The Role of Technology in Medication-Use

Process
Jhayne C. Ducay BSN 2B
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.
•Thesecomputers were generally installed in the pharmacy, radiology, and laboratory
departments and could also be found in the administration and business offices.
How do we solve the problems regarding to
medication usage and administration?
• IT INNOVATIONS IN MEDICATION USE PROCESS
1. Computerized Prescriber Order Entry (CPOE)
2. Bar Code-enabled point-of-care technology
3. Automated Dispensing Cabinets
4. Smart Infusion Pump Delivery Systems
Computerized prescriber order entry (CPOE)
• a process of electronic entry of medical practitioner instructions for the
treatment of patients (particularly hospitalized patients) under his or
her care.
• These orders are communicated over a computer network to the
medical staff or to the departments (pharmacy, laboratory, or radiology)
responsible for fulfilling the order. CPOE decreases delay in order
completion, reduces errors related to handwriting or transcription,
allows order entry at point-of-care or off-site, provides error-checking
for duplicate or incorrect doses or tests, and simplifies inventory and
posting of charges.
Features of CPOE system
• Ordering - Physician orders are standardized across the organization yet may be
individualized for each doctor or specialty by using order sets. Orders are
communicated to all departments and involved caregivers, improving response
time and avoiding scheduling problems and conflict with existing orders.

• Patient-centered decision support - The ordering process includes a display of

the patient’s medical history and current results and evidence-based clinical
guidelines to support treatment decisions. Often uses medical logic module and/or
Arden syntax to facilitate fully integrated Clinical Decision Support Systems
(CDSS).

• Patient safety features - The CPOE system allows real-time patient

identification, drug dose recommendations, adverse drug reaction reviews, and
checks on allergies and test or treatment conflicts. Physicians and nurses can
review orders immediately for confirmation.

• Intuitive Human interface - The order entry workflow corresponds to familiar

“paper-based” ordering to allow efficient use by new or infrequent users.
Features of CPOE system
• Regulatory compliance and security - Access is secure, and a permanent
record is created, with electronic signature.

• Portability - The system accepts and manages orders for all departments at
the point-of-care, from any location in the health system (physician’s office,
hospital or home) through a variety of devices, including wireless PCs and
tablet .

• Management - The system delivers statistical reports online so that

managers can analyze patient census and make changes in staffing, replace
inventory and audit utilization and productivity throughout the organization.
Data is collected for training, planning, and root cause analysis for patient
safety events.

• Billing - Documentation is improved by linking diagnoses (ICD-9-CM or ICD-

10-CM codes) to orders at the time of order entry to support appropriate
charges.
Benefits of cpoe
• Increased accessibility to patient information across multiple organizations.
• Standardization of patient’s record, minimizing illegible handwritten entries.
• Reduction in the variation of care to improve disease management-
improving follow-up of newly diagnosed conditions, reminder systems to
improve patient management, automating evidence-based protocols,
adhering to clinical guidelines, or providing screening instruments to help
diagnosis disorders.
• Improvement of drug prescription and administration- improving antibiotic
usage, suggesting whether certain antibiotics or their dosages are
appropriate for use.
• Improvement of patient outcomes and safety- increasing preventive health
guideline compliance by exposing prescribers to reminder messages.
 Bar Code-enabled point-of-care technology
• On admission, patients are issued an individualized barcode wristband that
uniquely identifies their identity, scanned prior to drug administration, verifies
the nurse, patient, and the medication, and electronically record the
administration of the medication in an online MAR.
Features:
• Increased accountability and capture of charges for items
• Up-to-date drug reference information from online medication reference
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.
Underlying issues
• Nurses were sometimes caught ‘off guard’ by the programmed automated actions taken by the
BPOC software
• The BPOC seemed to inhibit the coordination of patient information between prescribers and
nurses when compared to a traditional paper-based system.
• Nurses found it more difficult to deviate from the routine medication administration sequence
with the BPOC system.
• 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.
• Nurses used strategies to increase efficiency that circumvented the intended use of BPOC.
• Pharmaceutical industry’s unwillingness to adopt a universal bar code standard.
• Extended lag time between the launch of new medications and their availability in unit-dose
packaging, as well as non-bar coded medications
• Possibility of errors: Wrong drug Charting errors Wrong dose Unauthorized drug Wrong dosage
form.
New types of medication errors
• 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
• is a computerized drug storage device or cabinet designed for hospitals. ADCs
allow medications to be stored and dispensed near the point of care while
controlling and tracking drug distribution.
• A computerized point-of-use medication-management system that is designed
to replace or support the traditional unit-dose drug delivery system; it
requires the staff a unique logon and password to access the system using a
touch screen monitor or by using fingerprint identification.
BENEFITS
• Improving pharmacy productivity - reduce number of steps from filling medication bins to filling a
centralized station; reduce time needed to obtain missing medications
• Improving nursing productivity - reduce time in obtaining missing medications and newly ordered
medications
• Reducing costs- reduce inventory and containment costs associated with expired medications
• Improving charge capture- allow capture of all patient charges associated with administered medications
• Enhancing patient quality and safety- built-in decision support systems that warn user son drug-drug
interactions, drug-allergy interactions, drug-lab interactions, drug-drug duplications and so forth.
• Tracking the storage, dispensing, and use of controlled substances.
• Verification of the programming of medication delivery thru prompts and alerts, and setting dosage
limits
• Eased access to transaction data from the infusion device, leading to improved patient quality and
improved clinical decision-making
Smart infusion pump delivery system
• Infusion pumps with dosage-calculation software used in the administration of
parenteral medications thru IV or epidural lines; medications are administered
based on a calculation of a volume to be infused per hour of delivery
• Aim to reduce medication errors, improve workflow, and provide a new source
of data for continuous quality improvement.
Benefits
• Maximum flexibility, increasing application to different areas of the
hospital
• Applicability of the infusion pump regardless of patient’s condition, age,
and gender
• Improvement of patient care, minimizing human memory created errors.
• Improvement of drug administration- Thru comprehensive libraries of
drugs, usual concentrations, dosing units, and dose limits, warnings to
exceeded dosage limits, and configurable settings by patient type or
location
• Verification of the programming of medication delivery- Thru prompts
and alerts, and setting dosage limits
• Eased access to transaction data from the infusion device, leading to
improved patient quality and improved clinical decision-making.
UNDERLYING ISSUES
• Infusion device programming error.
 single wrong entry or button pressed
 Nurses wrong programming of the dosage

• High Implementation cost