Evidence-based research group project

Evidence-Based Research Group Project

Marcie ChenetteDulcebelle PearsonMelanie Underwoood

1IntroductionMedication errors are largely one of the things that caregivers are very concerned about when providing care for clients especially because of the high risk of harm that it can cause.

Even though these errors are fairly preventable, 7,000 fatalities each year are estimated to be the cause of medication errors and this number does not include disabilities (Crane & Crane, 2006).

It was found that 34% of errors happen during administration and only less than 2% were caught before it happened (Daniels, Helmons, & Wargels, 2009).

2An observed medication administration error is defined as any discrepancy between the medication administered to the patient and the medication ordered on the patients medical record (Daniels, Helmons, & Wargels, 2009).

The five rights have largely assisted health care professionals, especially nurses in making sure that we adhere to a standard of safety when it comes to giving medication (Grissinger, 2010). It is by no means a failsafe method in assuring that errors do not happen and the "human factor" in an already busy workflow cannot be avoided.

IntroductionTo help minimize errors when administering medication, bar-code-assisted medication administration (BCMA) has been developed as a safety barrier between the nurse and patient should the medication error reach the bedside.

BCMA aids the nurse in confirm the patients identity as well as identifying the medication for appropriate dose, time and form and route (Daniels et al., 2009).

3The past few years brought forth changes in the way medication is being administered to clients. Changes on how Medication Administration Records or MAR's are being kept; from the good old fashioned paper format, to built in MAR's in the computerized documentation systems, to the use of commercial applications to scan barcodes when preparing and administering medication.

Statement of the ProblemAlthough errors can happen in any area of the whole process of ordering, transcribing and administering medication, the focus of this project is to obtain research based evidence during the administration phase which is mostly done by nurses.

The objective is to address the question :

"Do staff nurses on a medical/ surgical floor, utilizing computerized medication administration systems experience a DIFFERENCE in the number of medication errors compared to the paper based MAR system?"

4P: Population staff nurses administering medication on the medical surgical floorI: Intervention computerized medication administration systemsC: Comparison paper MAR vs. computerized systemO: Outcome difference in medication error occurrences

Medication Administration Record (MAR)

Articles being examinedCase Study on the Use of Health Care Technology to Improve Medication Safety

Effect of bar code assisted medication administration on medication administration errors and accuracy in multiple patient care areas.

Preventing Medication Errors in Hospitals through a Systems Approach and Technological Innovation: A Prescription for 2010

The Effect of Hospital Electronic Health Record Adoption on Nurse-Assessed Quality of Care and Patient Safety

5The findings to be presented are based on four articles selected by the group members and the objective is to give a clearer picture as to what is currently known about this transition from paper based MAR system to computer administered systems.

These four articles would also pave the way for more questions that will lead for further research on the topic.

Findings related to the QuestionARTICLE: Effect of bar code assisted medication administration on medication administration errors and accuracy in multiple patient care areas.

During this study, BCMA technology proved to show improvements on the medical-surgical floor in the following areas, patient identification, charting after administration, availability of MAR at patients bedside when medications were administered. The goal of this technology is to decrease unauthorized drug, wrong form, wrong dose, wrong route, extra dose, and omission types of errors (Daniels, Helmons, & Wargel, 2009).

6bar-code-assisted medication administration (BCMA)Medication Administration Record (MAR)Findings related to the QuestionARTICLE: Effect of bar code assisted medication administration on medication administration errors and accuracy in multiple patient care areas.

Omission type errors were the most common on the medical-surgical units, which after the implementation of BCMA was reduce by 58%.

Wrong time errors increased after the start of BCMA likely a result of longer duration of medication administration. Nurses were often distracted during medication administration times which can also lead to increase in time as well as errors (Daniels, Helmons, & Wargel, 2009).

7bar-code-assisted medication administration (BCMA)Findings related to the QuestionARTICLE: Effect of bar code assisted medication administration on medication administration errors and accuracy in multiple patient care areas.

It was noted that after the implementation of BCMA that nurses were less likely to educate patients on medication they were being given on the medical-surgical units (Daniels, Helmons, & Wargel, 2009).

The results of this study emphasizes that BCMA really works and forces organizations to take a closer look at their medication administration process. It is shown to be a cost-effective intervention that makes sense (Daniels, Helmons, & Wargel, 2009).

8bar-code-assisted medication administration (BCMA)Findings related to the QuestionARTICLE: Effect of bar code assisted medication administration on medication administration errors and accuracy in multiple patient care areas.

Conclusion BCMA has shown a decrease in medication errors in medical-surgical units, when time error where excluded (Daniels, Helmons, & Wargel, 2009).

9bar-code-assisted medication administration (BCMA)Findings related to the QuestionARTICLE: Preventing Medication Errors in Hospitals through a Systems Approach and Technology Innovation: A Prescription for 2010

With EMRs physicians can easily access a patients medical records to check any current medications the patient is on, and probe for any allergies or adverse drug interactions. EMRs can also be made available to the patient via smart card technology (Crane & Crane, 2006 p.5).

One such study found that compared to paper-based systems, EMRs reduced medical errors by 55% (Crane & Crane, 2006, p.5).

10Clearly, illegible handwritten prescriptions, overlooked allergies and drug interactions, and incorrect dosage often lead to medication errors. CPOEs have been found to be effective in reducing such medication errors (Crane & Crane, 2006, p.5).

