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Sloss EA, Jones TL, Baker K, Robins JLW, Thacker LR. Factors Influencing Medication Administration Outcomes Among New Graduate Nurses Using Bar Code-Assisted Medication Administration. Comput Inform Nurs 2024; 42:199-206. [PMID: 38206171 PMCID: PMC10925919 DOI: 10.1097/cin.0000000000001083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Paramount to patient safety is the ability for nurses to make clinical decisions free from human error. Yet, the dynamic clinical environment in which nurses work is characterized by uncertainty, urgency, and high consequence, necessitating that nurses make quick and critical decisions. The aim of this study was to examine the influence of human and environmental factors on the decision to administer among new graduate nurses in response to alert generation during bar code-assisted medication administration. The design for this study was a descriptive, longitudinal, observational cohort design using EHR audit log and administrative data. The study was set at a large, urban medical center in the United States and included 132 new graduate nurses who worked on adult, inpatient units. Research variables included human and environmental factors. Data analysis included descriptive and inferential analyses. This study found that participants continued with administration of a medication in 90.75% of alert encounters. When considering the response to an alert, residency cohort, alert category, and previous exposure variables were associated with the decision to proceed with administration. It is important to continue to study factors that influence nurses' decision-making, particularly during the process of medication administration, to improve patient safety and outcomes.
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Affiliation(s)
- Elizabeth A Sloss
- Author Affiliation: School of Nursing, Virginia Commonwealth University (Dr Sloss), Richmond; College of Nursing, University of Utah (Dr Sloss), Salt Lake City; Department of Adult Health and Nursing Systems, School of Nursing, Virginia Commonwealth University (Dr Jones and Robins), Richmond, Virginia; UVA Health (Dr Baker), Charlottesville, Virginia; and Department of Biostatistics, School of Medicine, Virginia Commonwealth University (Dr Thacker)
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Sloss EA, Jones TL, Baker K, Robins JLW, Thacker LR. Describing Medication Administration and Alert Patterns Experienced by New Graduate Nurses During the First Year of Practice. Comput Inform Nurs 2024; 42:94-103. [PMID: 38062552 DOI: 10.1097/cin.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
The aim of this study was to describe medication administration and alert patterns among a cohort of new graduate nurses over the first year of practice. Medical errors related to clinical decision-making, including medication administration errors, may occur more frequently among new graduate nurses. To better understand nursing workflow and documentation workload in today's clinical environment, it is important to understand patterns of medication administration and alert generation during barcode-assisted medication administration. Study objectives were addressed through a descriptive, longitudinal, observational cohort design using secondary data analysis. Set in a large, urban medical center in the United States, the study sample included 132 new graduate nurses who worked on adult, inpatient units and administered medication using barcode-assisted medication administration. Data were collected through electronic health record and administration sources. New graduate nurses in the sample experienced a total of 587 879 alert and medication administration encounters, administering 772 unique medications to 17 388 unique patients. Nurses experienced an average medication workload of 28.09 medications per shift, 3.98% of which were associated with alerts, over their first year of practice. In addition to high volume of medication administration, new graduate nurses administer many different types of medications and are exposed to numerous alerts while using barcode-assisted medication administration.
