcodes and RFID utilization status, the effect of barcodes and RFID utilization, measures to expand the utilization of barcodes and RFID, and information on respondents' demographics and hospitals. A representative from each of 23 tertiary hospitals, 101 general hospitals, 232 hospitals, and 214 nursing hospitals completed the survey (total response rate 17%). The data were analysed using the chi-square test or Fisher's exact test to determine the differences in responses based on the type and characteristics of hospitals. The tertiary hospitals had the highest utilizations of both RFID and barcodes (n = 10, 43.5%), whereas the nursing hospitals had the lowest (n = 96, 55.1%). Barcodes and RFID were most commonly used in the visits and security management domains. However, the use of barcodes and RFID in medication dispensing and administration safety was low, despite its value in improving patient safety. The hospitals recognized the positive effect of utilization of barcodes and RFID, reporting the highest frequency for the prevention of patient safety incidents (n = 79, 85.9%). Nevertheless, the cost of barcodes and RFID facility investments (n = 128, 90.3%) appeared to be the greatest obstacle to the introduction of barcodes and RFID. Hence, barcodes and RFID facility investment support (n = 133, 95.5%) were given the highest priority among the measures to expand barcode and RFID utilization in health care. The utilization of barcodes and RFID varied across the type and domain of hospitals in the Republic of Korea. Hospitals recognized the positive effects of barcode and RFID utilization. Nonetheless, all hospitals were concerned about the cost of investment and maintenance of barcode and RFID facilities as the main obstacles to utilization. Therefore, a support plan must be developed for the cost of barcodes and RFID facility investments to expand barcode and RFID utilization in health care.

What to learn from analysis of medical disputes related to medication errors in nursing care

BACKGROUND

Nurses, who are the last safeguard against and have the final opportunity to prevent medication errors (MEs), play a vital role in patient safety by managing medications.

OBJECTIVE

This study described the characteristics of medical dispute cases, medication information, and stage and types of MEs in Korea.

METHODS

We performed a descriptive analysis of 27 medical dispute cases related to MEs in nursing care in Korea.

RESULTS

Around 77.7% of patients suffered serious harm or died due to MEs in this study. The types of medications included anxiolytics and analgesics, and 51.9% of them were high-alert medications. Among cases of administration errors, failure to patient assessment before and after administration was the most common error followed by administering the wrong dose.

CONCLUSION

Nurses should perform their duties to ensure safety and improve the quality of nursing care by monitoring patients after administering medications and should be prepared to take quick action to reduce harm.

Towards Safe Patient Identification Practices: the Development of a Conceptual Framework from the Findings of a Ph.D. Project

Patient identification errors are considered the root cause of other patient safety incidents. Despite the development, recommendation, and application of several initiatives to reduce and prevent misidentification in hospital settings, errors continue to occur. They directly impact the quality of care provided, resulting in delays in care, added costs, unnecessary injuries, misdiagnosis or wrong treatment, and other serious and irreversible types of harm and death. Furthermore, the certainty of the evidence of the effectiveness of interventions to reduce patient identification errors is considered very low.

This paper reports on the development of a conceptual framework for safe practices in the area of patient identification. The proposed conceptual framework was developed based on presuppositions regarding learning health systems and the available evidence from the published systematic reviews of the effectiveness of interventions in reducing patient identification errors in hospital settings. The core circle of the framework represents the partnership between managers, healthcare professionals, patients, and families working toward integrative and collaborative efforts for safe patient identification practices. The inner dimension states the recommendations for practice sustained by applying technological resources and educational strategies to raise awareness of the importance of accurate patient identification and interdisciplinarity, which works as an axis that supports integrated and collective work between healthcare professionals aiming for safe care. The outer dimension represents recommendations for teaching and research to develop effective patient identification practices that can enhance patient safety and the quality of care provided in hospital settings.

This framework provides a valuable method for engaging interdisciplinary teams to improve the safety of patient identification systems.

Patient safety as a global health priority

Patient safety is a discipline that has arisen in response to the increasing complexity of health care delivery and the associated increase in patient harm. Adverse health care events are a serious problem, causing significant harm to the patient and increasing health care costs. The World Health Organization has identified patient safety as one of the key priorities for world health. The current review presents the historical background that led to the formation of the discipline of patient safety, the determinants of adverse events in medical practice, and the main tools for dealing with them.

Formulary management guiding principles for automated systems

DISCLAIMER

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE

Structural and financial changes in US healthcare are the driving forces reshaping care delivery and the technologies that clinicians use in their practice. Structural-level changes in healthcare organizations bringing facilities varying in size, systems, and complexity under the new integrated care delivery networks create unprecedented challenges. This paper develops guiding principles for formulary management in automated systems that facilitate medication management and alignment of medication information technology (IT) solutions in healthcare organizations ranging in size from a single facility to very large enterprise/multifacility networks.

