Medication Cart Research Articles

Evaluation of ambient noise including conversation in medical facilities

We are studying the research focusing on an ambient noise in medical facilities with the aim of improving the acoustical environment, which can make patients comfortable to cure own illness at a medical area such as a patient room. At medical areas, there are many sound sources such as device sounds, personal active sounds, and talker’s voices during a conversation. It is necessary to develop a method which can record and analyze an ambient noise without any intelligible contents of conversation voices, since all personal information belonging to a patient should be protected as confidential in medical facilities. In this experiment, acoustical measurement of each environmental sound such as the sound of footsteps, equipment alarm, intravenous stand, and medical cart at the simulated patient room in my school was conducted. Then, recorded ambient noises mixed with conversation voices and the other environmental sounds were fragmented in time, and the fragmented signal components were removed alternately s...

Smart Medicine and Healthcare

Innovation and rapid technological development in Smart Medicine or Smart Healthcare impact profoundly on many aspects of healthcare. It is believed that Health Information Technology (HIT) has the potential to improve integration between care providers, reduce administrative costs and burdens, reduce medical errors, and improve care quality and patient outcomes. However, issues such as interoperability, compatibility, and integration are critical to effectively integrating hardware and software in order to fully realize the benefits of HIT. High-end medical devices and equipment, including medical carts / mobile computer carts and wireless physiological and biomedical monitoring devices, should also be integrated into the hospital information system. Furthermore, the Data, Information, Knowledge, and Wisdom Hierarchy (DIKW) has been gaining popularity in the development of Nursing Information Systems (NIS) since 2013. To create a DIKW-based information system, data must first be defined and analyzed and then transformed into meaningful information. Eventually, this information is transformed into an intelligent system. For example, if evidence-based nursing research results / findings are integrated into the NIS to guide clinical practice, patient outcomes, patient safety, and healthcare quality will be greatly enhanced.

Renovations Big and Small Can Help Make the SNF More Like Home

Renovations Big and Small Can Help Make the SNF More Like Home

病院内回診支援ロボットの設計と開発

We have developed “Terapio”, a next-generation robot that replaces the conventional medical cart used by healthcare staff during their rounds at the medical front. Terapio assists medical staff in delivering resources and recording round information with its robotic control abilities. An omnidirectional mobile mechanism and a human tracking control system to follow a specified medical professional realize smooth transfer movement from a nurses station to wards. Data on rounds is automatically recorded by a CCD camera and a voice recorder. When the robot is connected via a cable to a medical data server, the robot transmits patients' data to the server and receives new patients' information. The use of robots to support medical care allows humans to concentrate on those tasks requiring knowledge, skill, and experience, is then expected to contribute to the enhancement of the quality of healthcare services.

Determining high touch areas in the operating room with levels of contamination.

The Centers for Disease Control and Prevention put forth the recommendation to clean areas considered high touch more frequently than minimal touch surfaces. The operating room was not included in these recommendations. The purpose of this study was to determine the most frequently touched surfaces in the operating room and their level of contamination. Phase 1 was a descriptive study to identify high touch areas in the operating room. In phase 2, high touch areas determined in phase 1 were cultured to determine if high touch areas observed were also highly contaminated and if they were more contaminated than a low touch surface. The 5 primary high touch surfaces in order were the anesthesia computer mouse, OR bed, nurse computer mouse, OR door, and anesthesia medical cart. Using the OR light as a control, this study demonstrated that a low touch area was less contaminated than the high touch areas with the exception of the OR bed. Based on information and data collected in this study, it is recommended that an enhanced cleaning protocol be established based on the most frequently touched surfaces in the operating room.

A Case Illustrating the Costs of Quality Improvement: Nine Months to Move Needles and Syringes on the Anesthesia Cart.

Powerful entities are pushing physicians to become more involved with quality improvement (QI). We report a QI project to standardize and improve the ergonomics of the anesthesia medication and supply cart. Simply obtaining approval to make minor changes to the cart involved 54 phone calls, 164 e-mails, 4 presentations, 2 forms, 9 meetings, and 4 months of time. Confusion over fiscal matters further delayed the project by an additional 3 months. A combination of competing regulations, administrative overprocessing, and the lack of dedicated QI financial resources made simple improvements a challenge. The costs of participating in QI deserve attention.

Implementation of an Automated Dispensing Cabinet Stewardship Program at a Tertiary Academic Medical Center.