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Affiliation(s)
- Elizabeth Ann Sloss
- Author Affiliations : School of Nursing, Department of Adult Health and Nursing Systems (Drs Jones and Robins), School of Nursing (Dr Sloss), and Department of Biostatistics, School of Medicine (Dr Thacker), Virginia Commonwealth University; and UVA Health (Dr Baker), Richmond; and College of Nursing, University of Utah, Salt Lake City (Dr Sloss)
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Pruitt ZM, Kazi S, Weir C, Taft T, Busog DN, Ratwani R, Hettinger AZ. A Systematic Review of Quantitative Methods for Evaluating Electronic Medication Administration Record and Bar-Coded Medication Administration Usability. Appl Clin Inform 2023; 14:185-198. [PMID: 36889339 PMCID: PMC9995218 DOI: 10.1055/s-0043-1761435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/20/2022] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Although electronic medication administration records (eMARs) and bar-coded medication administration (BCMA) have improved medication safety, poor usability of these technologies can increase patient safety risks. OBJECTIVES The objective of our systematic review was to identify the impact of eMAR and BCMA design on usability, operationalized as efficiency, effectiveness, and satisfaction. METHODS We retrieved peer-reviewed journal articles on BCMA and eMAR quantitative usability measures from PsycInfo and MEDLINE (1946-August 20, 2019), and EMBASE (1976-October 23, 2019). Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we screened articles, extracted and categorized data into the usability categories of effectiveness, efficiency, and satisfaction, and evaluated article quality. RESULTS We identified 1,922 articles and extracted data from 41 articles. Twenty-four articles (58.5%) investigated BCMA only, 10 (24.4%) eMAR only, and seven (17.1%) both BCMA and eMAR. Twenty-four articles (58.5%) measured effectiveness, 8 (19.5%) efficiency, and 17 (41.5%) satisfaction. Study designs included randomized controlled trial (n = 1; 2.4%), interrupted time series (n = 1; 2.4%), pretest/posttest (n = 21; 51.2%), posttest only (n = 14; 34.1%), and pretest/posttest and posttest only for different dependent variables (n = 4; 9.8%). Data collection occurred through observations (n = 19, 46.3%), surveys (n = 17, 41.5%), patient safety event reports (n = 9, 22.0%), surveillance (n = 6, 14.6%), and audits (n = 3, 7.3%). CONCLUSION Of the 100 measures across the 41 articles, implementing BCMA and/or eMAR broadly resulted in an increase in measures of effectiveness (n = 23, 52.3%) and satisfaction (n = 28, 62.2%) compared to measures of efficiency (n = 3, 27.3%). Future research should focus on eMAR efficiency measures, utilize rigorous study designs, and generate specific design requirements.
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Affiliation(s)
- Zoe M. Pruitt
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
| | - Sadaf Kazi
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, District of Columbia, United States
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States
| | - Teresa Taft
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States
| | - Deanna-Nicole Busog
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
| | - Raj Ratwani
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, District of Columbia, United States
| | - Aaron Z. Hettinger
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, District of Columbia, United States
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Alert Types and Frequencies During Bar Code-Assisted Medication Administration: A Systematic Review. J Nurs Care Qual 2020; 35:265-269. [PMID: 32433151 DOI: 10.1097/ncq.0000000000000446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Existing literature explores the effectiveness of bar code-assisted medication administration (BCMA) on the reduction of medication administration error as well as on nurse workarounds during BCMA. However, there is no review that comprehensively explores types and frequencies of alerts generated by nurses during BCMA. PURPOSE The purpose was to describe alert generation type and frequency during BCMA. METHODS A systematic review of the literature using PRISMA guidelines was conducted using CINAHL, PubMed, EMBASE, and Ovid Medline databases. RESULTS After screening for inclusion and exclusion criteria, a total of 8 articles were identified and included in the review. Alert types included patient mismatch, wrong medication, and wrong dose, though other alert types were also reported. The frequency of alert generation varied across studies, from 0.18% to 42%, and not all alerts were clinically meaningful. CONCLUSIONS This systematic review synthesized literature related to alert type and frequency during BCMA. However, further studies are needed to better describe alert generation patterns as well as factors that influence alert generation.