SUMMARY

This paper describes formulary management best practices for healthcare organizations as they follow crucial medication management processes: formulary item builds, urgent and nonformulary medication requests, and formulary item build testing and maintenance. As medication management practices are embedded in automated technologies that are similar yet nuanced, we pay special attention to practices and change control processes that maximize coordination among systems while preserving medication data integrity and reducing medication errors.

CONCLUSION

For increasingly complex healthcare systems with multiple medication management system demands, formulary drug database builds and maintenance are challenging and time-consuming. Formulary item build, testing, and maintenance processes involve multifunctional teams collaborating to ensure the integrity of data, prevent unexpected system incompatibilities, and improve patient safety by reducing medication errors. Ideally, formulary item build, testing, and maintenance processes produce consistent final drug records in IT systems meeting user needs.

Interdisciplinary and Innovative: A Nursing and Computer Science Collaboration to Create a Barcode Medication Administration System

ABSTRACT

Preventing medication errors remains a priority in nursing education. The implementation of Barcode Medication Administration (BCMA) systems is one strategy that has been used to reduce medication errors. Practice using BCMA in simulated settings may enhance the transfer of these skills to the clinical practice setting. However, the purchase of BCMA educational products available for nursing students can be cost prohibitive for many nursing programs. To overcome the barrier of cost, an interdisciplinary and innovative collaborative approach was used to create a fully functional low-cost BCMA system.

Effect of barcode technology on medication preparation safety: a quasi-experimental study

BACKGROUND

Medication errors are a common problem in hospitals and a major driver of adverse patient outcomes. Barcode verification technology is a promising strategy to help ensure safe medication preparation practices.

OBJECTIVES

The objectives of this study were (i) to assess the effects of a barcode-assisted medication preparation and administration system regarding the rate of medication preparation errors and (ii) to compare the time spent on medication preparation tasks by medical staff.

METHODS

A quasi-experimental study with a pre-post design was conducted, from August 2017 to July 2018, in two mixed medical/surgical units of a tertiary teaching hospital. The primary aim was to assess the effects of a barcode-based electronically assisted medication preparation and administration system linked to the hospital's electronic medication administration record regarding the rate of medication preparation errors and time-based staff performance. Data were collected using direct observation. Adjusted and unadjusted logistic models were used for error frequencies and linear regression models for time performance.

RESULTS

5932 instances of medication selection and dosing during 79 medication preparation procedures were observed. The overall medication preparation error incidence decreased from 9.9% at baseline to 4.5% at post-intervention, corresponding to a relative risk reduction of 54.5% (P < 0.001). However, the adjusted effect by registered nurses (RNs) and nurses' work experience of total medication preparation errors showed only borderline significance (odds ratio [OR] 0.64, P = 0.051). For adjusted error-specific analyses, significant error reductions were found in wrong medication errors (OR 0.38, P < 0.010) and wrong dosage errors (OR 0.12, P = 0.004). Wrong patient, wrong form and ambiguous dispenser errors did not occur at post-intervention. Errors of omission (OR 1.53, P = 0.17), additional doses (OR 0.63, P = 0.64) and wrong dispenser boxes (OR 0.51, P = 0.11) did not change significantly. The time necessary to prepare medications for a 24-h period also decreased significantly-from 30.2 min to 17.2 min (beta = -6.5, P = 0.047), while mean preparation time per individual medication dose fell from 24.3 s to 15.1 s (beta = -5.0, P = 0.002).

CONCLUSION

Use of the new barcode technology significantly reduced the rate of some medication preparation errors in our sample. Moreover, the time necessary for medication preparation, both per 24-h period and per single-medication dose, was significantly reduced.

Barcode medication administration technology use in hospital practice: a mixed-methods observational study of policy deviations

Introduction

Barcode medication administration (BCMA) can, if poorly implemented, cause disrupted workflow, increased workload and cause medication errors. Further exploration is needed of the causes of BCMA policy deviations.

Objective

To gain an insight into nurses’ use of barcode technology during medication dispensing and administration; to record the number and type of BCMA policy deviations, and to investigate their causes.

Methods

We conducted a prospective, mixed-methods study. Medication administration rounds on two hospital wards were observed using a digital tool and field notes. The SEIPS (Systems Engineering Initiative for Patient Safety) model was used to analyse the data.

Results

We observed 44 nurses administering 884 medications to 213 patients. We identified BCMA policy deviations for more than half of the observations; these related to the level of tasks, organisation, technology, environment and nurses. Task-related policy deviations occurred with 140 patients (66%) during dispensing and 152 patients (71%) during administration. Organisational deviations included failure to scan 29% of medications and 20% of patient’s wristbands. Policy deviations also arose due to technological factors (eg, low laptop battery, system freezing), as well as environmental factors (eg, medication room location, patient drawer size). Most deviations were caused by policies that interfere with proper and safe BCMA use and suboptimal technology design.

