The Role of
Technology in
Medication-Use
Process
Nursing Informatics
Introduction:
 The
healthcare industry is an inherently
error-prone process that is fraught with
opportunities for mistakes to occur.
 Between 44,000 and 98,000 patients die
each year in the United States from
preventable error. These deaths were the
results of practitioner interactions with
“bad systems”.
Technology and Healthcare
 The
majority of technology acquisitions have
consisted of basic stand-alone computer
systems , which were primarily used for data
input to increase each department’s
efficiency with financial accountability
measures
 But even as improving technologies have
emerged allowing for seamless integration of
information to occur , most organizations
have shown little interests to incentive to incur
the huge cost associated with replacing their
nonintegrated computer system.
Influences on the Adoption of
Technology


According to a 1994 American Medical Association
report, medication errors related to the
misinterpretation of physicians’ prescription were the
second most prevalent and expensive claim listed
on malpractice cases filed over a 7-year period on
90,000 malpractice claims between 1985 and 1992.
In outpatient setting , indecipherable or unclear
orders resulted in more than 150 million telephone
calls from pharmacists and nurses to prescribers
requiring clarifications ,which not only is timeconsuming for practitioners, but estimated to cost
healthcare systems billions of dollars each year.
One of the first healthcare facilities to adopt
bar code technology was the inspiration of a
nurse at the Department of Veterans Affairs
(VA) in Topeka , Kansas. Her insight resulted in
a
-74 % improvement in errors caused by wrong
medication administration
-57% improvement in errors caused by incorrect
doses
-91% improvement in wrong patients errors
-92% improvement in time errors

Computer Prescriber Order Entry
(CPOE)
 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.
 Barriers
that lead to ineffective
communication of medication orders:
1.
illegible handwriting
-common cause of prescribing errors and patients
injury and death
1.
2.
3.
Use of dangerous abbreviations
Dose designations
Verbal and faxed orders

Potential enhancements that a basic CPOE system can offer:
 Ambulatory care setting or both
 Allow prescribers to access records and enter orders from
their office or home
 Prescriber selectable standardized single orders or order
sets
 Implementation of organization-specific standing orders
based on specific situations such as before or after the
procedures
 Menu-driven organization-specific lists of medications on
formulary
 Passive feedback systems that present patient-specific
data in an organized fashion such as test results, charges
,reference materials and progress notes or active
feedback systems to provide clinical decision-making tools
by providing specific assessments or recommendations
through alerts and reminders
Advantages of CPOE:






Increasing preventive health guidelines
compliance by exposing to prescribers to
reminder messages
Identifying patients needing updated
immunizations and vaccinations
Suggesting cancer screening
Improve drug prescribing and administration
Medication refill compliance
Drug dosing can be improve
 CPOE
would not only improve
patient safety but also increase,
efficiency, productivity, and cost
effectiveness.
Bar Code-Enabled Point-of-Care
Technology




38% of medication errors occur during the drug
administration process
Medication administration error occurred in almost
20% of doses of medications administered.
One form of technology that will have a great
impact on medication safety during the
administration process BPOC technology.
Bar code technology improve productivity and
accuracy in the identification of products in variety
of business settings ,such as supermarkets and
department stores.
 Yet,
organizations in health industry embraced it.
 The reasons for these few numbers



Cost of implementation
Inadequate systems
Lack of number of medications that are package with
bar codes
 The
system helps to verify that the right drug is being
administered to the right patient at the right dose
by the right route and at the right time.
 On admission, patients are issued an individualized
bar code wristband that uniquely identifies their
identity.
 When a patient is to receive a medication, nurses
scans their bar coded wristband to confirm their
identity.
Additional levels of functionality can include some of the
following features:






Increased accountability and capture of charges for items
such unit-stock medications
Up-to-date drug reference information from online
medication reference libraries.
Customizable comments and alerts and reminders of
important clinical actions need to be taken
Monitoring the pharmacy and the nurse’s response to
predetermined rules or standards in the rules engine such as
alerts or reminders for the pharmacists and nurse
Reconciliation for the pending or STAT orders.
Capturing data for the purpose of retrospective analysis of
aggregate data to monitor trends.

Negative effects include:
1. Nurses were sometimes caught “off guard” by
the actions taken by the BPOC software.
2. Nurses found it more difficult to deviate from
the routine medication administration
sequence with the BPOC system.
3. Nurses felt that their main priority was the
timeliness of medication administration
4. Nurses used strategies to increase efficiency
that circumvented the intended use of BPOC.
Errors that had occurred:
1.
2.
3.
4.
5.
6.
7.
Omission
Extra dose
Wrong drug
Wrong dose
Unauthorized drug
Charting errors
Wrong dosage form
Bar Code-Enabled Point-ofCare Technology
Automated dispensing
Cabinets
 Is
a computerized point-of-use
medication-management system that is
designed to replace or support the
traditional unit-dose drug delivery system.
Automated Dispensing Cabinets
The 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
Some documented unsafe practices
with the use of these devices:
1.
2.
3.
4.
5.
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 ADC’s are problematic.
Storage of medications with look-alike
names and/or packaging
The development of “workarounds”
“Smart” Infusion Pump Delivery
Systems
 Infusion
pumps are primarily used to
deliver parenteral medications through IV
or epidural lines and can be found in a
variety of clinical settings ranging from
acute-care and long-term care facilities,
patient’s homes, and physician’s offices.
 Incidents
involving infusion pumps typically result
from the unintentional free flow of solution (when
the solution flows freely under the force of gravity
,without being controlled by the infusion pump).
 Due to incorrect, inappropriate, or miscalculation of
an order for the medication.
 “Smart
pumps” are infusion pumps with
dose calculation software.
 It could reduce medication errors,
improve work flow, and provide a new
source of data for continuous quality
improvement by identifying pumpprogramming errors.
Implementation of Technology
 Many
organizations have purchased
various forms of automation, with little or
inadequate planning and or preparation,
which can lead to errors as well as the
development of serious problems.
 It is vitally important to thoroughly plan for
this process, and to remember your goal is
to improve clinical processes, which can
be facilitated by technology.
The multidisciplinary team will need to address the
following issues:




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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.
Identify the required capabilities and configuration
of the new system.
Development of an implementation plan.