Electronic Medication Administration System Research Articles

Adopting an electronic medication administration system in long-term care facilities: a key stakeholder interview study in Macao

ABSTRACT To improve medication safety for residents in long-term care facilities (LTCFs), electronic medication administration records (eMARs) are widely adopted in Macao. This study aimed to (1) develop a logic model for adopting eMAR in LTCFs and (2) explore the contextual factors relevant to the implementation. Semi-structured interviews were conducted with key stakeholders (managers, doctors, nurses, pharmacy staff and other frontline workers) experienced with eMAR in LTCFs in Macao between February and March 2021. Purposive sampling was used for recruitment and thematic analysis followed the theoretical framework of the logic model. All 57 participants were positive about eMAR. Financial and nonfinancial resources were critical to adopting eMAR. eMAR was mostly used for its functions in documentation, e-prescribing and monitoring. Immediate output included simplified working process, reduced errors, closer monitoring of residents’ conditions, and timely communication among staff. The outcomes mainly related to efficiency, safety and quality of care, workload redundancy, and data unification. Key influencing factors included eMAR flexibility, stability, and technical support. Adopting eMARs is highly consuming and the benefits in improving quality of care can only be realized with appropriate implementation, precise execution, regular evaluation and responsive adjustment. The proposed logic model framework serves as a roadmap for LTCFs, both current and future users of eMAR.

INAPPROPRIATE CONTINUATION OF ACID-SUPPRESSION MEDICATION AND BRONCHODILATORS ON DISCHARGE FROM ICU

SESSION TITLE: Late-breaking Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Failure to reconcile medications at various transitions of care can cause substantial harm to patients and increase the cost to the healthcare system. There is evidence that bronchodilators are administered without clinical indication and that acid-suppressing agents are administered inappropriately in the ICU setting. Prophylactic acid suppression is routinely used for critically ill patients as GI bleed prophylaxis. Studies revealed that hospitalized patients are at risk of being discharged with prescriptions for medications typically used to prevent or treat complications of acute illness, despite having no documented indication for chronic use. We hypothesize that medications such as these may have been started through a ventilator order set and were inappropriately reconciled on discharge from the ICU. METHODS: This was a retrospective, cohort study of adult patients admitted to an intensive care unit (ICU) in 13 hospitals across the HCA North Texas Division during a 6 month period. Demographic data, inpatient medication, clinical data, and discharge diagnosis were extracted using a data extraction tool and recorded. RESULTS: A search of electronic health records yielded 23,204 patients admitted during the time period with 12,930 patients admitted to the ICU. A total of 387 patients were excluded for not receiving at least one bronchodilator, PPI, or H2RA during their ICU stay. Of these 2,557 were started on at least one medication of interest during their ICU stay without having a history of use prior to admission, with 1,912 (75%) receiving a bronchodilator, 1,834 (72%) receiving an H2RAs, 1,225 (48%) receiving PPIs. The highest incidence of inappropriate medication continuation after ICU transfer or discharge occurred in patients receiving PPI(n=366, 26.78%), followed by H2 blockers(n=181, 8.39%), and Bronchodilators(n=105, 5.9%). CONCLUSIONS: Inappropriate discharge of patients on these medications not only poses risk for long term effects on a patient's body but also costs the patients money for a medication they may not require. Studies have shown no benefits of adding PPI/H2RA medications in decreasing morbidity and mortality in the ICU; furthermore, many studies on long-term PPI usage have shown adverse renal side effects. We believe that a multi-disciplinary approach to medication reconciliation during ICU downgrade would prove beneficial in preventing such occurrences. CLINICAL IMPLICATIONS: While utilizing ventilator order sets in an electronic medication administration system (EMAR) may be useful in a clinical setting, it is imperative to update the order sets in keeping up with new evidence-based guidelines. As evident by our findings, continuations of medications that were initiated from an order set may have significant consequences for the patient and add unnecessary costs and diagnosis to the patient's history. DISCLOSURES: Employee relationship with HCA Healthcare Please note: $20001 - $100000 Added 07/23/2020 by Brendon Cornett, source=Web Response, value=Salary No relevant relationships by Marian Gaviola, source=Web Response No relevant relationships by Machaiah Madhrira, source=Web Response No relevant relationships by Anvitha Manduva, source=Web Response no disclosure on file for Ranjit Nair; No relevant relationships by Harsh Patel, source=Web Response no disclosure on file for Prashanth Reddy; No relevant relationships by Karen Singh, source=Web Response No relevant relationships by Muhammad Tola, source=Web Response

