Medication Administration System Research Articles

Drug Errors in Obstetric Anesthesia: A Narrative Review

The subspecialty of obstetric anaesthesiology is different from other subspecialties in anaesthesiology in that, at any point of time, two lives are at stake, making drug errors particularly critical. This narrative review explores the incidence, contributing factors, and preventive strategies for medication errors in Obstetric Anaesthesia. Key contributors of medication errors include distractions, fatigue, look-alike/sound-alike drugs, lack of standardized protocols, poor communication strategies, inadequate training and education. Effective strategies for reducing errors include double-check procedures, bar-coded medication administration systems, implementing “Tall Man lettering for look-alike/sound-alike drugs, structured communication tools, continuous education and training. The review also introduces the mnemonic "SAFE-LABEL CHECK" to encapsulate best practices for minimizing drug errors. Future directions suggest integrating advanced technologies and fostering a multidisciplinary approach to enhance patient safety in obstetric anaesthesia.

Medical Record Monitoring an Administration System

Abstract— A state-of-the-art software program called the Medical Record Monitoring and Administration System offers a consolidated platform for monitoring and managing medical data, hence streamlining the management of healthcare. Healthcare personnel can effectively handle patient data, keep track of medical histories, and guarantee regulatory compliance using this system. Medical records are kept accurate, current, and easily accessible thanks to the system’s sophisticated features, which also include safe data storage, automatic alarms, and real-time monitoring. This solution improves data management, lowers mistakes, improves patient care, and boosts operational efficiency by automating administrative activities. The Medical Record Monitoring and Administration System is a vital tool for healthcare businesses looking to increase the caliber and effectiveness of their services because of its user-friendly interface and strong security features. Keywords – Pregnancy care management, Monitoring of scheduled visits, Maternal health informatics.

Factors influencing nurse satisfaction with Automated Medication Dispensing Cabinets

To improve efficiency, quality and safety of medication administration systems, hospitals have been implementing automated dispensing cabinets (ADCs) in healthcare units. The purpose of this study was to evaluate nursing staff’s level of satisfaction with ADCs by analyzing several aspects and differences in perceptions between groups of users. It being a fact that nurses are the end users of the ADC system, their perceptions and opinions are crucial to the success of this technological implementation. A cross-sectional survey was conducted in units with ADCs from a Spanish hospital (n = 97, 32.12%. response rate). Data were analyzed using comparisons between groups and principal component analysis (PCA). The results show that, in general terms, nursing staff have a high degree of satisfaction with ADCs, with order and organization being the most valued aspect. The type of clinical unit and personnel seniority explain some of the differences in valuation. PCA revealed the existence of two general dimensions of nurse satisfaction: efficiency and safety. From this study, conclusions can be drawn to help hospital managers achieve success in implementing ADCs in their centers.

Lipid-Based Nanoparticles in Delivering Bioactive Compounds for Improving Therapeutic Efficacy.

In recent years, due to their distinctive and adaptable therapeutic effects, many natural bioactive compounds have been commonly used to treat diseases. Their limited solubility, low bioavailability, inadequate gastrointestinal tract stability, high metabolic rate, and shorter duration of action limited their pharmaceutical applications. However, those can be improved using nanotechnology to create various drug delivery systems, including lipid-based nanoparticles, to adjust the compounds' physicochemical properties and pharmacokinetic profile. Because of the enormous technical advancements made in the fundamental sciences and the physical and chemical manipulation of individual atoms and molecules, the subject of nanotechnology has experienced revolutionary growth. By fabricating certain functionalized particles, nanotechnology opens an innovative horizon in research and development for overcoming restrictions, including traditional medication administration systems. Nanotechnology-driven bioactive compounds are certain to have a high impact and clinical value for current and future uses. Lipid-based nanotechnologies were shown to deliver a range of naturally occurring bioactive compounds with decent entrapment potential and stability, a successfully controlled release, increased bioavailability, and intriguing therapeutic activity. This review outlines bioactive compounds such as paclitaxel, curcumin, rhodomyrtone, quercetin, kaempferol, resveratrol, epigallocatechin-3-gallate, silymarin, and oridonin, fortified within either a natural or synthetic lipid-based drug delivery system based on nanotechnology and their evaluation and clinical considerations.

Surveillance for Diabetes in Hospital-Evaluation of Dashboard Effectiveness.