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Corbett BM, O'Connell C, Boutin MA, Fatayerji NI, Sauer CW. Inadvertent Methylergonovine Administration to a Neonate. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:770-773. [PMID: 27765939 PMCID: PMC5077293 DOI: 10.12659/ajcr.900263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, Newborn Final Diagnosis: Accidental methylergonovine poisoning Symptoms: Respiratory distress Medication: — Clinical Procedure: — Specialty: Pediatrics and Neonatology
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Affiliation(s)
- Bryan M Corbett
- Department of Emergency Medicine, University of California, San Diego, CA, USA
| | - Charles O'Connell
- Department of Emergency Medicine, University of California, San Diego, CA, USA
| | - Mallory A Boutin
- Department of Pediatrics, University of California, San Diego, CA, USA
| | - Nabil I Fatayerji
- Department of Pediatrics, University of California, San Diego, CA, USA
| | - Charles W Sauer
- Department of Pediatrics, University of California, San Diego, CA, USA
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Truitt E, Thompson R, Blazey-Martin D, NiSai D, Salem D. Effect of the Implementation of Barcode Technology and an Electronic Medication Administration Record on Adverse Drug Events. Hosp Pharm 2016; 51:474-83. [PMID: 27354749 DOI: 10.1310/hpj5106-474] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hospitals have attempted to reduce adverse drug events (ADEs) by investing in new technologies, but data regarding their efficacy are lacking. OBJECTIVES This study evaluates the effects of the implementation of barcode medication administration (BCMA) and electronic medication administration record (eMAR) technology on the profile of ADEs in a hospital setting. METHODS We conducted a before-and-after study examining the effects of the implementation of BCMA and eMAR technology on the profile of ADEs at a 400-bed academic medical center by using incident reports. We compared reported ADEs in pre- and post-implementation periods of 5 months to determine whether there was a reduction in the rate of ADEs within medication use phases. We further examined the severity of errors and described changes in the distribution of types of errors. RESULTS A total of 775 electronic error-reporting system reports were included in this study: 397 (51%) in the pre-implementation period and 378 (49%) in the post-implementation period. The rate of ADEs significantly decreased from 0.26% to 0.20% after implementation of the technology (relative risk [RR], 0.78; 95% CI, 0.67-0.89). The rate of transcription errors decreased from 0.089% to 0.036% (RR, 0.40; 95% CI, 0.30-0.54), which was largely attributed to reduction of "wrong time" errors. The rate of administration errors was identical in both groups at 0.017% (RR, 0.98; 95% CI 0.58-1.66). The mean severity level of administration errors significantly decreased from 4.44 to 3.23 (p = .005). CONCLUSION The implementation of eMAR and BCMA technology improved patient safety by decreasing the overall rate of ADEs and the rate of transcription errors. These technologies also reduced the harmful impact to patients caused by administration errors.
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Khammarnia M, Kassani A, Eslahi M. The Efficacy of Patients' Wristband Bar-code on Prevention of Medical Errors: A Meta-analysis Study. Appl Clin Inform 2015; 6:716-27. [PMID: 26767066 DOI: 10.4338/aci-2015-06-r-0077] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 10/06/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Patient misidentification, as a major patient safety issue, occurs in any healthcare setting and leads to inappropriate medical procedures, diagnosis or treatment, with serious outcomes. OBJECTIVES The study aimed to investigate the effectiveness of wristband bar-code medication scanning to reduce medical errors (ME). METHODS A meta-analysis study was conducted. The relevant studies were searched in PubMed, Embase, Cochrane Library, Web of Science and Scopus from 1990 to March 2015. Thereafter, the studies retrieved were screened based on predefined inclusion and exclusion criteria. Data were extracted, and the quality of the included studies was evaluated using the STROBE checklist. RESULTS In total, 14 articles involving 483 cases were included. The meta-analysis indicated that the use of wristband bar-code medication scanning can reduce the ME around 57.5% (OR=0.425, 95% CI: 0.28-0.65, P<0.001). The study results showed a marked heterogeneity in the subgroup analysis (I-squared=98%). This was I(2)=70.35, P-value=0.018 for the type of samples and I(2)=99%, P-value<0.001 for years and countries. CONCLUSION Wristband bar-code medication scanning can decrease the ME in hospital setting. Since the patient's safety is the main goal of the World Health Organization, it is recommended that a unique patient identification barcode should be used with name, medical record number, and bar-coded financial number.
