Essentials of Nursing Informatics Chapter 12. OBJECTIVES 1. Define the limits and limitations of...
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The Role of Technology in the Medication-Use Process Essentials of Nursing Informatics Chapter 12
Essentials of Nursing Informatics Chapter 12. OBJECTIVES 1. Define the limits and limitations of (ADC) in healthcare and its application to the medication
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. 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.
Slide 3
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. 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.
Slide 4
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. 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.
Slide 5
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. 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.
Slide 6
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. 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.
Slide 7
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.
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.
Slide 8
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 1. Can
improve quality patient outcomes & safety 2. Increasing
preventive health guideline compliance by exposing prescribers to
reminder messages 3. Identifying patients need 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 1. Can
improve quality patient outcomes & safety 2. Increasing
preventive health guideline compliance by exposing prescribers to
reminder messages 3. Identifying patients need
Slide 9
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 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
Slide 10
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. 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.
Slide 11
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 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
Slide 12
Bar Code-Enabled Point of Care Technology
Slide 13
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. 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.
Slide 14
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. 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.
Slide 15
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: 1. Increase
accountability & capture of charges for items such as unit
stock medications. 2. Up-to-date drug reference information from
online medication libraries. 3. Customizable comments or alerts. 4.
Monitoring the pharmacy & the nurses response to predetermined
rules or standards. The use of online MAR is likely to be more
accurate than traditional handwritten MARs. Additional levels of
functionality are the following: 1. Increase accountability &
capture of charges for items such as unit stock medications. 2.
Up-to-date drug reference information from online medication
libraries. 3. Customizable comments or alerts. 4. Monitoring the
pharmacy & the nurses response to predetermined rules or
standards.
Slide 16
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. 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.
Slide 17
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. 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.
Slide 18
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. 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.
Slide 19
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 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
Slide 20
Automated Dispensing Cabinets (ADC)
Slide 21
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. 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.
Slide 22
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. 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.
Slide 23
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
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
Slide 24
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 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
Slide 25
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.
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.
Slide 26
Smart Infusion Pump Delivery Systems
Slide 27
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. 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.
Slide 28
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. 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.
Slide 29
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.
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.
Slide 30
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. 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.
Slide 31
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 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
Slide 32
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. 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.
Slide 33
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. 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.
Slide 34
The End Thank You for Listening!!! Prepared by: Miss Roseanne
Geraldizo Cabrera BSN II KNOWLEDGE is best with VIRTUE Prepared by:
Miss Roseanne Geraldizo Cabrera BSN II KNOWLEDGE is best with
VIRTUE