Conclusion

Our findings indicate that adaptations of the work system are needed, particularly in relation to policies and technology, to optimise the use of BCMA by nurses during medication dispensing and administration. These adaptations should lead to enhanced patient safety, as the absolute goal with BCMA implementation.

Nurses' Compliance With Bar-code Medication Administration Technology: Results of Direct Observation of Jordanian Nurses' Practice

Medication administration using bar-code medication administration technology enhances the verification of medication administration rights. Nurses' compliance with bar-code medication administration procedure is essential to maximize the benefits. This study evaluated the current rate of nurses' compliance with bar-code medication administration use through direct observation. A descriptive design was used and 134 RNs were recruited from two public hospitals located in the middle region of Jordan. Compliance with bar-code medication administration was evaluated using an evidence-based checklist of 17 items. Participants' compliance with the bar-code medication administration was 55%, which had a significant positive correlation with their level of comfort using bar-code medication administration, usefulness, and ease of use, perceived job productivity, and overall rating of bar-code medication administration. Stakeholders can benefit from assessing end-user acceptance and perceptions regarding the bar-code medication administration technology to promote acceptance and compliance.

The impact of health information technology on patient safety

Since the original Institute of Medicine (IOM) report was published there has been an accelerated development and adoption of health information technology with varying degrees of evidence about the impact of health information technology on patient safety.  This article is intended to review the current available scientific evidence on the impact of different health information technologies on improving patient safety outcomes. We conclude that health information technology improves patient's safety by reducing medication errors, reducing adverse drug reactions, and improving compliance to practice guidelines. There should be no doubt that health information technology is an important tool for improving healthcare quality and safety. Healthcare organizations need to be selective in which technology to invest in, as literature shows that some technologies have limited evidence in improving patient safety outcomes.

Experiences with Lean Six Sigma as improvement strategy to reduce parenteral medication administration errors and associated potential risk of harm

In this controlled before-after study the effect of improvements, derived from Lean Six Sigma strategy, on parenteral medication administration errors and the potential risk of harm was determined. During baseline measurement, on control versus intervention ward, at least one administration error occurred in 14 (74%) and 6 (46%) administrations with potential risk of harm in 6 (32%) and 1 (8%) administrations. Most administration errors with high potential risk of harm occurred in bolus injections: 8 (57%) versus 2 (67%) bolus injections were injected too fast with a potential risk of harm in 6 (43%) and 1 (33%) bolus injections on control and intervention ward. Implemented improvement strategies, based on major causes of too fast administration of bolus injections, were: Substitution of bolus injections by infusions, education, availability of administration information and drug round tabards. Post intervention, on the control ward in 76 (76%) administrations at least one error was made (RR 1.03; CI95:0.77-1.38), with a potential risk of harm in 14 (14%) administrations (RR 0.45; CI95:0.20-1.02). In 40 (68%) administrations on the intervention ward at least one error occurred (RR 1.47; CI95:0.80-2.71) but no administrations were associated with a potential risk of harm. A shift in wrong duration administration errors from bolus injections to infusions, with a reduction of potential risk of harm, seems to have occurred on the intervention ward. Although data are insufficient to prove an effect, Lean Six Sigma was experienced as a suitable strategy to select tailored improvements. Further studies are required to prove the effect of the strategy on parenteral medication administration errors.

Traceability and Quality Control in Traditional Chinese Medicine: From Chemical Fingerprint to Two-Dimensional Barcode

Chemical fingerprinting is currently a widely used tool that enables rapid and accurate quality evaluation of Traditional Chinese Medicine (TCM). However, chemical fingerprints are not amenable to information storage, recognition, and retrieval, which limit their use in Chinese medicine traceability. In this study, samples of three kinds of Chinese medicines were randomly selected and chemical fingerprints were then constructed by using high performance liquid chromatography. Based on chemical data, the process of converting the TCM chemical fingerprint into two-dimensional code is presented; preprocess and filtering algorithm are also proposed aiming at standardizing the large amount of original raw data. In order to know which type of two-dimensional code (2D) is suitable for storing data of chemical fingerprints, current popular types of 2D codes are analyzed and compared. Results show that QR Code is suitable for recording the TCM chemical fingerprint. The fingerprint information of TCM can be converted into data format that can be stored as 2D code for traceability and quality control.

Reducing medication errors in critical care: a multimodal approach

The Institute of Medicine has reported that medication errors are the single most common type of error in health care, representing 19% of all adverse events, while accounting for over 7,000 deaths annually. The frequency of medication errors in adult intensive care units can be as high as 947 per 1,000 patient-days, with a median of 105.9 per 1,000 patient-days. The formulation of drugs is a potential contributor to medication errors. Challenges related to drug formulation are specific to the various routes of medication administration, though errors associated with medication appearance and labeling occur among all drug formulations and routes of administration. Addressing these multifaceted challenges requires a multimodal approach. Changes in technology, training, systems, and safety culture are all strategies to potentially reduce medication errors related to drug formulation in the intensive care unit.