Medication Management System Research Articles

Reduction in preventable time-critical dose omissions: impact of electronic medication management systems on in-patients

Background: The omission of time-critical medication doses may result in poor patient outcomes. There are few publications about the influence of electronic medication management (EMM) systems, including automated dispensing cabinets (ADC), on timely medication administration. The study aimed to evaluate the influence of EMM systems, including ADCs, on timely medication administration 6 and 30 months after EMM implementation, focussing on preventable time-critical medication dose omissions and documented reasons for not administering a dose. Methods: Data on doses of regular inpatient medications not administered were obtained from electronic medication records (EMR) over 1 week in March 2019 and 4 weeks in March 2021. An omission was a dose not administered before the next due dose. Time-critical medications were defined using the health service’s guidelines. Reasons for doses not being administered were obtained from nursing documentation in the EMR collated from digital health reports. Reasons for time-critical medication doses not given were defined as ‘valid’ or ‘preventable’. Results: In 2019 and 2021, 620 and 2524 patients with 44,756 and 146,940 scheduled medication doses were reviewed. Of these, 4385 (9.8%) and 19,610 (13.4%) doses were not administered. In 2019 and 2021, there were 593 (1.3%) and 1811 (1.2%), p < 0.0001, time-critical doses not administered. Preventable time-critical dose omissions decreased from 0.20% in 2019 to 0.15% (p = 0.015) in 2021. Wards with ADCs had a significantly lower rate of time-critical dose omissions compared to those without ADCs (1.1% vs 1.3%, p = 0.014). Conclusion: With the introduction of an EMM system, there was a decrease in the rate of time-critical medications not administered, including a reduced rate of preventable omissions over the 24-month period. Regular assessment of time-critical medication administration will help target patient safety improvements.

Surveillance of Antimicrobial Use in Long-Term Care Facilities: An Antimicrobial Mapping Survey

ObjectivesTo explore antimicrobial management processes in Australian residential aged care facilities (RACFs), including antimicrobial prescribing, supply, administration, and documentation to inform surveillance activities. DesignVoluntary, online cross-sectional survey. Setting and ParticipantsThe survey was disseminated to all South Australian RACFs (n = 237) seeking participation from an infection prevention and control lead (preferred respondent), a nurse or senior RACF staff member, or an aged care pharmacist. MethodsThe survey was open during May-June 2023. Questions aimed to understand clinical and medication management systems, sources of antimicrobial prescription and supply, management by external health care providers and documentation of antimicrobial administration. A process map of antimicrobial management in RACFs was developed. ResultsOf the 54 RACFs included in the analysis (29.5% response rate), most used an electronic clinical documentation system (74.1%) or a hybrid electronic paper-based system (22.2%). Medication charts were either electronic (81.0%), hybrid (5.6%), or paper-based (13.0%). Antimicrobials were prescribed by the resident's usual general practitioner, but also by locums, hospital or specialist physicians, nurse practitioners, virtual care physicians, and dentists. Oral, topical, and inhaled antimicrobial formulations were usually supplied by community pharmacies, and intravenous formulations were predominately supplied by hospitals for administration by outreach nurses. Almost all RACFs (96.2%) had imprest stock of antimicrobials that included both oral and intravenous formulations. Antimicrobials were predominately administered by an enrolled nurse or a registered nurse. Conclusions and ImplicationsAntimicrobial management in RACFs is complex, particularly during care transitions. Multiple prescribers and sources of antimicrobials, use of different systems for clinical documentation, particularly by external health care providers, and clinical governance relating to imprest supplies were identified as key areas where medication management could be improved. Addressing these gaps will facilitate comprehensive, real-time antimicrobial surveillance in Australian RACFs.