There is a large burden of diabetes in Western Sydney, and this descriptor is also valid for the inpatient population. Optimizing diabetes care in hospital is important to prevent inpatient morbidity. A surveillance system was developed to address this need and a diabetes dashboard was developed around a data model built around the patient journey that integrated key data feeds from the pathology, medication, and patient administration systems. This facilitated the rapid identification and triaging of individuals with diabetes. We evaluated this dashboard using high level clinical and financial indicators. This implementation resulted in an improved time to patient review, and a reduction in 28-day readmission rates but the inpatient length of hospital stay was unchanged. (116 words).

Patient-centred medication management: How to enhance patient safety and reduce the work burden for medical staff by digitalised closed-loop cabinets

Medication management is both an economic challenge and a patient safety issue. In German hospitals between 19 per cent and 35 per cent of all failures causing harm to patients are attributable to medication errors. As a consequence, an estimated 15,000 patients die each year. In addition, about 14 per cent of the average length of stay is assignable to unplanned drug interactions. Independent of patient risks, health impairments and outcome deficits, every non-fatal medication error leads to additional costs totalling €3,000 on average. Nurses, in particular, who typically suffer from work overload, are affected by error-prone medication logistics. Between 26 per cent and 44 per cent of all failures occurring in the medication administration process result from activities in which nurses are substantially involved. International best-in-class hospitals like the Mayo Clinic (Phoenix), Scripps (San Diego), OLVG (Amsterdam) and Guy’s and St. Thomas’ (London) have been using automated dispensing systems (smart cabinets) for medication safety reasons for many years. Moreover, in the USA, automated medication dispensing cabinets are ubiquitous in various types of hospitals and have an implementation rate of 89 per cent. But in German hospitals, this technology is still nowhere to be seen. In 2020, the German government, via legal act, decided that all hospitals must implement a closed-loop medication administration system in combination with a unit dose drug delivery by January 2025 in order to minimise medication errors. Otherwise, a penalty of 2 per cent of the total hospital revenue would have to be paid. Derived from best-practice reports in the literature, this paper explores the benefits of smart cabinets in terms of economic efficiency, patient safety, reduced work burden and employee acceptance. Furthermore, the reasons why many German hospital decision makers refuse to implement smart cabinets are presented and analysed. Finally, based on all this information, a generic medication administration process has been developed to provide a blueprint for a successful implementation of smart cabinets as an electronically based backbone in a closed-loop medication administration system.

Hospital pharmacists', doctors' and nurses' perceptions of intra- and inter- professional communication in the context of electronic prescribing and medication administration systems: A qualitative study.

Effective, integrated and coordinated communication is essential in providing high quality patient care. Little prior research has detailed the impact of electronic prescribing and medication administration (ePMA) systems on healthcare professionals' (HCPs') communication. We investigated hospital pharmacists', doctors' and nurses' perceptions of how ePMA systems have affected, or are expected to affect, the way they communicate with each other in an inpatient setting. A qualitative study in three English NHS hospitals: two used different inpatient ePMA systems, and one used paper-based prescribing. We conducted focus groups with pharmacists, and semi-structured individual interviews with doctors and nurses. Transcribed data were analysed inductively using thematic analysis. Nine focus groups, three at each hospital, were conducted with pharmacists with different levels of seniority (58 pharmacists in total). Fourteen doctors and twelve nurses took part in individual interviews. Four themes were generated: modes of communication, reduced pharmacist visibility, system limitations, and future aspirations for ePMA. Whether working with ePMA or paper-based systems, all participants preferred to communicate face-to-face to facilitate collaborative discussions regarding patient care. Participants perceived that ePMA reduced contact time with patients. Pharmacists perceived that both their physical ward presence and their written communication on medication charts had reduced since introduction of ePMA. Doctors felt they were now less likely to ask pharmacists questions due to pharmacists' reduced physical presence on the ward. Hardware and software limitations were identified by all HCPs, with suggestions made for future developments to better support communication. ePMA does not necessarily support communication among HCPs. Pharmacists and doctors were also concerned that ePMA reduces communication between themselves and their patients. Hospital managers should ensure sufficient hardware for HCPs, including pharmacists, to conduct their work in clinical areas, and work with ePMA system suppliers to develop ways of enhancing, rather than inhibiting, communication.