Automated dispensing cabinet (ADC) use within hospitals is designed to replace or partially replace medication cabinets or carts to allow for a more decentralized model of medication distribution. This project was designed to improve medication delivery by decreasing the burden of dispensing patient-specific medications from a centralized inpatient pharmacy while decreasing overall inventory cost. This single-center pilot analysis evaluated ADC inventory optimization in a mixed medical population. Data collected included inventory cost on ADC, medications removed from or added to ADC, patient-specific medications sent from central pharmacy, and the rate of medication stock outs on ADC.

Shoulder Joint Loading and Posture During Medicine Cart Pushing Task

Excessive physical loads and awkward shoulder postures during pushing and pulling are risk factors for shoulder pain. Pushing a medicine cart is a major component of a work shift for nurses and medical assistants in hospitals and other health care facilities. A laboratory experiment was conducted to examine the effects of common factors (e.g., lane congestion, cart load stability, floor surface friction) on shoulder joint moment and shoulder elevation angle of participants during cart pushing. Participants pushed a medicine cart on straight tracks and turning around right-angle corners. Peak shoulder joint moments reached 25.1 Nm, 20.3 Nm, and 26.8 Nm for initial, transition, and turning phases of the pushing tasks, indicating that shoulder joint loading while pushing a medical cart is comparable to levels previously reported from heavy manual activities encountered in industry (e.g., garbage collection). Also, except for user experience, all other main study factors, including congestion level, cart load stability, location of transition strip, shoulder tendency, surface friction, and handedness, significantly influenced shoulder joint moment and shoulder elevation angle. The findings provide a better understanding of shoulder exposures associated with medicine cart operations and may be helpful in designing and optimizing the physical environment where medicine carts are used.

Designing a Medication Cart and Computerized Chart on a Budget

Designing a Medication Cart and Computerized Chart on a Budget

Storm surge prediction with management information systems: A case study of estimating value and observations system

A natural disaster is a major adverse event resulting from the earth’s natural forces. We can now take advantage of information technology (IT) devices to make migration decisions and hazard analysis. The range of IT applications is very wide, and could include robot manufacturing, remote exploration, fuzzy Lyapunov techniques, artificial intelligence, intelligent devices, tension leg platform design, consumer and service quality, and management information systems. Management information systems are especially helpful to medical personnel when carrying out the treatment and medication of patients. Sometimes, though, hospital staff might not have immediate access to a patient’s records such as response to treatments, medication status, or examination results because the computer equipment is not easily portable. In such situations, it is only possible to keep written records, with the data being cataloged or referred to only after returning to the nursing station or office. If the hospital could implement a computerized medical service cart for use in the wards, the above problems would be solved. These computers could use a wireless network system, linked with the central server to access information. The technology now exists and the era of the smart phone has now been entered. Smart phones/tablet PCs could be applied for clinical medical care. For the elderly and patients with chronic diseases, smart health devices designed for home care service are necessary and should be applied as soon as possible. This study designs a wireless physiology signal monitoring system that uses a smart phone with a wireless network apparatus to provide convenient monitoring for patients in the home care service system. The wireless care system is designed for patients who need long-term home care services or assistance with chronic diseases. This paper provides important suggestions to develop ways to connect patients to medical care institutions through the internet.

Dynamic Performance of Fuel Cell Power Module for Mobility Applications

Fuel cell powered vehicles have been developed as another alternative to internal combustion engine powered vehicles for some applications including passenger cars, buses, trains, motorcycles, forklifts, electric wheelchairs, electric trolleybuses, medical carts, military engines, personal sports craft, mobility devices and other self propelled equipment. Up to now, many researches have focused on the development of the power module in the Fuel cell vehicles (FCVs) and the components of these systems such as membranes, bipolar plates, and electrodes. However, our work in this study focuses on operating the integrated fuel cell power module system efficiently for various operating conditions such as pressure, relative humidity and operating modes. In our validation we have utilized PEMFC single cell, with active area geometry 16 cm2 and of 120 cm2. Some results obtained in our study shown significant performance indicators for PEMFC stack (composed of 2 cells and 4 cells in a series) at different humidification levels.

