Medication Administration System Research Articles

“On time ‐ every time” A new strategy for dosing levodopa in hospital

AbstractMost Parkinson’s Disease (PD) patients are hospitalised for reasons other than their PD. Their PD symptoms are usually under control before admission, however, too many seem to experience medication‐related problems in hospital. Hospitalised PD patients should receive their levodopa within 30 min of the scheduled time (“on time”) and not miss doses (“every time”). Hospital staff should avoid prescribing and administering contraindicated dopamine antagonists to PD patients in their care. Multiple studies have shown the failure to deliver levodopa “on time” to PD patients, with less than 50% of doses being “on time” and an average 0.7 of doses missed each day. The evidence points to hospital medication administration systems (HMAS) as the likely cause of late and missed levodopa doses. PD medication administration guidelines were reviewed to find strategies that reduced late and missed doses. An integrated “on time – every time” medication administration approach is proposed. PD patients should be encouraged to self‐administer their medication in hospital. More PD nurse navigators will be needed to facilitate PD patient care in Australian hospitals.

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.

Hoitotyöntekijöiden näkemyksiä lääkehoidon hallintajärjestelmän tuesta ammattimaiseen ja turvalliseen lääkehoitoon

Turvallinen lääkehoito on keskeinen osa sairaanhoitajan työtä. Turvallista lääkehoitoa on tutkittu lääkitysvirheiden avulla, mutta turvallista ja ammattimaista lääkehoitoa tukevista asioista on vähemmän aiempaa tutkimustietoa. Tämän tutkimuksen tarkoituksena on kuvata hoitotyöntekijöiden näkemyksiä siitä, mikä nykyisessä lääkehoidon hallintajärjestelmässä tukee turvallista ja ammattimaista lääkehoitoa. Lääkehoidon hallintajärjestelmällä tarkoitetaan kaikkia lääkehoidon antamista ja siihen liittyviä toimenpiteitä ohjaavia ja tukevia organisaation rakenteita ja käytäntöjä.
 Tutkimus toteutettiin yhdessä Suomen keskussairaalassa. Aineisto kerättiin kaksoiskäännetyn Medication Administration System – Nurses Assesment Scale (MAS - NAS) -mittarin avoimen osion ja taustakysymysten avulla. Aineisto analysoitiin induktiivisella sisällönanalyysilla.
 Turvallista lääkehoitoa tuki säilytyspaikan asianmukaisuus, tarvikkeiden tarpeenmukaisuus, lisätiedon saatavuus lääkkeistä, sähköisen järjestelmän hyödyllisyys ja hyvä käytettävyys, potilaskohtaisten tietojen saatavuus, lääkityksen varmistusmahdollisuus, tarkistuskäytäntöjen ja lääkehoidon osa-alueestaan vastuun kantaminen. Ammattimaista lääkehoitoa tuki yhteistyössä toimiminen ja ajan tasalla pysyminen.
 Tukeakseen turvallista lääkehoitoa johtajien tehtävänä on tarjota lääkkeille asianmukaiset säilytystilat ja hoitotyöntekijöiden käyttöön tarvittavat tarvikkeet sekä sellaiset välineet, että lääkityksessä tarvittavat tiedot ovat saatavilla ja lääkitys on mahdollista varmistaa. Tarkistuskäytännöt tulee ottaa käyttöön ja varmentaa, että kaikki tuntevat lääkehoidon vastuunsa. Sähköisen järjestelmän hyvä käytettävyys ja hyödyllisyys hoitotyöntekijöille on keskeistä turvalliselle lääkehoidolle. Ammattimaista lääkehoitoa vahvistavat tiedon jakaminen ja esimiesten kannustus yhteistyössä toimimiseen, kouluttautumiseen ja aktiiviseen tiedonhakuun.