Computer vision to enhance healthcare domain: An overview of features, implementation, and opportunities

The emergence of Artificial Intelligence (AI) has already brought several advantages to the healthcare sector. Computer Vision (CV) is one of the growing modern AI technologies. The distribution and administration of medications are about to change by using CV for medication management. This system scans pharmaceutical labels and keeps track of the process from delivery to administration using cameras, sensors, and computer algorithms. In order to assure accuracy in medicine delivery and dose, the system also makes it easier for doctors, nurses, and chemists to communicate. The computer vision-driven medication management system can significantly lower the number of medical mistakes that result from inaccurate or missing prescriptions, improper doses, or simply forgetting to take a particular drug. An exhaustive literature review has been done to identify work related to the research objectives. This paper is about CV and their need in healthcare. Various tasks associated with CV in the healthcare domain are discussed. Targeted healthcare goals through CV traits are briefed. Finally, the significant applications of CVs in healthcare were identified and discussed. Nowadays, CV has practical uses in healthcare. Its methods are widely used since they have shown excellent utility in several medical contexts, including medical imaging and surgical planning. The CV is used to study how to program computers to comprehend digital pictures. Numerous medical applications utilise this technology, such as automated abnormality identification, illness diagnosis, and surgical procedure guiding. CV is expanding quickly and has enormous promise to enhance healthcare. Some of the many CV applications in the healthcare sector include patient identification systems, medical picture analysis, surgical simulation and illness diagnosis.

Evaluation of opioid prescribing for surgical patients discharged from three metropolitan hospitals between 2012 and 2020.

This multicentre, retrospective medical record audit evaluated opioid analgesia prescribing within a Victorian metropolitan public hospital network. The study included all surgical patients discharged between January 2012 and December 2020 with one or more discharge prescriptions from three metropolitan hospitals (n = 117,989). The main outcome measures were mean oral morphine equivalent daily dose (OMEDD), mean number of opioid types and proportion of patients prescribed one or more slow-release opioids on discharge.Total opioid prescribing (mean OMEDD) peaked in 2013. Between 2017 and 2020 there was a trend towards prescribing fewer opioids on discharge. Over the study period, there was decreasing prescription of codeine and increasing prescription of oxycodone and tapentadol. The proportion of patients prescribed slow-release opioids increased in the earlier years of the study, reaching a peak of 20.6% in 2017. Since 2017 there has been a rapid reduction in the prescription of slow-release opioids.Subanalysis was undertaken to evaluate key changes in the opioid prescribing landscape in the health network. The removal of default opioid pack sizes in the electronic medication management system (December 2014) and the release of the Faculty of Pain Medicine-Australian and New Zealand College of Anaesthetists' statement regarding the use of opioid analgesics in patients with chronic non-cancer pain (March 2018) were associated with significant reductions in mean OMEDD prescribed on discharge (136 mg vs 122 mg and 120 mg vs 85.4 mg, respectively, P < 0.001).In conclusion, the quantity of opioids prescribed on discharge in this patient group peaked in 2013 and has been decreasing since.

An Analysis of Incident Reports Related to Electronic Medication Management: How They Change Over Time.

Electronic medication management (EMM) systems have been shown to introduce new patient safety risks that were not possible, or unlikely to occur, with the use of paper charts. Our aim was to examine the factors that contribute to EMM-related incidents and how these incidents change over time with ongoing EMM use. Incidents reported at 3 hospitals between January 1, 2010, and December 31, 2019, were extracted using a keyword search and then screened to identify EMM-related reports. Data contained in EMM-related incident reports were then classified as unsafe acts made by users and the latent conditions contributing to each incident. In our sample, 444 incident reports were determined to be EMM related. Commission errors were the most frequent unsafe act reported by users (n = 298), whereas workarounds were reported in only 13 reports. User latent conditions (n = 207) were described in the highest number of incident reports, followed by conditions related to the organization (n = 200) and EMM design (n = 184). Over time, user unfamiliarity with the system remained a key contributor to reported incidents. Although fewer articles to electronic transfer errors were reported over time, incident reports related to the transfer of information between different computerized systems increased as hospitals adopted more clinical information systems. Electronic medication management-related incidents continue to occur years after EMM implementation and are driven by design, user, and organizational conditions. Although factors contribute to reported incidents in varying degrees over time, some factors are persistent and highlight the importance of continuously improving the EMM system and its use.