Is there evidence that length-based tapes with precalculated drug doses increase the accuracy of drug dose calculations in children? A systematic review.

The use of pediatric length-based weight estimation tapes with precalculated drug doses is advocated by major Advanced Life Support organizations, but concerns have been raised on the accuracy of these systems. The objective of this systematic review was to collect, review, evaluate, and create a synthesis of the current literature to establish whether there is high-quality evidence for use of length-based tapes in accurate drug dose administration. A further objective was to compare these tapes with other dosing aids. Eligible studies were identified and analyzed if they were peer reviewed, full text articles containing original data. Studies including any form of length-based precalculated drug dosing methodology in children aged 0 to 18 years were included. Eighteen studies met the inclusion criteria. The most studied of the tapes was the Broselow tape in 16 studies (88.9%). When these tapes were used on their own without additional reference material, they produced a substantial number of potentially harmful dosing errors (>20% error). No tape was superior to another. Using the tapes was better than using no dosing aid but was inferior to using both comprehensive drug dosing guides and novel color-coded medication administration systems. There was no high-quality evidence that the use of length-based tapes with precalculated drug doses leads to accurate drug dosing. However, comprehensive drug dosing systems were more effective at reducing dosing errors than were length-based tapes on their own. The confounding effect of weight estimation accuracy on drug dosing accuracy has not been sufficiently studied.

Patient Safety of Perioperative Medication Through the Lens of Digital Health and Artificial Intelligence.

Perioperative medication has made significant contributions to enhancing patient safety. Nevertheless, administering medication during this period still poses considerable safety concerns, with many errors being detected only after causing significant physiological disturbances. The intricacy of medication administration in the perioperative setting poses specific challenges to patient safety. To address these challenges, implementing potential strategies and interventions is critical. One such strategy is raising awareness and revising educational curricula regarding drug safety in the operating room. Another crucial strategy is recognizing the importance of redundancy and multiple checks in the operating room as a hallmark of medication safety, which is not a common practice. Digital health technologies and artificial intelligence (AI) also offer the potential to improve perioperative medication safety. Computerized physician order entry systems, electronic medication administration records, and barcode medication administration systems have been proven to reduce medication errors and improve patient safety. By implementing these strategies and interventions, health care professionals can enhance the safety of perioperative medication administration and improve patient outcomes.

A review of medicines with sustained release

Sustained-release matrix tablets allow for continuous drug release while also optimizing a drug's biologic, pharmacokinetic, and pharmacodynamic properties for maximum therapeutic efficacy. The matrix regulates the rate at which the drug is released. Because it facilitates prolonged release, the major excipient in the formulation is a release retardant. The technology may promote patient compliance and efficiently treat chronic illnesses by decreasing the overall dosage and dosing schedule. The drug is supplied in this system via diffusion- and dissolution-controlled methods. The primary goal of this analysis is to provide comprehensive information on the sustained release system and to discuss the many selection criteria for medicines used in medication administration system

Understanding complexity in a safety critical setting: A systems approach to medication administration

‘Medication errors’ are a significant concern and are associated with a higher incidence of adverse events and unintentional patient harm than any other aspect of healthcare. While much research has focused on adverse medication errors, limited studies have specifically examined ‘normal’ medication delivery performance and the interactions between tasks, agents, and information within the medication administration system. This article describes a study that applied the Event Analysis of Systemic Teamwork (EAST) model to study the hospital medication administration system to identify opportunities to optimise performance and patient safety. Key findings of this study demonstrate that this is a highly complex system, comprising many social agents and a relatively closely linked series of tasks and information. However, most of the workload relies on a small proportion of healthcare professionals. Significantly, the patient has a minimal role in the medication administration system during their hospital stay. The research has shown that this approach enables mapping networks and their interdependencies to optimise the system as a whole rather than its parts in isolation.

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.

Improving Administration and Documentation of Enteral Nutrition Support Therapy in a Veteran Affairs Health Care System: Use of Medication Administration Record and Bar Code Scanning Technology.