Feasibility of reusing routinely recorded data to monitor the safe preparation and administration of injectable medication: A multicenter cross-sectional study

BackgroundReusing routinely recorded data from electronic hospital records (EHR) may offer a less-time consuming, and more real time alternative for monitoring compliance by nurses with a protocol for the safe preparation and administration of injectable medication. However, at present it is unknown if the data necessary to calculate the quality indicators (QIs) are recorded in EHRs, or if these data are suitable for automated QI calculation. Therefore, the aim of this study was to determine the feasibility of monitoring compliance by nurses with a protocol for the safe injectable medication preparation and administration by reusing routinely recorded EHR data for the automated calculation of QIs. MethodsA cross-sectional study in 12 Dutch hospitals (October 2015–May 2016). The checks included in the currently prevailing national protocol for the safe preparation and administration of injectable medication were translated into 16 data elements required to calculate the QIs. At each hospital, one interview was conducted using a structured questionnaire to decide whether the data elements were available in EHRs. To present these results, descriptive statistics were used. ResultsIn total, 20 health-care professionals were interviewed and four different EHR systems were evaluated. The availability of data elements was comparable between the four evaluated EHR systems. Nine of the 16 required data elements were recorded in EHRs, eight in a structured format. The seven missing data elements were mainly related to checks such as ‘gather all materials needed’ or ‘conduct hand hygiene’. Furthermore, changes were identified in the process for the preparation and administration of injectable medication. These changes are mostly related to the increased use of electronic medication administration registration and barcode medication administration systems. ConclusionsReusing EHR data to monitor compliance by nurses with the currently prevailing protocol for the safe preparation and administration of injectable medication is not entirely feasible. A decision should be made on which checks should be recorded in the EHRs and which checks should be audited in order to minimize the registration burden for nurses. Moreover, the currently prevailing protocol should be revised to bring it in line with work-as-done. Our results can be used as guidance for such a revision and also for designing new QIs that can be calculated by reusing routinely recorded EHR data.

The influence of peer beliefs on nurses' use of new health information technology: A social network analysis.

Implementation of health information technology fails at an alarming rate because intended users often choose not to use it. Implementation theory and frameworks suggest that social networks may influence individuals' use, but empirical study remains limited. Furthermore, neither theory nor research has identified whose beliefs within the network matter most for implementation. We examine the relationship between an individual's system use and the beliefs of his or her peers. We assess the relationship for two peer groups: the entire group of peers and the subset that shares the individual's beliefs about the system. We used data collected from an academic hospital in the United States that had recently implemented a bar code medication administration system, a technology meant to increase medication safety. We administered a survey to nurses (N=207) in six clinical units approximately 3-5 months (April-June 2013) after the "go-live" of the system to identify peer groups and beliefs about system usefulness. We calculated mean peer belief for the entire peer group and sharedness of belief using a homophily measure. From the hospital's electronic health record system, we obtained nurses' system use during the 3-month data collection period. We used multivariable linear regression to examine relationships. We found no effect of mean peer beliefs on individual system use. However, sharedness of belief about usefulness was positively associated with individual system use. Individuals' own positive belief was only associated with greater system use when shared with peers. Our findings indicate a significant role of social networks in implementation, and specifically that shared beliefs between an individual and his or her peer network may be critical to implementation success, more so than the beliefs across the entire peer group. Reinforcement by the social network appears to dictate whether individuals' own beliefs translate into system use.

Restrictions on Nursing Students' Electronic Health Information Access.

Restrictions on students' use of electronic health information have been anecdotally reported as a threat to clinical learning, development of informatics competency, and adherence to personal health information privacy laws. However, evidence on which informatics education and policy strategies can be designed is lacking. This study describes the scope of nursing students' access to and use of electronic health information systems as reported by clinical instructors. Clinical faculty (n = 193) in prelicensure programs from 25 states completed the online survey. Students are often restricted in retrieving patient health information, charting assessment data and delivered care, and using medication administration systems. Students alternatively use faculty or staff nurses' system security access. Results suggest the need for critical review of nursing curriculum related to informatics competency and clinical site health records access policies.