Risk Factors Associated with Medication Administration Errors in Children: A Prospective Direct Observational Study of Paediatric Inpatients.

Limited evidence exists regarding medication administration errors (MAEs) on general paediatric wards or associated risk factors exists. The aim of this study was to identify nurse, medication, and work-environment factors associated with MAEs among paediatric inpatients. This was a prospective, direct observational study of 298 nurses in a paediatric referral hospital in Sydney, Australia. Trained observers recorded details of 5137 doses prepared and administered to 1530 children between 07:00h and 22:00h on weekdays and weekends. Observation data were compared with medication charts to identify errors. Clinical errors, potential severity and actual harm were assessed. Nurse characteristics (e.g. age, sex, experience), medication type (route, high-risk medications, use of solvent/diluent), and work variables (e.g. time of administration, weekday/weekend, use of an electronic medication management system [eMM], presence of a parent/carer) were collected. Multivariable models assessed MAE risk factors for any error, errors by route, potentially serious errors, and errors involving high-risk medication or causing actual harm. Errors occurred in 37.0% (n=1899; 95% confidence interval [CI] 35.7-38.3) of administrations, 25.8% (n=489; 95% CI 23.8-27.9) of which were rated as potentially serious. Intravenous infusions and injections had high error rates (64.7% [n=514], 95% CI 61.3-68.0; and 77.4% [n=188], 95% CI 71.7-82.2, respectively). For intravenous injections, 59.7% (95% CI 53.4-65.6) had potentially serious errors. No nurse characteristics were associated with MAEs. Intravenous route, early morning and weekend administrations, patient age ≥ 11 years, oral medications requiring solvents/diluents and eMM use were all significant risk factors. MAEs causing actual harm were 45% lower using an eMM compared with paper charts. Medication error prevention strategies should target intravenous administrations and not neglect older children in hospital. Attention to nurses' work environments, including improved design and integration of medication technologies, is warranted.

Navigating complexity of the medication management system within the home setting-a functional resonance analysis method (FRAM) analysis of people with dementia and their carers' experiences.

There is a strong imperative to support people with dementia to live independently in their homes for as long as possible. A starting point is to understand how they manage medications on a daily basis. To understand how people with dementia and their informal carers manage medications within the home setting to inform the identification of opportunities to improve medication management. A qualitative study using the Functional Resonance Analysis Method (FRAM). Interview data with people with dementia and informal carers were analysed to (i) Identify and describe key functions, (ii) identify and describe variability in performing key functions, and its potential consequences and (iii) map performance variability to Resilient Healthcare capacities. A FRAM model was developed and consisted of 14 interdependent key functions. The interdependent nature of functions, and the different nature and sources of variability in how each key function was performed highlighted the level of complexity of the medication management system within the home setting. The medication system was managed almost entirely by the person with dementia and/or their informal carers. This shows the lack of system-level controls to support the safe functioning of the medication management system in the home setting. Future work will develop a comprehensive FRAM model that includes the perspectives of health and social care professionals and those from the third sectors to underpin the development of a range of system recommendations to strengthen resilience in the medication management system within the home setting.

IoT Based Drug Delivery System

This IoT-based medicine dispenser system presents a smart medication management system designed to enhance user adherence and automate dispensing processes. This project proposes a NodeMCU and Arduino-based Drug Delivery System utilizing a buzzer, RTC DS3231 module, LCD display, IR sensor, and GSM technology. The system is designed to enhance medication adherence and patient care. The NodeMCU and Arduino facilitate seamless integration of components, while the RTC DS3231 module ensures precise timekeeping for medication schedules. An LCD display provides real-time information on dosage and timings. An IR sensor enables user interaction, allowing patients to confirm dosage retrieval. Additionally, a buzzer provides audible alerts for medication reminders. The incorporation of GSM technology allows remote monitoring and alerts for healthcare providers, ensuring efficient and timely drug delivery. This system aims to improve patient outcomes and simplify medication management.