The goal of this project was to evaluate and improve the ordering, administration, documentation, and monitoring of enteral nutrition therapies within the inpatient setting in a Veteran's Health Administration system. An interdisciplinary team of clinicians reviewed the literature for best practices and revised the process for enteral nutrition support for hospitalized veterans. Interventions included training staff, revising workflows to include scanning patients and products, including enteral nutrition orders within the medication administration record (MAR), and using the existing bar code medication administration system for administration, documentation, and monitoring. Baseline and postprocess improvement outcomes over a year period were collected and analyzed for quality improvement opportunities. Before process change, only 60% (33/55) of reviewed enteral nutrition orders were documented and 40% (22/55) were not documented in the intake flowsheet of the electronic health record. In the year after adding enteral nutrition therapies to the MAR and using bar code scanning, a total of 3807 enteral nutrition products were evaluated. One hundred percent of patients were bar code scanned, 3106/3807 (82%) products were documented as given, 447/3807 (12%) were documented as held (with comments), 12/3807 (<1%) were documented as missing/unavailable, and 242/3807 (6%) were documented as refused. Inclusion of enteral nutrition order sets on the MAR and using bar code scanning technology resulted in sustained improvements in safety, administration, and documentation of enteral therapies for hospitalized veterans.

Medication safety in the perioperative setting: A comparison of methods for detecting medication errors and adverse medication events.

The purpose of this study was to evaluate perioperative medication-related incidents (medication errors (MEs) and/or adverse medication events (AMEs)) identified by 2 different reporting methods (self-report and direct observation), and to compare the types and severity of incidents identified by each method. We compared perioperative medication-related incidents identified by direct observation in Nanji et al's 2016 study[1] to those identified by self-report via a facilitated incident reporting system at the same 1046-bed tertiary care academic medical center during the same 8-month period. Incidents, including MEs and AMEs were classified by type and severity. In 277 operations involving 3671 medication administrations, 193 MEs and/or AMEs were observed (5.3% incident rate). While none of the observed incidents were self-reported, 10 separate medication-related incidents were self-reported from different (unobserved) operations that occurred during the same time period, which involved a total of 21,576 operations and approximately 280,488 medication administrations (0.004% self-reported incident rate). The distribution of incidents (ME, AME, or both) did not differ by direct observation versus self-report methodology. The types of MEs identified by direct observation differed from those identified by self-report (P = .005). Specifically, the most frequent types of MEs identified by direct observation were labeling errors (N = 37; 24.2%), wrong dose errors (N = 35; 22.9%) and errors of omission (N = 27; 17.6%). The most frequent types of MEs identified by self-report were wrong dose (N = 5; 50%) and wrong medication (N = 4; 40%). The severity of incidents identified by direct observation and self-report differed, with self-reported incidents having a higher average severity (P < .001). The procedure types associated with medication-related incidents did not differ by direct observation versus self-report methodology. Direct observation captured many more perioperative medication-related incidents than self-report. The ME types identified and their severity differed between the 2 methods, with a higher average incident severity in the self-reported data.

Implementing a Home-Grown Barcoded Medication Administration System in a Quaternary Care Hospital

Implementing a Home-Grown Barcoded Medication Administration System in a Quaternary Care Hospital

316 Improving Electronic Prescribing of Mechanical VTE Prophylaxis in General Surgery Patients

Abstract Aim Mechanical VTE prophylaxis forms part of NICE guidance in general surgical patients. Locally, thromboembolic deterrent (TED) stockings are used but not available as a prescription item on the electronic system. They are often prescribed verbally or via noted plans but do not appear on the medication administration record. Importantly, multiple incidents of patient harm through pressure damage have been seen due to poorly checked TEDs. Our aim was to audit and improve safe mechanical VTE prophylaxis prescribing. Method At each cycle, we retrospectively collected data from two weeks of admissions. Data relating to VTE assessment completion, VTE score, TEDs in use, TEDs prescription and LMWH prescription was collected. Our initial intervention consisted of departmental education regarding a work around enabling TEDs to be prescribed as a freehand extra-formulary item. This was reaudited at 12 months. Results All patients in both cycles had VTE assessments completed. TED stocking use increased significantly from 5.1% to 26.4% and prescription of TEDs, when used, increased from 0% to 61.1%. However, documentation regarding daily checks was non-existent. Conclusions Our QIP showed a significant improvement in TEDs use and prescription. However, the intervention is difficult and time consuming. Subsequently from this project, a TEDs stocking item is in the final approval phase for integration into the online prescribing system and will come with associated safety checks built into the nursing medication administration system. Once this is live, we will complete a third cycle to assess uptake and again at 6 months to assess for lasting change.