Integration of a Commercial Barcode-Assisted Medication Dispensing System in a Teaching Hospital

A commercial barcode-assisted medication administration (BCMA) system was integrated to secure the medication process and particularly the dispensing stage by technicians and the administration stage with nurses. We aimed to assess the impact of this system on medication dispensing errors and barriers encountered during integration process. We conducted a controlled randomized study in a teaching hospital, during dispensing process at the pharmacy department. Four wards were randomized in the experimental group and control group, with two wards using the system during 3 days with dedicated pharmacy technicians. The system was a closed loop system without information return to the computerized physician order entry system. The two dedicated technicians had a 1-week training session. Observations were performed by one observer among the four potential observers previously trained. The main outcomes assessed were dispensing error rates and the identification of barriers encountered to expose lessons learned from this study. There was no difference between the dispensing error rate of the control and experimental groups (7.9% for both, p = 0.927). We identified 10 barriers to pharmacy barcode-assisted system technology deployment. They concerned technical (problems with semantic interoperability interfaces, bad user interface, false errors generated, lack of barcodes), structural (poor integration with local information technology), work force (short staff training period, insufficient workforce), and strategic issues (system performance problems, insufficient budget). This study highlights the difficulties encountered in integrating a commercial system in current hospital information systems. Several issues need to be taken into consideration before the integration of a commercial barcode-assisted system in a teaching hospital. In our experience, interoperability of this system with the electronic health record is the key for the success of this process with an entire closed loop system from prescription to administration. BCMA system at the dispensing process remains essential to purchase securing medication administration process.

The devil is in the detail: How a closed-loop documentation system for IV infusion administration contributes to and compromises patient safety.

Many studies have highlighted the patient safety risks in intravenous medication administration, and various technological solutions have been proposed to mitigate those risks, including 'smart pumps' and closed-loop systems. Few studies describe these implementations in detail. In this article, we report on a sociotechnical investigation of a closed-loop documentation system linked with smart pumps for intravenous infusion administration on an intensive care unit. The smart pumps are 'mapped' to an electronic prescribing and medication administration system, allowing infusion rates, volumes and boluses of intravenous medication to be monitored in real time. Ethnographic observations were conducted over 37 h, including direct observation of infusion administration (n = 23 infusions), discussions with clinical staff and semi-structured interviews with intensive care unit managers (n = 2). Analysis was based on the Distributed Cognition for Teamwork (DiCoT) method to understand how information is processed across individuals, teams and technologies. We report on how the system works in context, and identify contributions and compromises to patient safety with new risks that need to be managed at bedside and intensive care unit level.

The impact of implementing a hospital electronic prescribing and administration system on clinical pharmacists\u2019 activities - a mixed methods study

BackgroundThe increasing adoption of hospital electronic prescribing and medication administration (ePA) systems has driven a wealth of research around the impact on patient safety. Yet relatively little research has sought to understand the effects on staff, particularly pharmacists. We aimed to investigate the effects of ePA on pharmacists’ activities, including interactions with patients and health professionals, and their perceptions of medication safety risks.MethodsA mixed methods study comprising quantitative direct observations of ward pharmacists before and after implementation of ePA in an English hospital, and semi-structured interviews post-ePA. Quantitative data comprised multi-dimensional work activity sampling to establish the proportion of time ward pharmacists spent on different tasks, with whom and where. These data were extrapolated to estimate task duration. Qualitative interviews with pharmacists explored perceived impact on (i) ward activities, (ii) interactions with patients and different health professionals, (iii) locations where tasks were carried out, and (iv) medication errors.ResultsObservations totalled 116 h and 50 min. Task duration analysis suggested screening inpatient medication increased by 16 mins per 10 patients reviewed (p = 0.002), and searching for paper drug charts or computer decreased by 2 mins per 10 patients reviewed (p = 0.001). Pharmacists mainly worked alone (58% of time pre- and 65% post-ePA, p = 0.17), with patient interactions reducing from 5 to 2% of time (p = 0.03). Seven main themes were identified from the interviews, underpinned by a core explanatory concept around the enhanced and shifting role of the ward pharmacist post-ePA. Pharmacists perceived there to be a number of valuable safety features with ePA. However, paradoxically, some of these may have also inadvertently contributed to medication errors.ConclusionThis study provides quantitative and qualitative insights into the effects of implementing ePA on ward pharmacists’ activities. Some tasks took longer while others reduced, and pharmacists may spend less time with patients with ePA. Pharmacists valued a number of safety features associated with ePA but also perceived an overall increase in medication risk. Pharmacy staff demonstrated a degree of resilience to ensure ‘business as usual’ by enhancing and adapting their role.