Electronic Medical Record (EMR)

Computerized Physician Order Entry (CPOE)Findings related to the QuestionARTICLE: Preventing Medication Errors in Hospitals through a Systems Approach and Technology Innovation: A Prescription for 2010

Veteran Affairs hospitals use bar code technology and have seen an 86% reduction in medication errors. Bar coding technology used in conjunction with EMRs can prevent even more medication errors (Crane & Crane, 2006, p.5).

Brigham and Womens and its sister hospital, Massachusetts General, both located in Boston, MA, have demonstrated patient safety benefits of EMRs. These hospitals have cut frequency of serious medication errors by 55% and the number of overall medication errors by 81% (Crane & Crane, 2006, p.6).

11Electronic Medical Record (EMR)Findings related to the QuestionARTICLE: Preventing Medication Errors in Hospitals through a Systems Approach and Technology Innovation: A Prescription for 2010

Conclusion: Medication errors are not inevitable, but are preventable with proper system redesign and innovative and emerging technologies. Patients deserve to be safe in our healthcare system (Crane & Crane, 2006, p.7).

12Findings related to the QuestionARTICLE: Case Study on the Use of Health Care Technology to Improve Medication Safety

There were application modifications that needed to be made to the computerized system but despite functionality issues, the rate of serious medication errors which are defined as ones that has the potential to harm the patient dropped by 55% and generally, adverse drug event rates fell even if the decrease was not statistically significant (Fiumara et al., n.d.).

Transcription error rates also dropped by 50% after the system was implemented (Fiumara et al., n.d.).

13Findings related to the QuestionARTICLE: Case Study on the Use of Health Care Technology to Improve Medication Safety

"A follow-up study conducted at Brigham and Women's Hospital (BWH) to assess the impact of bar code technology on dispensing errors demonstrated that the rate of target dispensing errors decreased by 85% and that the rate of potential ADE's also decreased following implementation of bar coding technology" (Fiumara et al., n.d., p. 109).

14Adverse Drug Event (ADE)Findings related to the QuestionARTICLE: Case Study on the Use of Health Care Technology to Improve Medication Safety

Implementation of the "smart pump" technology and including these in a "closed loop, point-of-care medication administration system" decreased risk associated with IV infusions (Fiumara et al., n.d., p. 112).

"Time motion studies demonstrate that there was no significant change in the time nurses spent on medication administration before and after implementation of the system" (Fiumara et al., n.d., p. 112).

15Findings related to the QuestionARTICLE: Case Study on the Use of Health Care Technology to Improve Medication Safety

Conclusion: BWH continues to enhance its system but based on the initial results, it appears to favor the integrated the computerized ordering, transcribing and delivery system that it has implemented (Fiumara et al., n.d.).

16Brigham and Women's Hospital (BWH) Findings related to the QuestionARTICLE: The Effect of Hospital Electronic Health Record Adoption on Nurse- Assessed Quality of Care and Patient Safety

Only 21 of the 316 hospitals in the sample had a basic EHR system implemented on all patient care areas. There were no significant differences between hospitals with and without a basic EHR in terms of staffing levels (Kutney-Lee & Kelly, 2010, p.470).

17Electronic Health Record (EHR)Findings related to the QuestionARTICLE: The Effect of Hospital Electronic Health Record Adoption on Nurse- Assessed Quality of Care and Patient Safety

Nurses in hospitals with fully implemented basic EHRs were consistently and significantly less likely to report unfavorable outcomes in their hospitals than did nurses in hospitals without fully implemented basic EHRs. Nurses working in hospitals with a fully implemented basic EHR also reported fewer frequent medication errors (Kutney-Lee & Kelly, 2010, p.470).

18Electronic Health Record (EHR)

Findings related to the QuestionARTICLE: The Effect of Hospital Electronic Health Record Adoption on Nurse- Assessed Quality of Care and Patient Safety

The degree to which nurse leaders support the growth of technology and champion its use in the clinical setting is bound to affect the success of EHR implementation and ,subsequently patient care (Kutney-Lee & Kelly, 2010, p.471).

19Electronic Health Record (EHR)

Findings related to the QuestionARTICLE: The Effect of Hospital Electronic Health Record Adoption on Nurse- Assessed Quality of Care and Patient Safety

Conclusion: Findings suggest that the implementation of a basic EHR shows promise in bringing about improved safety for patients (Kutney-Lee & Kelly, 2010, p.471).

20Electronic Health Record (EHR)

ReferencesCrane, J., & Crane, F. G. (2006). Preventing medication errors in hospitals through a systems approach and technological innovation: A prescription for 2010. Hospital Topics, 84(4), 3-8. http://dx.doi.org/http://dx.doi.org/10.3200/HTPS.84.4.3-8

Daniels, C. E., Helmons, P. J., & Wargels, L. N. (2009). Effect of bar-code assisted medication administration on medication administration error and accuracy in multiple patient care areas. American society of Health-System Pharmacists, 1202-1210.

Fiumara, K., Moniz, T., Churchill, W., Bane, A., Luppi, C., Bates, D., & Gandhi, T. (n.d.). Case study on the use of health care technology to improve medication safety. Retrieved from http://www.jointcommission.org/

Grissinger, M. (2010). The five rights. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957754/

Kutney-Lee, A. K. & Kelly, D. (2010). The effect of hospital electronic health record adoption on nurse-assessed quality of care and patient safety. Journal of Nursing Administration, 41(11), 466-472. doi:10.1097/NNA.0b013e3182346e4b

21