A Digitally Enabled, Pharmacist service to detecT medicine harms in residential aged care (nursing home) (ADEPT): protocol for a feasibility study

IntroductionThis feasibility study aims to develop and test a new model of practice in Australia using digital technologies to enable pharmacists to monitor early signs and symptoms of medicine-induced harms...

Flexit: Flexible Location Encoding for Item Access in Medication Management Systems

Flexit: Flexible Location Encoding for Item Access in Medication Management Systems

Effect of a closed-loop medication order executive system on safe medication administration at a tertiary hospital: a quasi-experimental study.

Closed-loop electronic medication management systems are effective measures for preventing medication errors (MEs). However, there is limited evidence supporting this, and few studies have evaluated the long-term effects of these systems on safe medication. To evaluate the long-term effects of implementing a closed-loop medication order executive system on the safe clinical use of medications. A quasi-experimental design. Data from 2017 to 2023 were extracted and retrospectively analyzed. The primary outcome indicator was the ME rate. Secondary outcome indicators were the accuracy of order verification and patient identification and the implementation rate of fresh medicine dispensing. The autoregressive integrated moving average (ARIMA) model in time-series analysis was used to evaluate the level and trend changes in ME rates using SPSS 25.0 before and after system implementation. Root cause analysis and descriptive statistics were used to assess changes in types, stages, and causes of ME rates. The independent samples t-test was used to analyze secondary outcomes. Overall, 295 MEs were reported with a mean of 0.26 ± 0.26 ME rates per month during 2017-2023. The ARIMA model showed a decrease in the average level of ME rates after system implementation, with no statistically significant decrease in the long term, and a significant drop in the ME rate in the short and medium term (p < 0.01). Nurses' administration accounted for more than 60% of errors post-implementation, and lack of communication was a prominent factor. The accuracy of order verification and patient identification and the implementation rate of fresh medicine dispensing all increased after implementation. Adopting a closed-loop executive system is beneficial for ensuring patient medication safety, but a single integrated system does not completely eliminate MEs. Optimizing system functionalities and applying structured handoff tools are recommended to meet clinical needs and enhance system usability.

The Impact of Health Informatics on Radiologist, Laboratory Technician, Pharmacist-Physician Collaboration, and Patient Outcomes

Health informatics has revolutionized the way healthcare professionals collaborate and deliver care, with significant implications for patient outcomes. This abstract explores the impact of health informatics on the collaboration between radiologists, laboratory technicians, pharmacists, and physicians, and its influence on patient outcomes. The abstract provides an overview of the role of health informatics in facilitating communication, information sharing, and decision-making among these healthcare professionals. It also discusses the potential benefits and challenges associated with integration of health informatics in collaborative care, and highlight the importance of leveraging technology to improve patient safety, treatment efficacy, and overall healthcare quality. The review concludes that, the professions of radiologists, laboratory technicians, chemists, doctors, and patient outcomes have all been significantly impacted by health informatics. Healthcare practitioners are now able to make better decisions thanks to the increased efficiency and accuracy of diagnostic imaging and laboratory tests brought about by the integration of technology and data management systems. Electronic prescribing and medication management systems have improved collaboration between chemists and doctors, guaranteeing safe and efficient pharmaceutical use. The application of health informatics has also helped patients receive more individualized care, better communication, and access to health information. All things considered, the use of health informatics has changed the way that healthcare is delivered and may continue to enhance patient outcomes in the future.