TH7.12 Improving electronic prescribing of mechanical VTE prophylaxis in general surgery patients

Abstract Aims Mechanical VTE prophylaxis forms part of NICE guidance in general surgical patients. Locally, thromboembolic deterrent (TED) stockings are used but not available as a prescription item on the electronic system. They are often prescribed verbally or via noted plans but do not appear on the medication administration record. Importantly, multiple incidents of patient harm through pressure damage have been seen due to poorly checked TEDs. Our aim was to audit and improve safe mechanical VTE prophylaxis prescribing. Methods At each cycle, we retrospectively collected data from two weeks of admissions. Data relating to VTE assessment completion, VTE score, TEDs in use, TEDs prescription and LMWH prescription was collected. Our initial intervention consisted of departmental education regarding a work around enabling TEDs to be prescribed as a freehand extra-formulary item. This was reaudited at 12 months. Results All patients in both cycles had VTE assessments completed. TED stocking use increased significantly from 5.1% to 26.4% and prescription of TEDs, when used, increased from 0% to 61.1%. However, documentation regarding daily checks was non-existent. Conclusions Our QIP showed a significant improvement in TEDs use and prescription. However, the intervention is difficult and time consuming. Subsequently from this project, a TEDs stocking item is in the final approval phase for integration into the online prescribing system and will come with associated safety checks built into the nursing medication administration system. Once this is live, we will complete a third cycle to assess uptake and again at 6 months to assess for lasting change.

Development of the Leapfrog Group's Bar Code Medication Administration Standard to Address Hospital Inpatient Medication Safety.

Medication errors are the most common type of error in hospitals and reflect a leading cause of avoidable harm to patients. Bar code medication administration (BCMA) systems are a technology designed to help intercept medication errors at the point of medication administration. This article describes the process of developing, testing, and refining a standard for BCMA adoption and use in U.S. hospitals, as measured through the Leapfrog Hospital Survey. Building on the published literature and an expert panel's collective experience in studying, implementing, and using BCMA systems, the expert panel recommended a standard with 4 key domains. Leapfrog's BCMA standard provides hospitals with a "how-to guide" on what best practice looks like for using BCMA to ensure safe medication administration at the bedside.

Mindful Workarounds in Bar Code Medication Administration.

Bar-Coded Medication Administration systems (BCMA) are often used with workarounds. These workarounds are usually judged against standard operating procedures or the use of the technology as 'designers' intended'. However, some workarounds may be reasonable and justified to prevent safety errors. In this conceptual paper, we clarify BCMA safety mechanisms and provide a framework to identify workarounds with BCMA that nullify the error prevention mechanisms inherent in the technology design and process. We also highlight the importance of understanding the purpose behind a nurse's workaround in BCMA, focusing on the notion of mindful (thoughtful) workarounds that have the potential to improve patient safety.

Trends in blood pressure diagnosis, treatment, and control among VA nursing home residents, 2007-2018.

Inadequate treatment of high blood pressure (BP) can lead to preventable adverse events in nursing home residents, while excessive treatment can lead to associated harms. Data were extracted from the VA electronic health record and Bar Code Medication Administration system on 40,079 long-term care residents aged ≥65 years from October 2006 through September 2018 (FY2007-2018). Hypertension prevalence at admission was identified by ICD code(s) in the year prior, and antihypertensive medication use was defined as administration ≥50% of days. BP measures were averaged over 2-year epochs. The age-standardized prevalence of hypertension diagnosis at admission increased from 75.2% in FY2007-2008 to 85.1% in FY2017-2018 (p-value for trend <0.001). Rates of BP treatment and control among residents with hypertension at admission declined slightly over time (p-values for trend <0.001) but remained high (80.3% treated in FY2017-2018, 80.1% with average BP <140/90 mmHg). The age-adjusted prevalence of chronic low BP (average <90/60 mmHg) also declined from 11.1% in FY2007-2008 to 4.7% in FY2017-2018 (p-value for trend <0.001). Persons identified as Black race or Hispanic ethnicity and those with a history of diabetes, stroke, and renal disease were less likely to have an average BP <140/90 mmHg. Hypertension is well controlled in VA nursing homes, and recent trends of less intensive BP control were accompanied by a lower prevalence of chronic low BP. Nonetheless, some high-risk populations have average BP levels >140/90 mmHg. Future research is needed to better understand the benefits and harms of BP control in nursing home residents.