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Affiliation(s)
- M Khammarnia
- Health Promotion Research Center, Zahedan University of Medical Sciences , Zahedan, Iran
| | - A Kassani
- Prevention of Psychosocial Injuries Research Center, Ilam University of Medical Sciences , Ilam, Iran
| | - M Eslahi
- Student Research Committee, Shiraz University of Medical Sciences , Shiraz, Iran
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Abstract
OBJECTIVE Safety advocates have identified barcode verification technology as an important tool to improve health-care practices. METHODS We evaluated the evidence for the role of barcode technology in improving a wide range of medication safety outcomes across a broad range of settings. Important implementation issues were highlighted to guide standards for the safe adoption of barcode technology. RESULTS Adverse drug events are common, occurring frequently in both inpatient and outpatient settings. Although approximately half of all preventable adverse drug events in inpatients result from medication errors arising from transcription, dispensing, and administration, these errors are far less likely to be caught than in any of the earlier stages of the medication use process and are therefore most amenable to improvement. When integrated with electronic medication administration records, barcode systems are associated with complete elimination of transcription errors. Furthermore, barcode-assisted dispensing systems are associated with 93% to 96% reductions in dispensing errors, and 85% reductions in potential adverse drug events in dispensing. Most studies have reported large and significant reductions in administration errors by up to 80% after implementation of barcode medication administration systems. Although most studies of barcode technology have been conducted in the adult inpatient setting, the limited data available also support their benefit in pediatric and outpatient settings. CONCLUSIONS There is growing evidence for the efficacy of barcode solutions in improving overall medication safety. Standards for the implementation of barcode technology are proposed.
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Bach DS, Risko KR, Zaran FK, Farber MS, Polk GJ. A Pharmacy Blueprint for Electronic Medical Record Implementation Success. Hosp Pharm 2015; 50:484-95. [PMID: 26405340 PMCID: PMC4568109 DOI: 10.1310/hpj5006-484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Implementation of an integrated, electronic medical record (EMR) has been promoted as a means of improving patient safety and quality. While there are a few reports of such processes that incorporate computerized prescriber order entry, pharmacy verification, an electronic medication administration record (eMAR), point-of-care barcode scanning, and clinical decision support, there are no published reports on how a pharmacy department can best participate in implementing such a process across a multihospital health care system. METHOD This article relates the experience of the design, build, deployment, and maintenance of an integrated EMR solution from the pharmacy perspective. It describes a 9-month planning and build phase and the subsequent rollout at 8 hospitals over the following 13 months. RESULTS Key components to success are identified, as well as a set of guiding principles that proved invaluable in decision making and dispute resolution. Labor/personnel requirements for the various stages of the process are discussed, as are issues involving medication workflow analysis, drug database considerations, the development of clinical order sets, and incorporation of bar-code scanning of medications. Recommended implementation and maintenance strategies are presented, and the impact of EMR implementation on the pharmacy practice model and revenue analysis are examined. CONCLUSION Adherence to the principles and practices outlined in this article can assist pharmacy administrators and clinicians during all medication-related phases of the development, implementation, and maintenance of an EMR solution. Furthermore, review and incorporation of some or all of practices presented may help ease the process and ensure its success.