Use of Simulation-Based Learning to Teach High-Alert Medication Safety: A Feasibility Study

BackgroundDespite the significant risk of harm, nurses receive little training before licensure on best practices for administering high-alert medications. This study evaluates the feasibility of a simulation-based learning study to improve student nurse competence to safely administer high-alert medications. MethodsFeasibility outcomes for a simulation-based learning trial (participation, simulation resources, simulation scenarios, and technological and administrative support) were assessed. The sample consisted of thirty-three student nurses. ResultsResources to support a simulation-based learning intervention included high-quality simulators, smart pumps, computers, audio-visual recording, rooms for prebriefing and debriefing, and secure areas for data storage. Barriers to feasibility included a lack of electronic health record and electronic medication administration systems and the lack of access to participants during regular semester hours. ConclusionAccess to electronic resources that mimic practice settings, coupled with institutional support allowing student participation during regular semester hours, would be needed for an interventional study. A multisite study is recommended to improve the sample size and access to resources.

Electronic Medication Administration System Supports Safe Medication Administration.

The purpose of this study is to describe nurses' views of what supports safe medication administration in the current electronic medication administration system. Data was collected at the turn of 2014-2015 and open-ended answers were inductively analyzed using content analysis. The system's usefulness, good usability, and the feature that there is extra information available on medications and the patient-specific information needed in medication administration are elements that support safe medication administration. The study identifies wide support for the electronic medication administration system in safe medication administration.

Impact of Bar-Code Medication Administration and Electronic Medication Administration Record System in Clinical Practice for an Effective Medication Administration Process

Clinical innovations are ideations resulting from collective experiences that enhance the “norm” and embrace an avenue for change with an invention. As such, collective data that were suggestive of increased medication errors that compromised patient safety initiated the exploration of methods that could reduce multifactorial human errors. The pursuit for an appropriate system followed with the discovery of barcode medication administration system (BCMA) and electronic medication administration system (e-MAR). Prior to the adoption of BCMA and e-MAR, it was crucial to assess the impact of the new medication administration system and the rate of medication administration errors recorded, specifically those that resulted in harm. The purpose of the study was to evaluate BCMA and e-MAR usage outcomes, clinical practices, policies, and processes impacting nurses administering medications in the clinical environment using BCMA and e-MAR system. Thus, an annotated literature review was conducted prior to the implementation of the innovation which analyzed various studies that elaborated on their study methods, data collection and analysis that deliberated on the advantages and disadvantages of barcode medication administration system. It is evident in the researched journals that increased compliance was observed with appropriate guidance, processes and policies in place. There was also a significant reduction in reported errors. The incorporation of barcode technology with electronic medication administration record (e-MAR) had greatly improved the efficiency of the BCMA system. BCMAs method was one of the proposed solutions to medication administration errors and to enhance patient safety measures. As such, the innovation could significantly reduce medication error resulting from intrinsic and extrinsic factors. This paper will further elaborate on the advantages and disadvantages of BCMA and e-MAR, the strategies assumed in the development of BCMA and e-MAR system and its implementation process by identifying and overcoming potential challenges that may arise.