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.

Development and application of a closed-loop medication administration system in University of Hongkong-Shenzhen Hospital

Abstract Objective This study aimed to develop and apply a closed-loop medication administration system in a hospital in order to reduce medication administration errors (MAEs). Methods The study was implemented in four pilot general wards. We used a before-and-after design to collect oral medication administration times before and after the implementation of the closed-loop medication administration system, evaluated MAE alert logs after the intervention, and conducted a survey of the nurses’ satisfaction with the system in the pilot wards. Results (a) Nursing time of oral medication administration: before the adoption of the closed-loop medication administration system, the average nursing time was 31.56 ± 10.88 minutes (n = 78); after the adoption of the system, the time was 18.74 ± 5.60 minutes (n = 54). Independent sample t-tests showed a significant difference between two groups (t = 8.85, P <0.00). (b) Degree of nurses’ satisfaction with the closed-loop medication administration system: 60.00% (n = 42) of nurses considered the system to be helpful for their work and nearly half of the nurses (47.14%, n = 33) believed that the system could facilitate clinical work and reduce workload; 51.43% (n = 36) believed that the system could reduce checking time and enhance work efficiency; 82.86% (n = 58) believed that the system was helpful in improving checking accuracy to reduce MAEs and ensure patient safety. More than 60% of the nurses considered the system to be a method that could help to track MAEs to improve nursing quality. (c) The MAE alert logs during observation period: it revealed only 27 alerts from the repeated scans of 3,428 instances of medication administration. Conclusions The nurses were satisfied with the closed-loop medication administration system because it improved their work efficiency and reduced their workload. The current investigation was limited by time; therefore, further research is needed to more closely examine the relationship between the system and MAEs.

Data Model for Initiatives to Monitor Exposure to Antimicrobials (DataMIME)