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Affiliation(s)
- David S. Bach
- Corporate Vice President, Pharmacy Services, Detroit Medical Center, Detroit, Michigan
- Associate Professor, Pharmacy Practice, Eugene Applebaum College of Pharmacy and Allied Health Sciences, Wayne State University, Detroit, Michigan
| | - Kenneth R. Risko
- Director, Pharmacy Informatics, Department of Pharmacy Services, Detroit Medical Center, Detroit, Michigan
| | - Frank K. Zaran
- Clinical Pharmacist Specialist, Drug Information Department of Pharmacy Services, Detroit Receiving Hospital and University Health Center, Detroit, Michigan
| | - Margo S. Farber
- Director, Drug Information/Drug Use Policy, Department of Pharmacy Services, Detroit Medical Center, Detroit, Michigan
| | - Gregory J. Polk
- Director, Pharmacy Services, Department of Pharmacy Services, Harper University Hospital/Hutzel Women’s Hospital/Rehabilitation Institute of Michigan, Detroit, Michigan
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Patient safety and technology-driven medication – A qualitative study on how graduate nursing students navigate through complex medication administration. Nurse Educ Pract 2015; 15:203-11. [DOI: 10.1016/j.nepr.2014.11.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 11/15/2014] [Accepted: 11/19/2014] [Indexed: 11/17/2022]
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Applying bar code medication administration to make a difference in adverse drug events with potential for harm: lessons learned. Comput Inform Nurs 2013; 31:457-62. [PMID: 24135882 DOI: 10.1097/cin.0000000000000020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gerhart D, O'Shea K, Muller S. Advancing medication infusion safety through the clinical integration of technology. Hosp Pract (1995) 2013; 41:7-14. [PMID: 24145584 DOI: 10.3810/hp.2013.10.1075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Adverse drug events resulting from errors in prescribing or administering medications are preventable. Within a hospital system, numerous technologies are employed to address the common sources of medication error, including the use of electronic medical records, physician order entry, smart infusion pumps, and barcode medication administration systems. Infusion safety is inherently risky because of the high-risk medications administered and the lack of integration among the stand-alone systems in most institutions. Intravenous clinical integration (IVCI) is a technology that connects electronic medical records, physician order entry, smart infusion pumps, and barcode medication administration systems. It combines the safety features of an automatically programmed infusion pump (drug, concentration, infusion rate, and patient weight, all auto-programmed into the device) with software that provides visibility to real-time clinical infusion data. Our article describes the characteristics of IVCI at WellSpan Health and its impact on patient safety. The integrated infusion system has the capability of reducing medication errors, improving patient care, reducing in-facility costs, and supporting asset management. It can enhance continuous quality improvement efforts and efficiency of clinical work flow. After implementing IVCI, the institution realized a safer patient environment and a more streamlined work flow for pharmacy and nursing.
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Affiliation(s)
- Donald Gerhart
- Medication Safety Officer and Pharmacy Quality Assessment Manager, WellSpan Health, York, PA.
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Novak LL, Holden RJ, Anders SH, Hong JY, Karsh BT. Using a sociotechnical framework to understand adaptations in health IT implementation. Int J Med Inform 2013; 82:e331-44. [PMID: 23562140 DOI: 10.1016/j.ijmedinf.2013.01.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 01/18/2013] [Accepted: 01/21/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE When barcode medication administration (BCMA) is implemented nurses are required to integrate not only a new set of procedures or artifacts into everyday work, but also an orientation to medication safety itself that is sometimes at odds with their own. This paper describes how the nurses' orientation (the Practice Frame) can collide with the orientation that is represented by the technology and its implementation (the System Frame), resulting in adaptations at the individual and organization levels. METHODS The paper draws on two qualitative research studies that examined the implementation of BCMA in inpatient settings using observation and ethnographic fieldwork, content analysis of email communications, and interviews with healthcare professionals. RESULTS Two frames of reference are described: the System Frame and the Practice Frame. We found collisions of these frames that prompted adaptations at the individual and organization levels. The System Frame was less integrated and flexible than the Practice Frame, less able to account for all of the dimensions of everyday patient care to which medication administration is tied. CONCLUSION Collisions in frames during implementation of new technology result in adaptations at the individual and organization level that can have a variety of effects. We found adaptations to be a means of evolving both the work routines and the technology. Understanding the frames of clinical workers when new technology is being designed and implemented can inform changes to technology or organizational structure and policy that can preclude unproductive or unsafe adaptations.