CONTROLPHARM - MEDICATION MANAGEMENT SYSTEM IN THE URGENT AND EMERGENCY HOSPITAL ENVIRONMENT

This article presents a detailed analysis of the implementation of a Medication Management System in hospital settings, focusing on optimizing dispensing processes, inventory control, and drug traceability. Using an agile methodological approach, tools such as Canva and Scrum were employed to ensure efficient and collaborative project management. The study reveals promising results, highlighting operational efficiency, accurate inventory control, and significant cost and waste reduction in the analyzed hospitals. The integration of advanced technologies, such as the Army Materiel System (SIMATEX), the strategic use of data, and the application of prototyping and web development techniques were instrumental in achieving tangible improvements in hospital management, contributing to patient safety and operational efficiency.

Evaluating the Impact of a Tailored Electronic Medication Management System on Anemia Management in Outpatient Hemodialysis Patients

Evaluating the Impact of a Tailored Electronic Medication Management System on Anemia Management in Outpatient Hemodialysis Patients

Outpatients satisfaction and perceptions toward pharmaceutical services in public and private hospitals in Palestine: a cross-sectional study

BackgroundPharmaceutical care is an essential component of healthcare services, and patient satisfaction with these services is crucial for improving overall health outcomes. We aimed to evaluate patient satisfaction and perception with pharmaceutical care services provided at public and private hospitals for outpatient pharmacies. This study can provide insights into the quality of pharmaceutical services provided in both settings and identify areas for improvement.Materials and methodsA cross-sectional 1-month study was conducted in three hospitals in Nablus city in the Northern District of West Bank, Palestine. Participants were a convenience sample of outpatients who attended the study-selected hospitals (two public and one private). A sample of 30 patients from each hospital was selected with a total of 90 patients. A self-administered questionnaire was used to assess socio-demographics pharmacist-related issues, waiting and working time, and medication availability.ResultsA total of 90 patients were recruited. The overall level of patient satisfaction with pharmaceutical health services was moderate with a mean of 3.24 out of 5. Females represented 58.9%. The most prevalent age was (30–39) years (30%). There was a statistically significant difference in patient satisfaction with pharmaceutical services regarding working time between the morning and evening shifts (p value = 0.009) in favor of morning shift. No statistically significant differences in satisfaction with pharmaceutical treatments based on socio-demographics (age, gender, marital status, education level, family income, employment status, and living place), were found. Nearly, 70% of patients indicated having problems getting the medicine on their last visit to the hospital pharmacy. Only 66.7% of patients expressed satisfaction with the pharmacies’ operating (working) hours.ConclusionsPatient satisfaction with pharmaceutical care services could be enhanced by involving pharmacists in patient-oriented training and informing patients about the role of pharmacists. Patient satisfaction in the evening shift might be improved by establishing a system for continuous evaluation and improvement of pharmaceutical care services in hospitals to ensure the highest quality of care for patients in addition to implementing technology such as electronic prescribing and medication management systems that can improve the accuracy and efficiency of pharmaceutical services in hospitals.

Closed-Loop Medication Management with an Electronic Health Record System in U.S. and Finnish Hospitals.

Many medication errors in the hospital setting are due to manual, error-prone processes in the medication management system. Closed-loop Electronic Medication Management Systems (EMMSs) use technology to prevent medication errors by replacing manual steps with automated, electronic ones. As Finnish Helsinki University Hospital (HUS) establishes its first closed-loop EMMS with the new Epic-based Electronic Health Record system (APOTTI), it is helpful to consider the history of a more mature system: that of the United States. The U.S. approach evolved over time under unique policy, economic, and legal circumstances. Closed-loop EMMSs have arrived in many U.S. hospital locations, with myriad market-by-market manifestations typical of the U.S. healthcare system. This review describes and compares U.S. and Finnish hospitals' EMMS approaches and their impact on medication workflows and safety. Specifically, commonalities and nuanced differences in closed-loop EMMSs are explored from the perspectives of the care/nursing unit and hospital pharmacy operations perspectives. As the technologies are now fully implemented and destined for evolution in both countries, perhaps closed-loop EMMSs can be a topic of continued collaboration between the two countries. This review can also be used for benchmarking in other countries developing closed-loop EMMSs.