Potential Risks Associated with Medication Administration, as Identified by Simple Tools and Observations

Adverse events are common in health care institutions. In a study published in 2007, the Canadian Institute for Health Information reported that “1 in 13 adult medical and surgical patients admitted to acute care hospitals in Canada in 2000 experienced an adverse event”. Medication errors are among the most frequent adverse events. In an international survey of adults with health problems, administered by The Commonwealth Fund, about 10% of Canadian respondents reported having received the wrong medication or dose from a health care provider in the previous 2 years. These errors may result in morbidity, mortality, increases in monitoring and costs of care, and delays in hospital discharge. A prospective cohort study analyzing the incidence of drug-related adverse events in 2 tertiary care hospitals showed that 34% of preventable adverse medication-related events were at the administration stage, making this category the second most frequent cause (after errors at the ordering stage, which accounted for 56% of preventable adverse medication events). Given this reality, the management of medication-related risks is a priority for hospitals. The medication-use system is complex, with a total of 54 identified phases, for which many activities, tools, equipment, and information systems are needed and for which several interfaces are typically required. Many of these phases, particularly the medication administration process, carry high risks. Typically, nurses are responsible for the critical stages of the medication-use system, with a risk of error at each stage. Importantly, there seems to be a link between the way nurses’ work is organized and the occurrence of errors during the administration of medications. According to a study on nurses’ perceptions of medication errors, “a single hospital patient can receive up to 18 medications per day, and a nurse can administer as many as 50 medications per working shift”. A study of the delivery of nursing care in acute care settings showed that nurses spent 16% of their time preparing or administering medications. In addition, 22% of interruptions occurred during the medication preparation process. A high number of interruptions can lead to medication errors. At the authors’ centre, medication errors were an important cause of incidents and accidents from 2004 to 2010. More specifically, medication errors represented 74% of incidents and accidents in 2004/2005, although this proportion was reduced to 39% in 2010/2011. Errors related to drug administration represented 66.3% of these medication errors. Various preventive strategies are used to manage risk within the medication-use system, including training and use of daily unit-dose medication distribution systems, with medication carts containing individual drawers designated for specific patients (identified by bed numbers). Nonetheless, errors still occur frequently in health care institutions.

Nursing Perception of the Impact of Medication Carts on Patient Safety and Ergonomics in a Teaching Health Care Center

Objectives: In our Quebec (Canada) University Hospital Center, 68 medication carts have been implemented as part of a nationally funded project on drug distribution technologies. There are limited data published about the impact of medication carts in point-of-care units. Our main objective was to assess nursing staff’s perception and satisfaction of medication carts on patient safety and ergonomics. Method: Quantitative and qualitative cross-sectional study. Data were gathered from a printed questionnaire administered to nurses and an organized focus group composed of nurses and pharmacists. Results: A total of 195 nurses completed the questionnaire. Eighty percent of the nurses agreed that medication carts made health care staff’s work easier and 64% agreed that it helped to reduce medication incidents/accidents. Only 27% and 43% agreed that carts’ location reduces the risk of patients’ interruptions and colleagues’ interruptions, respectively. A total of 17 suggestions were extracted from the focus group (n = 7 nurses; n = 3 pharmacist) and will be implemented in the next year. Conclusions: This descriptive study confirms the positive perception and satisfaction of nurses exposed to medication carts. However, interruptions are a major concern and source of dissatisfaction. The focus group has revealed many issues which will be improved.

Three-Dimensional Dynamics of a Rigid Body with Wheels on a Moving Base

AbstractFor reasons more related to functionality than safety, it is not uncommon for heavy mechanical and electrical equipment to be placed on wheels. Examples of such devices are medical carts, mechanical equipment in hospitals, electrical transformers, and recently, even supercomputers. Although wheels facilitate the operation of these devices, they also affect the response of these objects during earthquakes, but not necessarily in a beneficial way. While a wheel rolling favors the translational displacement of the body in the horizontal direction parallel to its plane over rocking, rocking is still possible along the plane perpendicular to the plane of the wheel. Moreover, because the plane of the wheel is in most cases free to rotate with respect to the body, it is not easy to identify the directions that favor rocking or displacement at any time. The problem becomes even more complicated, if one considers that one of the wheels, which can swivel, may be locked. Thus, in the most general case, a bod...