Using etechnology to create quality care for seniors

Problem statement: Does integrated etechnology enhance quality and safety of seniors’ care? Practice change implemented: Slow changes in seniors’ health status (e.g. weight loss over time) are often not detected until they escalate, leading to unnecessary admissions to the emergency room or hospital. Monitoring seniors’ health status more regularly may allow earlier detections in changes, thus improving seniors' health outcomes. We used wireless devices that allowed healthcare staff to weekly monitor blood pressure, oxygen saturation, weight and hydration. Data was saved in a common data hub; staff received immediate alerts when data fell outside of a desirable range or changed significantly from the last measurement. We also created care pathways for staff to respond to abnormal values or changes. Aim: Our aim was to understand if wireless devices can enhance seniors' safety and quality of care by detecting changes in health status early. Monitoring technology was implemented with 30 seniors in an assisted living facility in Alberta, Canada. Timelines: This 1-year study included several phases: readiness assessment at the care facility, procuring and implementing the monitoring devices, developing the alert software, training healthcare staff to use the devices, weekly monitoring for six months. Highlights: Weekly measurements are ongoing; early data suggest that there is value in monitoring subtle changes in health status (e.g. water retention or dehydration, poor oxygen saturation) that allows staff to be more proactive in their care management. Staff can take immediate action following defined care pathways, which may help prevent admissions to the emergency room or hospitalization. Sustainability and transferability: After initial technical challenges, staff and residents are comfortable with the new monitoring routine. Some devices (e.g., body composition scale) may not be suited for all elderly residents due to their inability to stand without help. The technology will be easy to transfer to other facilities. It is imperative that researchers work with each facility to understand their needs and current process to ensure there is value added in implementing new technology. Conclusion: One of the big successes was our ability to engage staff and residents. Staff were keen to try the technology and their feedback helped fine-tune the devices, training materials, and measurement process. The standardized response pathways will ensure appropriate action is taken when residents’ health status changes. Discussions: The longer-term goal of our study is to link the monitoring data and alerts with the facility’s electronic medication administration system, resulting in an integrated electronic record for each resident. This is an important step for sustainability but was not possible within our short timeframe. An integrated record will enhance the quality of care and keep seniors safer in their environment. Lessons learned: It took longer than anticipated to procure suitable devices, set up the software, and recruit residents. This limited the data collection period. Future studies should dedicate more time to implementation and propose studies with longer timelines.

Developing and Implementing a Simulated Electronic Medication Administration Record for Undergraduate Nursing Education: Using Sociotechnical Systems Theory to Inform Practice and Curricula.

Knowledge and skills related to medication administration are a fundamental element of nursing education. With the increased use of electronic medication administration technology in practice settings where nurses work, nursing educators need to consider how best to implement these forms of technology into clinical simulation. This article describes the development of a simulated electronic medication administration system, including the use of sociotechnical systems theory to inform elements of the design, implementation, and testing of the system. Given the differences in the medication administration process and workflow generated by electronic medication administration technology, nursing educators should explore sociotechnical theory as a potentially informative lens from which to plan and build curricula related to simulation activities involving clinical technology.

Abstract 266: Heparin Documentation Improvement to Safely Manage Heparin Infusions

Background: Documentation of intravenous (IV) heparin infusion dose/hold by nurses is a vital component in heparin infusion management. The barcode electronic medication administration system is used when administering and documenting medications but precludes the documentation of continuous IV infusion doses such as heparin. Aim: To increase documentation of IV Heparin Administration Documentation in the electronic nursing documentation system. Methods: We reviewed multiple adverse patient events that involved heparin infusions. When discussing these events, we identified a common trend regarding the inability for nurses to document heparin IV doses/holds in the nursing electronic documentation. Although heparin volume infusion is charted every 4 hours, this does not reflect the exact heparin dose that the patient received when factoring heparin hold orders and boluses. With the involvement of clinical informatics, physicians, nurses, and a quality consultant (QC), we developed a method for nurses to document heparin IV doses and holds via the electronic documentation (Figure 1). On October 30 th 2012, two Cardiovascular Step-Down (CVSD) units championed the heparin process improvement documentation. The nurses on these units receive targeted education about the process improvement change. Audits were performed daily during the first month of implementation and periodically by the QC. Electronic communication was also sent out throughout VUH regarding the changes in heparin documentation. Results: Documentation of administered dose increased from 46% to 71% across VUH regardless of the type or level of education to the change. CVSD: Pre / Post n = 16/21 DOSE: 37.5% / 81% Both DOSE & VOLUME: 31.3% / 71.4% HOLD: 75% / 81% Drop Down: 43% use (68.8% annotation) Non ICU Control: Pre / Post n = 12 / 17 DOSE: 16.7% / 41.2% BOTH DOSE & VOLUME: 8.3% / 11.8% HOLD: 50% / 41.2% Drop Down: 11.1% use (88.9% annotation) ICU units were 100% in dose documentation post changes Conclusion: The heparin documentation change has increased the accuracy of the documentation of heparin dose, volume, and hold across VUH. Targeted education has the potential to increase compliance and adoption. The heparin dose documentation is now exported to an electronic heparin dashboard that physicians/providers can easily access.

