The Role of Technology in the Medication-Use Process Essentials of Nursing Informatics Chapter 12

OBJECTIVES 1. Define the limits and limitations of (ADC) in healthcare and its application to the medication process. 2. Describe factors that will influence on the adoption of technology in healthcare. 3. Recognize the benefits & limitations of (BPOC). 4. Describes the challenges and rewards related to implementing a (CPOE) system. 5. Recognize the value of and a methodology for assessing an organizations readiness for implementing technology.

Introduction Due to the numerous steps required in the care of patients, the healthcare industry is an inherently error-prone process that is fraught with opportunities for mistakes to occur. From the first of a series of IOM reports on healthcare is to improve the safety design of systems as is presently being employed in other high error-prone industries such as the aerospace and nuclear industry.

Technology and Healthcare The majority of technology acquisitions have considered of basic stand-alone computer systems. Computers were generally installed in the pharmacy, radiology, and laboratory departments. Most organizations have shown little interest or incentive to incur the huge costs associated with replacing their present non-integrated computer systems.

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 we have resulted in patient harm and deaths. A root cause analysis of the error revealed that there was no malpractice or egregious behavior, but healthcare professionals simply interpreted an ambiguous handwritten chemotherapy order incorrectly.

Influences on the Adoption of Technology Medications errors related to the misinterpretation of physicians prescriptions were the second most prevalent and expensive claim listed on malpractice cases. As more technology introduced into healthcare, it is important that nurses understand their benefits and problems, & how technology will affect their practice.

Computerized Prescriber Order Entry (CPOE) Healthcare practitioners still communicate information in the “old fashioned way” Barriers that lead to ineffective communication to medication: 1. Issues with eligible handwriting 2. Use dangerous abbreviations & dose designations 3. Verbal and faxed orders The use of a CPOE system has the potential to alleviate many of these problems.

Computerized Prescriber Order Entry (CPOE) 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 electronically to the appropriate department. CPOE system offer many advantages over the traditional paper based system Can improve quality patient outcomes & safety Increasing preventive health guideline compliance by exposing prescribers to reminder messages Identifying patients need

Computerized Prescriber Order Entry (CPOE) 4. Updated immunizations and vaccinations 5. Suggesting cancer screening and diagnosis reminders and prompts 6. Automating evidenced based protocols 7. Providing screening instruments to help diagnosis disorders 8. Can improve drug prescribing and administration by improving antibiotic usage

Computerized Prescriber Order Entry (CPOE) Eventhough (CPOE) system is intended for use by prescribers, their presence in organizations will affect nursing & other personnel as well. It affect or even change the work of nurses in many ways, both negative and positive. 1. These systems will require nurses to possess basic computer skills. 2. Nurses may find it difficult to know when new orders have been entered into the system. 3. Nurses sometimes see off-site entry of orders by prescribers as detrimental.

Beneficial aspects of CPOE system for nurses: 1. Nurses have more time for patients 2. Reductions in time wasted in transcribing duplicate orders 3. Lessening the need to understand and adhere to diverse regimens and schedules 4. Improved efficiency 5. Orders would be executed faster , medication would be available more quickly & patients receive prompters care 6. Reducing time devoted to carrying out redundant orders

Bar Code-Enabled Point of Care Technology

Bar Code-Enabled Point of Care Technology A definition of the medical term "bar code-enabled point of care technology," which refers to a keyless data entry technique that facilitates automatic identification and collection of data and allows real-time confirmation of medical records such as patient identity and medication taken, is presented. For the healthcare industry, the potential affect of implementing bar code technology to improve the safe administration of medications is enormous. The VA Healthcare system is the pioneer in the use of bar code technology.

Bar Code-Enabled Point of Care Technology BPOC can improve medication safety through several levels of functionality. On admission, patients are issued on individualized bar code wristband that uniquely identifies their identity. The JCAHO, a nonprofit organization that is the nations leading standards-setting and accrediting body in healthcare. Prior to medication administration, each bar coded package of medication to be administered at the bedside is scanned.

Bar Code-Enabled Point of Care Technology The use of online MAR is likely to be more accurate than traditional handwritten MARs. Additional levels of functionality are the following: 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. Monitoring the pharmacy & the nurses response to predetermined rules or standards.

Bar Code-Enabled Point of Care Technology Continuation 5. Reconciliation for pending or STAT orders. 6. Capturing data for purpose of retrospective analysis of aggregate date to monitor trends. 7. Verifying blood transfusion and laboratory specimen collection identification. It is vitally important to its success that affected staff members, and specially front line nurses, are involved in all decisions, related to the purchase, education, and implementation of BPOC.