Understanding Risks of Workplace Injury in Labor and Delivery

ObjectivesTo understand nurse and other staff perceptions about care activities in labor and delivery (L&D) that were performed with high frequency, required high exertion, and had the greatest potential to cause injury and to determine what personal characteristics might be related to the caregiving tasks with potential for injury. DesignThis exploratory study employed a mixed methods design using qualitative open‐ended questions and quantitative surveys administered in three different times (n = 56, 58, and 58). SettingA 22‐room L&D unit in a women's hospital with 8,500 annual deliveries. ParticipantsNurses and assistive staff. ResultsHigh‐risk tasks were classified in three categories. High‐exertion tasks included (a) moving patients in labor, delivery, recovery (LDR) beds to other locations; (b) breaking delivery beds and applying stirrups; (c) assisting dependent patients with mobility in bed; and (d) pushing medical equipment and delivery carts. Awkward posture tasks during patient care included (a) listening for heart tones; (b) performing difficult vaginal exams; (c) keeping the fetal head off of the cord during cord prolapse; and (d) assisting with epidurals. Culture of safety tasks included (a) physician requests to conduct patient care tasks that put staff at risk for injury; (b) providers ignoring broken equipment in the environment; (c) responding to emergent/urgent situations without regard to self‐posturing to prevent injury; and (d) holding patients’ legs during delivery at the physician's direction. Several significant correlations were noted between demographic variables and high potential for risk items. ConclusionsThis study provides the first information about the caregiving tasks L&D nurses perceive to be risky for personal injury because of their high frequency and exertion or breaches in the culture of safety.

Experience with a “tech-check-tech” program in an academic medical center

A "tech-check-tech" (TCT) program to support unit dose drug distribution at an academic medical center is described. In April 2004, the University of Wisconsin Hospital and Clinics implemented a TCT program to provide validated pharmacy technicians with the opportunity to serve as the person checking unit dose medication cassettes that are filled during a 24-hour cart-fill process. This program required special authorization from the Wisconsin Pharmacy Examining Board and included detailed training and validation expectations of the pharmacy technicians, along with quality-assurance oversight by pharmacists who are completing a double check. For initial validation, the technician should attain a 99.8% accuracy rate for at least 2500 consecutive doses checked during at least five separate audits occurring over a minimum of five separate days. During the validation process, a pharmacist artificially introduces errors at a minimum rate of 0.2% (5 of every 2500 doses). A staff pharmacist performs a final check of the medications before releasing them to the inpatient units. The overall time for pharmacists spent on checking medication doses for cart fill was reduced from an average of 6 hours and 5 minutes per day to 20 minutes per day. Through the implementation of a TCT program at a university hospital, specially trained pharmacy technicians safely and efficiently checked unit dose medication carts filled by other technicians. The program reduced interruptions in the pharmacists' daily workflow and allowed pharmacists to spend more time on patient care activities.

Monitoring Medication Errors in Personalised Dispensing Using the Sentinel Surveillance System Method

ObjectiveTo assess the efficacy of a new quality control strategy based on daily randomised sampling and monitoring of a sentinel surveillance system (SSS) medication cart, in order to identify medication errors and their origin at different levels of the process. MethodProspective quality control study with one-year follow-up. An SSS medication cart was randomly selected once a week and double-checked before dispensing medication. Medication errors were recorded before the cart was taken to the relevant hospital ward. Information concerning complaints after receiving medication and 24-h monitoring was also noted. Type and origin of error data were assessed by a unit dose quality control group, which proposed relevant improvement measures. ResultsThirty-four SSS carts were assessed, including 5130 medication lines and 9952 dispensed doses, corresponding to 753 patients. Ninety erroneous lines (1.8%) and 142 mistaken doses (1.4%) were identified at the pharmacy department. The most frequent error was dose duplication (38%) and its main cause was inappropriate management and forgetfulness (69%). Fifty medication complaints (6.6% of patients) were mainly due to new treatment at admission (52%), and 41 (0.8% of all medication lines), did not completely match the prescription (0.6% lines) as recorded by the pharmacy department. Thirty-seven (4.9% of patients) medication complaints due to changes at admission and 32 matching errors (0.6% medication lines) were recorded. The main cause also was inappropriate management and forgetfulness (24%). The simultaneous recording of incidences due to complaints and new medication coincided in 33.3%. In addition, 433 (4.3%) of dispensed doses were returned to the pharmacy department. After the unit dose quality control group conducted their feedback analysis, 64 improvement measures for pharmacy department nurses, 37 for pharmacists, and 24 for the hospital ward were introduced. ConclusionsThe SSS programme has proven to be useful as a quality control strategy to identify unit dose distribution system errors at initial, intermediate and final stages of the process, improving the involvement of the pharmacy department and ward nurses.