ObjectivePlan, develop, and pilot an open source system that could be integrated into the PCORnet (PCORI) and Sentinel (FDA) national common data models (CDMs) to generate antimicrobial use (AU) reports submittable to CDC’s National Healthcare Safety Network (NHSN). The system included ancillary tables, and data quality and report generation queries. The DataMIME system will allow hospitals to generate comparable AU reports for hospital inpatients.IntroductionDespite decades of attempts to promote judicious AU, the US has high rates of per-person antimicrobial consumption, and extremely high rates of carbapenem use1. Such profligate use is a key factor in the high rate of antimicrobial-resistant infections seen in US healthcare facilities2. Antimicrobial stewardship (AS) programs have been identified as a critical component of intervention strategies3. A core component of AS programs is tracking AU, which is needed to monitor trends in use, focus interventions on aberrant behaviors, promote judicious use, and evaluate the effectiveness of interventions. A system designed to extend two national data models would provide a scalable platform for rapid adoption of AU reporting.MethodsVirtual meetings were held with all participating sites (five hospitals in IL, LA, and TN) to develop the ancillary tables to capture intrahospital patient movement, and administration of antimicrobial agents. Ancillary tables were designed & sites populated the tables with calendar year 2016 data. Data characterization was performed to assess overall table statistics, and verify mappings of facility unit locations to NHSN location codes, medications to RxNorm, and routes of administration to one of four SNOMED categories. Additional characterization focused on CDC’s NHSN Validation Protocol for the AU module. Analytical queries were developed to produce the output metrics required for submission to the NHSN AU module.ResultsTwo ancillary tables and two look-up tables were developed: a bed information table (Table 1) to capture local location codes with a date-time stamp for precise tracking of patient location; a separate location look-up table allows mapping to other terminologies (Table 2); and, an inpatient drug administration table (Table 3) to capture data from the electronic medication administration record (eMAR) or bar coding medication administration (BCMA) system, utilizing a route of administration look-up table (Table 4). The data model was structured to accommodate use cases with alternative mapping terminologies for local location code, local term for route of administration, local codes for medication, and the option of including the NDC code. All sites populated the ancillary tables. For the bed information table, all sites utilized their ADT table information for patient movement. For the medication administration table, most sites limited the inclusion criteria to the 89 antimicrobial agents required for reporting to the NHSN AU module. Aggregate results from participating sites for facility-wide measures and select antimicrobial agents are presented in Table 5.ConclusionsThe data model developed was able to produce the metrics required for reporting to CDC’s NHSN AU module. The data dictionary language, implementation guidance, mappings, and queries will be distributed as a tool-kit for other PCORnet and Sentinel sites for reporting to the AU module. In addition, this CDM could allow for the development of additional metrics including excessive use of antibiotic combinations of redundant spectra, syndrome specific antibiotic use, or increased use of excessively broad spectrum antibiotic classes.

Mixed methods study of medication-related decision support alerts experienced during electronic prescribing for inpatients at an English hospital

ObjectivesElectronic prescribing and medication administration systems are being introduced in many hospitals worldwide, with varying degrees of clinical decision support including pop-up alerts. Previous research suggests that prescribers override a...

Implementing Barcode Medication Administration Systems in Public Sector Medical Units

Medication errors in healthcare have a high cost since it is one of the main causes of harming a patient; it leads to inefficient utilization of healthcare organization resources. The barcode medication administration system helps in improving the patients' safety. The purpose of this article is to determine preparatory needs for introducing a Barcoding Medication Administration System (BCMA) in the medical units in one of the largest tertiary hospital in Abu Dhabi City, United Arab Emirates. Analytical Hierarchical Process (AHP) has been employed to describe systematic decision-making by prioritizing different factors that affect the implementation of BCMA and how technology plays a role in helping to reduce or prevent human errors by promoting safety in the health care sectors. Five major domains are identified: leadership, technology, process, education, quality and safety. Leadership was found to be the most important factor oppositely of technology was the least important.

An Image Sharing-based Solution for Secure Inpatient Medication Administration

Patients face risks of health damage from medication error. To prevent such errors, hospitals need a secure medication administration system. Using threshold sharing technology, a secure medication administration method is proposed here. When a patient visits the doctor and the doctor prescribes n medications, a photo of the patient is encoded into n portions. Then the prescription and these n portions are stored in the hospital information system. Any portion provides the smallest quantity of information needed to reveal the smallest part of the original photo. As more portions are received, more of the photo is revealed. Once all n portions have been received, the original photo is revealed with very little distortion, meaning that the method is highly fault-tolerant. Before dispensing medications, the dispensers at the medication counter should scan the tags of all drug packages. If the dispensers at the medication counter have the correct n medications, the computer receives the n portions, and the photos of the patients are displayed on the screen. Then the dispensers at the medication counter know that there are no drugs missing or wrong, and also which drugs belong to which patient.

HOW BAR CODED MEDICATION ADMINISTRATION TECHNOLOGY AFFECTS THE NURSE-PATIENT RELATIONSHIPS: AN ETHNOGRAPHIC STUDY.