Inpatient pharmacological sleep aid utilization is common at a tertiary medical center.

Sleep is known to be poor in the hospital. Patients frequently request pharmacological sleep aids, despite the risk of altered mental status (delirium) and falls. Little is known about the scope of pharmacological sleep aid use in hospitalized patients. We performed a single center, retrospective review of all patients admitted to the general adult (age >18 years) medical and surgical units of a tertiary care center during a recent 2-month period (January 2013-February 2013). Review of the electronic medication administration system was performed to assess for medications administered for sleep. Of 642 unique admissions, 168 patients (26.2%) received a medication for sleep. Most (n = 115, 68.5%) had no known history of insomnia or regular prior sleep medication use. Patients most frequently were treated with trazodone (30.4%; median dose, 50 mg; range, 12.5-450 mg), lorazepam (24.4%; median, 0.5 mg; range, 0.25-2 mg), and zolpidem tartrate (17.9%; median, 10 mg; range, 2.5-10 mg). Of the medications given, 36.7% were given early (before 9 pm) or late (after midnight). Of patients not known to be previously taking a pharmacological sleep aid, 34.3% of them were discharged with a prescription for one. Despite increasing evidence of risks such as delirium or falls, pharmacological sleep aid use in general wards remains common, even in elderly patients. Medication administration time is frequently suboptimal. Many previously sleep medication-naïve patients leave the hospital with a sleep aid prescription. Further research is needed to understand the factors that contribute to the high rate of sleep medication use in hospitalized patients.

TCH015 effect of bar-code technology on the safety of cytostaic drugs administration

BackgroundSerious medication errors are common in hospitals and often occur during order transcription or administration of medication. To prevent such errors, technology has been developed to verify medications by incorporating...

Effect of bar-code technology on the safety of cytostatic drugs administration

BackgroundSerious medication errors are common in hospitals and often occur during order transcription or administration of medication. To prevent such errors, technology has been developed to verify medications by incorporating...

Workarounds in the use of IS in healthcare: A case study of an electronic medication administration system

Healthcare information systems such as an Electronic Medication Administration System (EMAS) have the potential to enhance productivity, lower costs, and reduce medication errors. However, various issues have arisen from the use of these systems. A key issue relates to workarounds as a result of a misfit between the new information system (IS) implementation and existing work processes. However, there is a lack of understanding and studies on healthcare IS workarounds and their outcomes. This paper applies the theoretical perspectives of accommodation to misfit and IS evolution to understand the phenomenon through an in-depth case study of an EMAS implemented in a large public hospital. Based on the findings, it develops a process framework to explain how the benefits, issues, and workarounds inter-relate and determine the impacts of the system. The findings have implications for research and practice on workarounds in the use of healthcare IS.