Bar Code-Enabled Point of Care Technology Five significant negative effects that occurred during the implementation of a BPOC system. 1. Nurses were sometimes caught “off guard” by the programmed automated actions taken by the BPOC software. 2. Inhibit the coordination of patient information between prescribers and nurses. 3. Nurses found it more difficult to deviate from the routine medication administration sequence with the BPOC system.

Bar Code-Enabled Point of Care Technology 4. Nurses felt that their main priority was the timeliness of medication administration because BPOC required nurses to type an explanation. 5. Nurses used strategies to increase efficiency that circumvented the intended use of BPOC. It is important to understand that the successful implementation of an BPOC system “forces” nurses to accept and change some of their long-held practices when administering medications to achieve a higher level of medication safety.

Bar Code-Enabled Point of Care Technology The use of BPOC systems can possibly introduce new types of medication errors and this are the following: 1. Omissions 2. Extra dose 3. Wrong drug 4. Wrong dose 5. Unauthorized drug 6. Charting errors 7. Wrong dosage form

Automated Dispensing Cabinets (ADC)

Automated Dispensing Cabinets (ADC) 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. The devices require staff to enter a unique logon and password to access the system using a touch screen monitor or by using fingerprint identifications. Once logged into the system, the nurse can obtain patient-specific medications from drawers or bins that open after a drug is chosen from a pick list.

Automated Dispensing Cabinets (ADC) The rationales behind the wide acceptance of this technology are the following: 1. Improving pharmacy productivity 2. Improving nursing productivity 3. Reducing costs 4. Improving charge capture 5. Enhancing patient quality and safety ADCs can also be used to comply with regulatory requirements by tracking the storage, dispensing, and use of controlled substances.

Automated Dispensing Cabinets (ADC) Some documented unsafe practices with the use of these devices include the following: 1. The lack of pharmacy screening of medication order prior to administration 2. Choosing of the wrong medication from an alphabetic list. 3. High- alert medications placed, stored, and returned to ADCs are problematic. 4. Storage of medications with look-alike names and/or packaging 5. The development of “workarounds”

Automated Dispensing Cabinets (ADC) The following issues should be considered to ensure safe medication practices: 1. Consider purchasing a system that allow for patient profiling. 2. Carefully select the drugs that will be stocked in the cabinets. 3. Place drugs that cannot be accessed without pharmacy order entry. 4. Use individual cabinets to separate pediatric and adult medications

Automated Dispensing Cabinets (ADC) Continuation... 5. Periodically reassesses the drugs stocked in each unit- based cabinet. 6. Remove only a single dose of the medication ordered. 7. Develop a check system to assure accurate stocking of the cabinets. 8. Place allergy reminders for specific drugs. 9. Routinely run and analyze override reports to help track and identify problems.

“Smart” Infusion Pump Delivery Systems

“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. According to ECRI, a nonprofit organization that evaluates medical device safety. The delivery of an incorrect dose of a medication or incorrect rate of infusion of an IV solution can cause an error when programming an infusion pump.

“Smart” Infusion Pump Delivery Systems Medication errors with infusion pumps can occur due to: Incorrect, inappropriate, or miscalculation of an order for the medication. 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 (CQI) by identifying & correcting pump-programming errors.

“Smart” Infusion Pump Delivery Systems The software also enables the infusion system to provide an additional verification of the programming of medication delivery. The limits can be set as either “soft” (can be overridden) or “hard” ( one that will not let the nurse go any further). The drug library in the system requires the practitioner to confirm the patient care area, drug name, drug amount, diluent volume, patient weight, dose and rate of infusion.

“Smart” Infusion Pump Delivery Systems To implement the “smart” pump infusion technology, use a proactive technique (FMEA) to assess for the risk of error to determine issues with IV drug administration. The system can allow organizations to configure unit-specific profiles, which include customized sets of operating variables, programming options, and drug libraries. The effective implementation of smart technology thus changes the role of the nurse from that of a looking or memorizing data and rules to that of a clinical decision maker.

Implementation of Technology Implementing any form of technology into healthcare organization can be an imposing task. Identify an interdisciplinary team of key individuals who can collaborate on an effective and realistic plan for implementation. Important key players are the following: Chief information officer (CIO) Information technology (IT) Risk managers Medical staff Front line practitioners

Implementation of Technology The multidisciplinary implementation team will need to address the following issues: 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.

Implementation of Technology Identify the required capabilities and configuration of the new system. “Sell” the benefits and objectives of automation to staff. Development of an implementation plan. Once the system has been implemented into the organization, there are still many issues that need to be considered. As soon as the system is installed, it is important to commit in a meaningful way to its continual monitoring and improvement.

The End Thank You for Listening!!! Prepared by: Miss Roseanne Geraldizo Cabrera BSN II “KNOWLEDGE is best with VIRTUE”