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Affiliation(s)
- Laurie Lovett Novak
- Department of Biomedical Informatics, Implementation Sciences Laboratory, Center for Research and Innovation in Systems Safety, Vanderbilt University School of Medicine, United States.
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FitzHenry F, Doran J, Lobo B, Sullivan TM, Potts A, Feldott CC, Matheny ME, McCulloch G, Deppen S, Doulis J. Medication-error alerts for warfarin orders detected by a bar-code-assisted medication administration system. Am J Health Syst Pharm 2011; 68:434-41. [PMID: 21330686 DOI: 10.2146/ajhp090666] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Medication-error alerts for warfarin orders detected by a bar-code-assisted medication administration (BCMA) system were evaluated. METHODS All patients receiving warfarin who were admitted to a university medical center between July 1, 2008, and February 6, 2009, in inpatient units with BCMA systems were candidates for inclusion in this study. Medication-error alerts displayed to the nurse administering the warfarin were reviewed to determine whether a true potential error was detected. Each alert was converted to a scenario, and its potential to require treatment or cause patient harm was rated using a validated severity scale of 0-10, where a score of 0 indicated no probable effect on the patient and 10 indicated that the error would likely result in patient death. A severity score was obtained by averaging the scores of four pharmacist reviewers. RESULTS Of the 18,393 warfarin doses ordered during the study period for 2,404 patients, error alerts associated with only 99 warfarin doses were found to be clinically meaningful. The mean ± S.D. severity rating of these alerts was low (2.93 ± 1.42), with a standardized Cronbach's coefficient alpha of 0.845. The mean ± S.D. warfarin dose attempted when the nurse received an alert was 4.10 ± 2.48 mg. The majority of doses with alerts (70%) were for patients who had an active order for warfarin. CONCLUSION Of the large number of medication-error alerts generated through a BCMA system, only a small proportion were considered clinically significant. This indicated that the rate of false-positive alerts was unexpectedly high, increasing the risk of alert fatigue.
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Affiliation(s)
- Fern FitzHenry
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37212, USA.
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Scanning for safety: an integrated approach to improved bar-code medication administration. Comput Inform Nurs 2011; 29:TC45-52. [PMID: 21562381 DOI: 10.1097/ncn.0b013e31821ef6c8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This is a review of lessons learned in the postimplementation evaluation of a bar-code medication administration technology implemented at a major tertiary-care hospital in 2001. In 2006, with a bar-code medication administration scan compliance rate of 82%, a near-miss sentinel event prompted review of this technology as part of an institutional recommitment to a "culture of safety." Multifaceted problems with bar-code medication administration created an environment of circumventing safeguards as demonstrated by an increase in manual overrides to ensure timely medication administration. A multiprofessional team composed of nursing, pharmacy, human resources, quality, and technical services formalized. Each step in the bar-code medication administration process was reviewed. Technology, process, and educational solutions were identified and implemented systematically. Overall compliance with bar-code medication administration rose from 82% to 97%, which resulted in a calculated cost avoidance of more than $2.8 million during this time frame of the project.
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Wulff K, Cummings GG, Marck P, Yurtseven O. Medication administration technologies and patient safety: a mixed-method systematic review. J Adv Nurs 2011; 67:2080-95. [DOI: 10.1111/j.1365-2648.2011.05676.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wakefield DS, Ward MM, Loes JL, O'Brien J. A network collaboration implementing technology to improve medication dispensing and administration in critical access hospitals. J Am Med Inform Assoc 2010; 17:584-7. [PMID: 20819868 DOI: 10.1136/jamia.2010.004267] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report how seven independent critical access hospitals collaborated with a rural referral hospital to standardize workflow policies and procedures while jointly implementing the same health information technologies (HITs) to enhance medication care processes. The study hospitals implemented the same electronic health record, computerized provider order entry, pharmacy information systems, automated dispensing cabinets (ADC), and barcode medication administration systems. We conducted interviews and examined project documents to explore factors underlying the successful implementation of ADC and barcode medication administration across the network hospitals. These included a shared culture of collaboration; strategic sequencing of HIT component implementation; interface among HIT components; strategic placement of ADCs; disciplined use and sharing of workflow analyses linked with HIT applications; planning for workflow efficiencies; acquisition of adequate supply of HIT-related devices; and establishing metrics to monitor HIT use and outcomes.
