Introduction
Due to the numerous steps in required in the care of the healthcare industry is an inherently error-prone process that is fraught with for mistakes to occur. This concept was confirmed in the oft-quoted 1999 Institute of Medicine (IOM) report, To Err is Human: Building a safer Health.
Technology and Healthcare
The majorities of technology acquisitions have consisted of basic stand-alone computer systems, which were primarily used for data input or increase each department’s efficiency with financial accountability measures.
These computers were generally installed in the pharmacy, radiology, and laboratory departments and could also be found in the administration and business offices.
Computerized Prescriber Order Entry (CPOE)
Studies have shown that as a result of poor handwriting, 50% of all written physician orders require extra time to interpret. Sixteen percent of physician has illegible hand writing.
Illegible handwriting on medication orders has been shown to be a common cause of prescribing errors and patient injury and death have actually resulted from such errors.
— The use of CPOE system has the potential to alleviate many of these problems. CPOE can 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 by electronically to the appropriate department.
Influences on the Adoption of Technology
Consumers have become increasingly concerned that hospitals are less than safe following the numerous mass media reporting of medical mistakes, which have resulted in patient harm and deaths.
In 1995, there were television and newspaper accounts that reported the tragic death of patient from a preventable adverse drug event (ADE) due to an inadvertent administration of a massive over dose of a chemotherapy agent over 4 days.
According to a 1992 American Medical Association report, medication errors related to the misinterpretation of physician’s prescriptions were the second most prevalent and expensive claim listed on malpractice cases filed over a 7-year period on 1992.
Other potential enhancements that even a basic CPOE system could offer to further enhance safe medications ordering practices including features unique to the acute-care setting, ambulatory care setting or both:
v Allow for prescribers to access records and enter orders from their office or home
v Prescribers selectable standardized single orders or order set.
v Implementations of organizations-specific standing orders based on specific situations such as before or after procedures
v Passive feedback systems that present patient-specific data in an organized fashion such as test results, charges, materials, and progress notes, or active feedback systems.
Bar Code-Enabled Point -of- Care Technology
For more than 20 yrs. bar code technology has clearly demonstrated its power to greatly improve productivity and accuracy in the identification of products in a variety of business settings, such as super markets and department stores.
One study noted five significant negative effects that occurred during the implementation of a BPOC system:
Ø Nurses were sometimes caught “off guard” by the programmed automated actions taken by the BPOC software.
Ø The BPOC seemed to inhibit the coordination of patient information between prescribes and nurses when compared to a traditional paper-based system.
Ø Nurses found it more difficult to deviate from the routine medication administration sequence with the BPOC system.
Ø Nurses felt that their main priority was the timeliness of medication administration because BPOC required nurses to type in an explanation when medications were given even a few minutes late.
Ø Nurses used strategies to efficiency that circumvented the intended use of BPOC.
NEW TYPES OF MEDICATION ERRORS
v Omissions: After the patient’s bar code armband and medication have been scanned, the dose is inadvertently dropped onto the floor.
v Extra dose: May be given when there are orders for the same drug to be administered by a different route.
v Wrong drug: In situations when the nurse administers a medication, which has not been labeled with a bar code.
v Wrong dose: In situations when the nurse has difficulty in scanning medication and proceeds to scan the medication twice.
v Unauthorized drug: An order to hold a medication unless a lab value is at a certain level such us an amino glycoside.
v Charting errors: Distinguish the indication for the administration of the medication.
v Wrong dosage form: Certain drug shortages may force a pharmacy to dispense a different strength or concentration other than what is entered in the BPOC software.
Automated Dispensing Cabinets
The ADC is a computerized point-of-use medication-management system that is designed to replace or support the traditional unit-dose drug delivery system. Many healthcare facilities have replaced medication carts or open unit-stock systems with ADCs.
The rationales behind the wide acceptance of this technology are the ff.:
q Improving pharmacy productivity: reduced number of steps from filling each patient’s individual medication bins to filling a centralized station.
q Improving nursing productivity: The time spent gathering or obtaining missing medications can be reduced.
q Reducing costs: Increased pharmacist and nursing productivity, which frees them from time consuming processes and allowing more time for patient and clinical interactions.
q Improving charge capture: ADCs that are interfaced with the accounting department allow for the capture of all patient charges associated with administered medications.
q Enhancing patient quality and safety: ADCs that have built-in decision support systems that warn users on drug-drug interactions, drug-allergy interactions.
Examples of High-Alert Medications Stored in Automated Dispensing Cabinets
Class/Category of medications:
Ø Adrenergic agonist, IV(e.g., epinephrine)
Ø Adrenergic antagonists, (e.g., propranolol)
Ø Anesthetic agents, general, inhaled, and IV(e.g., propofol)
Ø Hypoglycemic, oral
Ø Radio contrast agents, IV
Specific medications:
q IV amiodarone
q Colchicine injection
q Heparin, low molecular weight, injection
q Insulin, subcutaneous, and IV
q Magnesium sulfate injection
"Smart" Infusion Pump Delivery System
Infusion pumps with dose calculation software, sometimes referred to as “smart pumps”, could reduce medication errors, improve workflow, and provide a new source of data for continuous quality improvement by identifying and correcting pump-programming errors.
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