This study aims to assess how care is mediated through technology by analyzing the interaction between nurses, patients, and a Bar Coded Medication Administration (BCMA) system. The objective is to explore how patients experience care through medication technology, with the main focus of our observations and interviews on nurses rather than patients. A qualitative ethnographic study was conducted in an orthopedic ward of a Dutch general hospital. After analyses, the following two themes were discerned: (i) the use of bar code medication technology organizes double institutionalization, and (ii) nurses frequently need to work around the BCMA, as the system is not always supportive of patient needs. The results of this study indicate that BCMA is not merely a neutral tool, but an active component within the nurse-patient relationship, as it influences medication administration and profoundly affects patient participation in the care process.

Impact of a Barcode Medication Administration System on Patient Safety

To determine the impact of barcode medication administration (BCMA) on the incidence of medication administration errors among patients in an onco-hematology day hospital and to identify the characteristics of medication errors in that setting. . 715 patients treated in the onco-hematology day unit at the Príncipe de Asturias University Hospital in Madrid, Spain. . A between-groups, pre-/postintervention study was conducted. Administration errors observed in patients with solid tumors (intervention group) were compared with those in patients with hematologic cancer (control group) before and after the introduction of BCMA. Error incidence, type, and severity were assessed, as was length of stay for treatment. . Use of a BCMA system reduced the incidence and severity of errors in medication administration in the onco-hematology day hospital. . BCMA is a useful technology to check the five rights of medication administration in the onco-hematology day hospital and could help nurses increase the time spent on direct patient care activities. .

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.

Improving Insulin Administration Through Redesigning Processes of Care: A Multidisciplinary Team Approach.

This article describes a quality improvement project using a multidisciplinary team approach to improve the rate of errors of omission of preprandial subcutaneous coverage insulin orders. A Diabetic Management Work Group was created to evaluate the system processes that affect success and failure of timely administration and documentation of preprandial coverage insulin, commonly referred to as sliding scale coverage. Data before and after the project were collected to evaluate the effectiveness of a process change through the bar code medication administration system, in which preprandial coverage insulin order sets were changed to eliminate errors of omission and improve documentation. A review of 833 random blood glucose measurements with corresponding short- or rapid-acting insulin coverage orders was conducted. A mean error of omission rate of 23.4% was identified with respect to coverage insulin that was clinically indicated by provider-ordered insulin set but not administered or documented in the electronic medication record. After process redesign and implementation, 951 blood glucose measurements with corresponding insulin coverage orders were randomly reviewed, and a mean of 10.7% of omission rate for coverage insulin administration was identified. This represented a decrease in omission of coverage insulin by 54% compared with preprocess improvement. Decreased errors of omission as well as improved administration and documentation of coverage insulin were demonstrated by this multimodal process change. Scheduled standardized order sets, extensive nursing staff education, and enhanced efficiency of the existing process led to improved outcomes.

THE MONITORING OF DENTAL ORGANIZATION’S MEDICAL WORKERS COMPETENCES ACCORDING TO THE NEW SYSTEM OF WAGE PAYMENTS

Using the method of empirical anonymous sociological research the competence of 630 dentists and health care institutions managers according to the new system of wage payments (NSWP) was studied. On the 7 questions asked, containing about 6138 possible answers from all the respondents 2253 correct answers were retrieved which represents 36,7% of all responses. Found data shows that only every third dental clinic specialist has the competence in NSWP while the majority 63, 3% are not quite oriented in the NSWP. One of the main problems of the NSWP integration is lack of understanding of basic principles and specific criteria of work quality assessment from health care institutions employees thus nullifies the potentially high impact of its introduction. Raise of the transparency of wage payment system will cause significant personnel motivation improvement in achieving qualitative and quantitative labor values that the authority has laid for the organization that are tied to the work goals of the institution itself and the health care system as a whole. Medical institution administration system should use new tools for staff competence improvement nowadays. It is necessary to provide professional communication space for colleagues on the questions of NSWP.