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Affiliation(s)
- Douglas S Wakefield
- Department of Health Management and Informatics, and the MU Informatics Institute, University of Missouri, Columbia, MO, USA.
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Effects of BCMA on Clinicians' Communication, Coordination and Cooperation. ACTA ACUST UNITED AC 2010. [DOI: 10.1201/ebk1439834978-c59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Helmons PJ, Wargel LN, Daniels CE. Effect of bar-code-assisted medication administration on medication administration errors and accuracy in multiple patient care areas. Am J Health Syst Pharm 2009; 66:1202-10. [PMID: 19535659 DOI: 10.2146/ajhp080357] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The effect of a commercially available bar-code-assisted medication administration (BCMA) technology on six indicators of medication administration accuracy and nine types of medication administration errors in distinct patient care areas were studied. METHODS This prospective, before-and-after, observational study was conducted in two medical-surgical units, one medical intensive care unit (ICU), and one surgical ICU of a 386-bed academic teaching hospital. Nursing staff were observed administering medications one month before and three months after implementation of BCMA technology. Observations were conducted by two pharmacists and four pharmacy students on weekdays and weekends. Medication administration accuracy was measured using the accuracy indicator of the California Nursing Outcomes Coalition. RESULTS The majority of medication administrations occurred during the 9 a.m. medication round. After BCMA implementation in the medical-surgical units, improved adherence to patient identification policies was observed, but more distractions of the nursing staff occurred and the medications administered were less frequently explained to the patient. Although an increase in wrong-time errors was observed in the medical-surgical units, the total number of medication errors did not change. When wrong-time errors were excluded, the rate of medication errors decreased by 58%. In the ICUs, the charting of medication administration improved after BCMA implementation, but total medication errors and wrong-time errors did not change. CONCLUSION Implementing BCMA technology decreased medication administration errors in medical-surgical units but not in ICUs when time errors were excluded. BCMA technology affected different types of medication administration errors in different patient care areas.
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Affiliation(s)
- Pieter J Helmons
- UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, La Jolla, CA, USA.
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22
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Smith AD, Offodile OF. Data collection automation and total quality management: case studies in the health-service industry. Health Mark Q 2008; 25:217-40. [PMID: 19042545 DOI: 10.1080/07359680802081811] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The limitations, immeasurable, and seemly unquantifiable aspects of the healthcare service industry, make it imperative that quality assurance programs include total quality management (TQM) and automatic identification and data capture (AIDC)-related technologies. Most of standards used in TQM and AIDC require data, to measure improvement and achieve standardization. Major difference between managing a service firm and managing a product-manufacturing firm is the difficulty of achieving consistently high quality. Examination of two different healthcare service providers in the Pittsburgh, Pennsylvania area offers different views as to the implementation and practice of total quality management techniques and AIDC integration. Since the healthcare service industry must take into account its high customization needs, there are positive steps to make the hospital structure itself more patient friendly and quality related; hence improving its heath-marketing strategies to the general public.
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Affiliation(s)
- Alan D Smith
- Department of Management and Marketing, Robert Morris University, Pittsburgh, PA 15219-3099, USA.
