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ROLE OF TECHNOLOGY IN
MEDICATION - USE PROCESS
NCM
110
ENRIQUEZ, GAYLE LUREEN C. & EFREN, NICOLE DANIELLE
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.
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Automated Dispensing Cabinets (ADC)
Smart Infusion Pump Delivery Systems
COMPUTERIZED PRESCRIBER ORDER ENTRY
(CPOE)
TECHNOLOGY AND HEALTHCARE
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Using the information technology, it will
reduce the rate of medication errors as this
is helpful in medications process since it can
help the health care provider to search the
right medicine into a particular patient.
Computers are the excellent means for
storage of patient related data. Big
hospitals employ computer systems to
maintain patient records.
Computers can keep track of prescriptions
and billing information.
Medicine comprises good knowledge.
Computer storage can serve as the best
means of housing this information.
In medicine field, we use technology to
lessen some errors, to make our job work
fast and make our job easier. Technology
can help us meet our goal of improving
patient safety.
INFORMATION TECHNOLOGY (IT) INNOVATIONS
IN MEDICATION USE PROCESS
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Computerized Prescriber Order Entry
(CPOE)
Bar Code – Enabled Point – of – Care
Technology (BPOC)
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Computerized Provider Order Entry (CPOE)
refers to the process of providers entering
and sending treatment instructions –
including medication, laboratory, and
radiology orders – via a computer
application rather than paper, fax, or
telephone.
CPOE Major Integrations and Workflow
Modern CPOE systems come as an important
part of the healthcare IT infrastructure. Usually,
they extend the functionality of EHR (Electronic
Health Record) systems and employ a clinical
decision support module to check drug-drug
and drug-allergy interactions, verify the
dosage, and prevent duplicate therapy.
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BAR CODE – ENABLED POINT – OF – CARE
TECHNOLOGY (BPOC)
In the common scenario, the workflow involving
CPOE looks as follows.
1. A user (physician) logs in to an EHR
system.
2. The EHR system confirms that the user is
authorized and initiates the ordering
process via the CPOE system.
3. The physician creates or modifies an
order for medications, laboratory, or
radiology tests.
4. The order is validated against a patient’s
medical history, a knowledge base of a
clinical decision support system, and a
health insurance plan stored in a
practice management system.
5. After all the checks, the order is sent to a
product or service provider’s system (a
pharmacy, laboratory, etc.).
6. The order becomes part of the patient’s
record in the EHR system.
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Functionalities includes the following:
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BENEFITS
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Reduce errors and improve patient safety
Improve efficiency
Improve reimbursements:
Barcode Point of Care (BPOC) is an
electronic solution that enables physicians,
nurses, and other healthcare professionals
to record medication administration and
documentation electronically offline.
The barcode scanning makes sure of the
treatment administered to the patient, so
that correct treatment should be given
and continued to the right patient
ensuring patient safety and reduced
errors.
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Increase accountability & capture of
charges for items such as unit stock
medications.
Up-to-date drug reference information
from online medication libraries.
Customizable comments or alerts and
reminders of important clinical actions that
need to be taken when administering
certain medications
Monitoring the pharmacy and the nurse’s
response to predetermined rules or
standards in the rules engine
Reconciliation for pending or STAT orders
Capturing data for retrospective analysis of
aggregate data to monitor trends
Verifying blood transfusion and laboratory
specimen collection
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BPOC System Medication Error include the
following:
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Omissions: After the patient’s bar code
armband and medication have been
scanned, the dose is inadvertently dropped
onto the floor.
Extra dose: May be given when there are
orders for the same drug to be
administered by a different route.
Wrong drug: In situations when the nurse
administers a medication, which has not
been labeled with a bar code.
Wrong dose: In situations when the nurse
has difficulty in scanning medication and
proceeds to scan the medication twice.
Unauthorized drug: An order to hold a
medication unless a lab value is at a certain
level such us an amino glycoside.
Charting errors: Distinguish the indication for
the administration of the medication.
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 (ADC)
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Benefits:
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Automated dispensing cabinets (ADC) are
a computerized drug storage device.
ADCs allow drugs to be stored and
dispensed near the point of care while the
control and track the drug distribution.
It is designed tore place or support the
traditional unit-dose drug delivery system; it
requires the staff a unique log on and
password to access the system using a
touch screen monitor or by using finger print
identification
Many healthcare facilities have replaced
medication carts or open unit-stock systems
with ADCs.
Improving
nursing
and
pharmacy
productivity: reduce number of steps from
filling medication into filling a centralized
station; reduce time needed to obtain
missing medications. Reduce time in
obtaining missing medications and newly
ordered medications
Reducing costs: reduce inventory and
containment costs associated with expired
medications
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,
drug-allergy interactions.
Provide secure medication storage on
patient care units: They contain minidrawers that are stocked per patient by the
pharmacy. Secure access ensures only
authorized personnel can open the
cabinet and only selected quantities of
that medication can be accessed.
Capable of tracking the path of a drug
from pharmacy to ADSDS to nurse to
patient.
Unsafe practices with the use of ADC
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Lack of pharmacy screening of medication
order prior to administration
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Choosing of the wrong medication from an
alphabetic pick list
Use of high-alert medications placed,
stored and returned to ADCs - patient injury
or death may arise if there is absence of
independent double check from nurse and
from the pharmacy
Storage of medications with look-alike
names and/or packaging – due to
confirmation bias
SMART INFUSION PUMP DELIVERY SYSTEMS
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were encountered before smart pumps
existed. This has alarms that go off
whenever any air bubble is detected or
when the patient's body has taken in
enough nutrients.
Used on all patients: It can be used on
adult, pediatric, and neonatal patients. The
software has features that allow a user to
easily adjust the amount and duration of
delivery, for the type of patient.
Administer enough medications: It is
efficient because it delivers the exact
amount of medication needed. Using smart
pumps protects patients from receiving too
little or too much from the pump.
Underlying Issues:
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Infusion pumps with dosage-calculation
software used in the administration of
parenteral medications thru IV or epidural
lines.
Infusion pumps offer significant advantages
over manual administration of fluids,
including the ability to deliver fluids in very
small volumes, and the ability to deliver
fluids at precisely programmed rates or
automated intervals.
They can deliver nutrients or medications,
such as insulin or other hormones,
antibiotics, chemotherapy drugs, and pain
relievers.
It aims to reduce medication errors,
improve workflow and provide a new
source of data for continuous quality
improvement
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Inadequate user interface design or
human factors issues: The infusion pump
screen doesn’t make clear which units of
measurement the user is expected to
enter. For example, the user may enter
weight in pounds when the infusion
pump requires it in kilograms.
Software problems: The infusion pump
interprets a single keystroke as multiple
keystrokes. For example, the user
programs an infusion rate of 10 mL/hour,
but the device registers an infusion rate
of 100 mL/hour.
Alarm errors: The infusion pump fails to
generate an audible alarm for a critical
problem, such as an occlusion (e.g.,
clamped tubing) or the presence of air in
the infusion tubing.
Benefits:
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Help reduce errors: Errors, including
overfeeding and air bubbles in the tubing,
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