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JULIE Study Name: Barber, N., Donyai, P., Franklin, B., Jacklin, A., & O’ Grady, K. (2007).The Impact of a Closed-Loop Electronic Prescribing and Administration System on Prescribing Errors, Administration Errors and Staff Time: A Before-and-After Study. Quality and Safety in Health Care, 16, 279-284. Retrieved February 3, 2009, from PubMed. Type of Study: Quantitative Study Design: Before and after design Data was collected on all outcome measures 3-6 months before and 6-12 months after the intervention Pre-intervention data was collected simultaneously before the study was implemented Post- intervention data was collected in turn The X2 test used to measure nominal data t test used to measure continuous data Findings: It was found that there was a decrease in prescribing errors, decrease in percentage of doses with MAEs, a decrease in the percentage of medication given without checking patient identity, and an increase in time spent prescribing medication, providing a ward pharmacy service, and nursing time spent in medication tasks. Level: The level of evidence of this article is a level four because it was a controlled trial. Recommendations: Consider harm reduction before implementing system Fix technological aspects before implementing to reduce staff frustration Study Name: Barber, N., Cornford, T., & Klecun, E. (2007).Qualitative Evaluation of an Electronic Prescribing and Administration System. Quality Safe Health Care, 16, 271–278. Retrieved February 3, 2009, from PubMed. Type of Study: Qualitative Study Design: qualitative observational approach Framework structured as a matrix of Donabedian’s model Interviews werepreformed by two experienced researchers doctors, nurses, pharmacists, and hospital managers were interviewed Interviews took place on neutral ground, while being observed on the ward, and after project steering group meetings Observed focus groups Two experienced researchers conducted the analysis using discourse analysis Interview transcripts were reviewed for each professional group, then in temporal order Analysis that was preformed individually was then consolidated by discussion and checked against observations Throughout the procedure the work was reviewed by other members of the implementation and evaluation teams Findings: The system was successfully implemented on the ward and remained in operation for over two years. - At first the system had many technical problems, but over times its function and performance improved. - Nurses and doctors more likely to dislike system when first implemented - Pharmacists understood and were more supportive of system at the beginning - Doctors had little involvement in the shaping of the system and some doctors wanted to be more involved - Staff attitudes became more balanced and positive over time. - The system unintentionally structured the work of the staff - Participants felt that the errors were reduced, but new risks were also created. Level: The level of evidence for this article is six because this is a single qualitative study. Recommendations: Consider staff’s patience and willingness to learn before implementing system poster yourself
AMANDA Title: Medication Dispensing Errors and Potential Adverse Drug Events Before and After Implementing Bar Code Technology in the Pharmacy Level of Evidence: 4 Design: Before-and-after study using direct observations Findings:Statistically significant reduction in both target dispensing errors and target potential adverse drug events Recommendation: Hospitals should implement bar code technology Title: Severity of Medication Administration Errors Detected by a Bar-Code Medication Administration System Level of Evidence: 5 Design: Case study, secondary analysis Findings: 91% of errors detected by a BCMA system had minimum severity potential Recommendation: Most errors detected by a BCMA system have little clinical significance. However, a number of life-threatening errors were prevented.
“LINDSAY Using a Bar-Coded Medication Administration System to Prevent Medication Errors in a Community Hospital Network” Level of Evidence: 4 Evidence was obtained from a well-designed controlled trial without randomization 6 hospitals in a community network which had fully operational bar-coding systems were studied. Data was collected on 4 random Thursdays in early 2004 from 25 different adult inpatient point-of-care units. A sample of 17,025 attempted administrations was reviewed. The system generated reports in order to view patient charts, medication administration, and medication errors prevented Conclusion: Medication administration errors were prevented in 1.1% of all attempted administrations by the use of the bar-code system. Of the prevented errors, 12% involved drugs recognized as having a high potential for causing serious adverse drug events. “The Uptake of Technologies Designed to Influence Medication Safety in Canadian Hospitals” Level of Evidence: 7 Evidence was obtained from the opinion of authorities A cross-sectional survey was performed. The survey was sent to 100 of Canada’s largest acute-care hospitals. The objective of the survey was to determine the uptake of technologies designed to improve medication safety, plans for adopting technologies, attitudes towards technology use and perceptions of medication error from the pharmacy directors’ point of view. Conclusion: 90% of respondents felt that the use of bar-coding should increase. Estimates of the number of patients harmed by medication errors varied widely, ranging from 0 to 26,000 in the last year.poster yourself
Bar Code Medication
SIOBHAN Title: Poon, E.G., Keohane, C.A., Bane, A., Featherstone, E., Hays, B.S. (2008) Impact of Barcode Medication Administration technology on How Nurses Spend Their Time Providing Patient Care The Journal Of Nursing Administration 38(12), p. 541-549 Retrieved April 7, 2009 from Cinahl database Level of Evidence: Level 4-well designed control trial without randomization Design: Time- motion study during before and after Bar Coding Medication Administration Findings:The total amount of time that RNs spent on medication administration did not change in a statistically significant way. What did change is the proportion of time spent on each task in the process. *Additional time was spent on verifying pt. identity *Less time was spent on managing MD orders *RNs spent more time retrieving and reviewing pt. info from an eMAR, which may have safety advantages *Time spent on inefficient tasks may be minimized Recommendations: Title of Sccond Study: Patterson, E.S., Cook, R.I., Render, M.L. (2002) Improving Patient Safety by Identifying Side Effects from Introducing Bar Coding in Medication Administration. Journal of American Medical Information Association, Vol 9: 540-553. Retrieved April 6, 2009 from Cinahl database. Level of Evidence: Level 6- qualitaive study Design:A cross-sectional observational study of medication passes pre-and post- BCMA implementation using detailed, handwritten field notes of targeted ethnographic observations of in-situ RN- BCMA interactions Findings:The following five negative, unanticipated side effects were recorded following the introduction for BCMA technology: 1) Nurses were confused by automated removal of medications by BCMA 2) There was a degraded coordination between nurses and physicians 3) Nurses dropped BCMA activities to reduce workload during busy periods 4) Increased prioritization of monitored activities during goal conflicts (RNs dropped other activities to make sure meds were given on time, even if other activities were very important) as they felt they were closely monitored during the BCMA process) 5)Decreased ability to deviate from routine sequences- any changes from the routine process were very difficult to work around. I.e./ if a medication changed or had to be tapered, it was hard to let the system know of the change. Stats- NA- qualitative study Recommendations: This information is very helpful in planning an implementation of BCMA. It helps identify issues that can be solved well ahead of time in process review and by the IT people in developing a more efficient system