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Abstract
US adoption of health information technology as a path to improved quality of patient care (effectiveness, safety, timeliness, patient-centeredness, efficiency, and equity) has been promoted by the medical community. Children and infants (especially those with special health care needs) are at higher risk than are adults for medical errors and their consequences (particularly in environments in which children are not the primary patient population). However, development and adoption of health information technology tools and practices that promote pediatric quality and patient safety are lagging. Two inpatient clinical processes-medication delivery and patient care transitions-are discussed in terms of health information technology applications that support them and functions that are important to pediatric quality and safety. Pediatricians and their partners (pediatric nurses, pharmacists, etc) must develop awareness of technical and adaptive issues in adopting these tools and collaborate with organizational leaders and developers as advocates for the best interests and safety of pediatric patients. Pediatric health information technology adoption cannot be considered in terms of applications (such as electronic health records or computerized physician order entry) alone but must be considered globally in terms of technical (health information technology applications), organizational (structures and workflows of care), and cultural (stakeholders) aspects of what is best.
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Sakowski J, Newman JM, Dozier K. Severity of medication administration errors detected by a bar-code medication administration system. Am J Health Syst Pharm 2008; 65:1661-6. [DOI: 10.2146/ajhp070634] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Julie Sakowski
- Sutter Health Institute for Research and Education, San Francisco, CA, and Assistant Clinical Professor, Department of Clinical Pharmacy, University of California San Francisco, San Francisco
| | - Jeffrey M. Newman
- Sutter Health Institute for Research and Education, and Adjunct Professor, Institute for Health and Aging, University of California San Francisco
| | - Krystin Dozier
- Clinical Effectiveness, Clinical Integration Department, Sutter Health Institute for Research and Education, Sacramento, CA
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van Onzenoort HA, van de Plas A, Kessels AG, Veldhorst-Janssen NM, van der Kuy PHM, Neef C. Factors influencing bar-code verification by nurses during medication administration in a Dutch hospital. Am J Health Syst Pharm 2008; 65:644-8. [DOI: 10.2146/ajhp070368] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | | | - Alfons G. Kessels
- Department of Clinical Epidemiology and Medical Technology Assessment
| | | | | | - Cees Neef
- Department of Clinical Pharmacy and Toxicology, University Hospital Maastricht
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Rickrode GA, Williams-Lowe ME, Rippe JL, Theriault RH. Internal reporting system to improve a pharmacy's medication distribution process. Am J Health Syst Pharm 2007; 64:1197-202. [PMID: 17519462 DOI: 10.2146/ajhp060166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The current pharmacy occurrence-reporting system in an institution was reviewed, and an internal procedure that would provide data to improve the medication-use process was developed. SUMMARY In a rural, 353-bed, tertiary care academic center, the effectiveness of a departmental occurrence-reporting system was determined over a nine-month period to increase occurrence reporting within the pharmacy and allow administrators to identify specific areas for improvement within the medication distribution process. These events were identified according to the number and type of near misses documented by pharmacy staff. The pharmacy staff was asked to complete a survey about the department's current reporting process and what the staff desired in a new occurrence-reporting system. The staff was also surveyed on which steps of the pharmacy's medication distribution process could contribute to the most errors. Initially, a paper-based error-reporting form was developed for all steps of the pharmacy distribution process except pharmacist order entry. Once the paper-based error-reporting form was introduced, the pharmacist order-entry phase of the project was begun. During the evaluation period, 203 pharmacy-dispensing errors were reported to the hospital's error-reporting system. In contrast, 1385 total pharmacy events were documented using the pharmacy's internal occurrence-reporting system. At least 204 of those reported events involved high-alert medications according to the institution's high-alert medications policy. CONCLUSION A pharmacy internal occurrence-reporting system increased staff reporting and identified areas for improvement within the medication distribution process that may not have been recorded by a hospital-based reporting system.
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Affiliation(s)
- Geoffrey A Rickrode
- Adult Critical Care, Department of Pharmacy, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
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Evaluation of Nurse Interaction With Bar Code Medication Administration Technology in the Work Environment. J Patient Saf 2007. [DOI: 10.1097/pts.0b013e3180319de7] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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