Effect of Bar-Code Technology on the Safety of Medication Administration

ABSTRACT Hospital patients are at risk of serious medication errors that may result in patient harm. Such errors commonly occur during the ordering of medication, drug administration, or the transcription and dispensing stages. Previous studies have shown that use of bar-code technology can prevent errors by providing automatic verification of a patient's identity and the medication to be administered. Bar-code technology is usually implemented in conjunction with an electronic medication administration system (eMAR). Bar-code eMAR records physician and pharmacy medication orders electronically; its implementation may reduce medication errors and protect patients from potential adverse events. Use of this technology has been increasing, but there is only limited and mixed evidence of its effectiveness. This prospective study evaluated the effectiveness of bar-code eMAR technology to reduce administration and transcription errors, as well as lower potential adverse drug events. Over a 9-month period in 2005 in a tertiary academic medical center, error rates in units that were using this technology were compared with the rates in units that were not. The 2 primary study outcomes were errors in timing, involving early and late administration of drugs, and errors unrelated to timing. Identified errors were reviewed by 2 members of a medical panel to confirm the presence of an error and the potential for adverse drug events and patient harm. A total of 7318 medication administrations were observed on patient units implementing bar-code eMAR and 6723 medication administrations on patient units that did not. Transcription orders were reviewed for 1283 units that used the bar-code eMAR and for 1799 that did not use this technology. On units not using the bar-code eMAR, there was an error rate of 11.5% (776/6723) for nontiming medication-administration errors, whereas on units with the bar-code eMAR, the error rate for nontiming-errors was 6.8% (495/7318). The difference represents a 41.4% relative reduction in the rate of nontiming errors (P < 0.001). Compared with units without bar-code eMAR, use of this technology reduced the rate of potential adverse drug events because of nontiming administration errors from 3.1% to 1.6%, representing a relative reduction of 50.8% (P < 0.001). The overall rate of timing errors decreased from 16.7% without the bar-code eMAR to 12.2% with its use, a reduction of 27.3% (P = 0.001), but there was no significant difference in the incidence of potential adverse drug events due to timing errors between the comparison groups. The rate of transcription errors was 6.1% on units that did not use the bar-code eMAR; no transcription errors were found in units using it.

Effect of Bar-Code Technology on the Safety of Medication Administration

Serious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such errors, technology has been developed to verify medications by incorporating bar-code verification technology within an electronic medication-administration system (bar-code eMAR). We conducted a before-and-after, quasi-experimental study in an academic medical center that was implementing the bar-code eMAR. We assessed rates of errors in order transcription and medication administration on units before and after implementation of the bar-code eMAR. Errors that involved early or late administration of medications were classified as timing errors and all others as nontiming errors. Two clinicians reviewed the errors to determine their potential to harm patients and classified those that could be harmful as potential adverse drug events. We observed 14,041 medication administrations and reviewed 3082 order transcriptions. Observers noted 776 nontiming errors in medication administration on units that did not use the bar-code eMAR (an 11.5% error rate) versus 495 such errors on units that did use it (a 6.8% error rate)--a 41.4% relative reduction in errors (P<0.001). The rate of potential adverse drug events (other than those associated with timing errors) fell from 3.1% without the use of the bar-code eMAR to 1.6% with its use, representing a 50.8% relative reduction (P<0.001). The rate of timing errors in medication administration fell by 27.3% (P<0.001), but the rate of potential adverse drug events associated with timing errors did not change significantly. Transcription errors occurred at a rate of 6.1% on units that did not use the bar-code eMAR but were completely eliminated on units that did use it. Use of the bar-code eMAR substantially reduced the rate of errors in order transcription and in medication administration as well as potential adverse drug events, although it did not eliminate such errors. Our data show that the bar-code eMAR is an important intervention to improve medication safety. (ClinicalTrials.gov number, NCT00243373.)

Bar Code Verification Technology Improves Medication Safety

Medication errors often occur during order transcription or on administration to hospitalized patients. Bar code verification technology, within an electronic medication-administration system (bar code eMAR), is being used increasingly to prevent such errors. However, data on the effectiveness of this technology are limited, and study outcomes have been mixed. Researchers at a 735-bed tertiary academic medical center in Boston prospectively assessed …