Monitorización de errores de medicación en dispensación individualizada mediante el método del carro centinela

Objective To assess the efficacy of a new quality control strategy based on daily randomised sampling and monitoring a Sentinel Surveillance System (SSS) medication cart, in order to identify medication errors and their origin at different levels of the process. Method Prospective quality control study with one year follow-up. A SSS medication cart was randomly selected once a week and double-checked before dispensing medication. Medication errors were recorded before it was taken to the relevant hospital ward. Information concerning complaints after receiving medication and 24-hour monitoring were also noted. Type and origin error data were assessed by a Unit Dose Quality Control Group, which proposed relevant improvement measures. Results Thirty-four SSS carts were assessed, including 5130 medication lines and 9952 dispensed doses, corresponding to 753 patients. Ninety erroneous lines (1.8%) and 142 mistaken doses (1.4%) were identified at the Pharmacy Department. The most frequent error was dose duplication (38%) and its main cause inappropriate management and forgetfulness (69%). Fifty medication complaints (6.6% of patients) were mainly due to new treatment at admission (52%), and 41 (0.8% of all medication lines), did not completely match the prescription (0.6% lines) as recorded by the Pharmacy Department. Thirty-seven (4.9% of patients) medication complaints due to changes at admission and 32 matching errors (0.6% medication lines) were recorded. The main cause also was inappropriate management and forgetfulness (24%). The simultaneous recording of incidences due to complaints and new medication coincided in 33.3%. In addition, 433 (4.3%) of dispensed doses were returned to the Pharmacy Department. After the Unit Dose Quality Control Group conducted their feedback analysis, 64 improvement measures for Pharmacy Department nurses, 37 for pharmacists, and 24 for the hospital ward were introduced. Conclusions The SSS programme has proven to be useful as a quality control strategy to identify Unit Dose Distribution System errors at initial, intermediate and final stages of the process, improving the involvement of the Pharmacy Department and ward nurses.

Patient-care practices associated with an increased prevalence of hepatitis C virus infection among chronic hemodialysis patients.

To identify patient-care practices related to an increased prevalence of hepatitis C virus (HCV) infection among chronic hemodialysis patients. Survey. Chronic hemodialysis facilities in the United States. Equal-probability 2-stage cluster sampling was used to select 87 facilities from all Medicare-approved providers treating 30-150 patients; 53 facilities and 2,933 of 3,680 eligible patients agreed to participate. Patients were tested for HCV antibody and HCV RNA. Data on patient-care practices were collected using direct observation. The overall prevalence of HCV infection was 9.9% (95% confidence interval [CI], 8.2%-11.6%); only 2 of 294 HCV-positive patients were detected solely by HCV RNA testing. After adjusting for non-dialysis-related HCV risk factors, patient-care practices independently associated with a higher prevalence of HCV infection included reusing priming receptacles without disinfection (odds ratio [OR], 2.3 [95% CI, 1.4-3.9]), handling blood specimens adjacent to medications and clean supplies (OR, 2.2 [95% CI, 1.3-3.6]), and using mobile carts to deliver injectable medications (OR, 1.7 [95% CI, 1.0-2.8]). Independently related facility covariates were at least 10% patient HCV infection prevalence (OR, 3.0 [95% CI, 1.8-5.2]), patient-to-staff ratio of at least 7 : 1 (OR, 2.4 [95% CI, 1.4-4.1]), and treatment duration of at least 2 years (OR, 2.4 [95% CI, 1.3-4.4]). This study provides the first epidemiologic evidence of associations between specific patient-care practices and higher HCV infection prevalence among hemodialysis patients. Staff should review practices to ensure that hemodialysis-specific infection control practices are being implemented, especially handling clean and contaminated items in separate areas, reusing items only if disinfected, and prohibiting mobile medication and clean supply carts within treatment areas.

Applying Toyota Production System Techniques for Medication Delivery: Improving Hospital Safety and Efficiency

The inpatient medication delivery system used at a large regional acute care hospital in the Midwest had become antiquated and inefficient. The existing 24-hr medication cart-fill exchange process with delivery to the patients' bedside did not always provide ordered medications to the nursing units when they were needed. In 2007 the principles of the Toyota Production System (TPS) were applied to the system. Project objectives were to improve medication safety and reduce the time needed for nurses to retrieve patient medications. A multidisciplinary team was formed that included representatives from nursing, pharmacy, informatics, quality, and various operational support departments. Team members were educated and trained in the tools and techniques of TPS, and then designed and implemented a new pull system benchmarking the TPS Ideal State model. The newly installed process, providing just-in-time medication availability, has measurably improved delivery processes as well as patient safety and satisfaction. Other positive outcomes have included improved nursing satisfaction, reduced nursing wait time for delivered medications, and improved efficiency in the pharmacy. After a successful pilot on two nursing units, the system is being extended to the rest of the hospital.