Development of an immediate release excipient composition for 3D printing via direct powder extrusion in a hospital

3D printing offers the possibility to prepare personalized tablets on demand, making it an intriguing technology for hospital pharmacies. For the implementation of 3D-printed tablets into the digital Closed Loop Medication Management system, the required tablet formulation and development of the manufacturing process as well as the pharmaceutical validation were conducted. The goal of the formulation development was to enable an optimal printing process and rapid dissolution of the printed tablets for the selected model drugs Levodopa/Carbidopa. The 3D printed tablets were prepared by direct powder extrusion. Printability, thermal properties, disintegration, dissolution, physical properties and storage stability were investigated by employing analytical methods such as HPLC-UV, DSC and TGA. The developed formulation shows a high dose accuracy and an immediate drug release for Levodopa. In addition, the tablets exhibit high crushing strength and very low friability. Unfortunately, Carbidopa did not tolerate the printing process. This is the first study to develop an immediate release excipient composition via direct powder extrusion in a hospital pharmacy setting. The developed process is suitable for the implementation in Closed-Loop Medication Management systems in hospital pharmacies and could therefore contribute to medication safety.

Medication adherence in leukemia children receiving home-based treatment and its related factors

ABSTRACTObjectives:This study aimed to investigate home-based medication adherence in children with acute leukemia and its related factors.Methods:We examined 132 children with acute leukemia in a tertiary pediatric hospital in Chongqing. A general questionnaire, the MMAS-8 (the eight-item Morisky Medication Adherence Scale), SEAMS (Self-efficacy for Appropriate Medication Use Scale), and a multifactorial logistic regression model were used to analyze the factors related to drug adherence of the children.Results:54.55% of patients showed good medication adherence, while 50.76% either forgot a dose or administered an incorrect dose. The average score on the Self-Efficacy for Appropriate Medication Use Scale (SEAMS) was 32.47.61. The logistic regression analysis revealed that a SEAMS score, the occupation of caregivers, and the patient’s age were predictors of medication adherence among pediatric leukemia patients (P < 0.05).Conclusions:The home-based medication adherence in children with acute leukemia was not favorable. Patients with low SEAMS scores, farmers serving as caregivers, and children under the age of three should arouse more attention. It is expected to strengthen the confidence of patient families in medication by emphasizing the development of their relationships with healthcare professionals. Awareness of breakthroughs in leukemia home-based medication management systems by utilizing Internet technology.

Complexity: Tending to the Medication-Related Needs of Older People.

The solutions to reduce the prevalence of medication-related harm in aged care are just as multifaceted as those that can be used in other industries where processes are complicated and complex. Designing safe systems is a key element of these efforts, with factors such as automation, electronic medication management systems, and the emergence of artificial intelligence all supplementing other aspects of safe health delivery such as appropriate environmental design and safe staffing levels. Nevertheless, as any experienced health practitioner will readily confirm, there is both art and science involved in the processes of safely delivering care for patients, particularly people of advanced age.

A repeated cross-sectional study on the implementation of electronic medication management system

Many IS studies focus on initial user perceptions as drivers of initial IS success, but these perceptions may change over time. This study aims to examine whether there is any difference in the drivers of IS success between the initial adoption and the initial assimilation stages. With the Expectation Confirmation Model as the theoretical lens, a repeated cross-sectional study was conducted regarding clinicians’ perceptions of the implementation of electronic medication management systems (eMMS) in an Australian hospital, one at the time of implementation and another one at one year after the implementation. The results indicated that the means of perceived usefulness, perceived ease of use, social influence, clinician satisfaction, and organizational benefits are significantly higher in the initial assimilation stage than in the initial adoption stage, which means that expectations have been positively confirmed in the initial assimilation stage. More importantly, while perceived usefulness and social influence remain important one year after the implementation, perceived ease of use and facilitating conditions are moving toward a decrease in importance to the success of eMMS. This study provides a better understanding of how the importance of the factors influencing eMMS success changes over time.