THE ROLE OF TECHNOLOGY IN THE

MEDICATION-USE PROCESS
NURSING INFORMATICS
  DUE TO THE NUMEROUS STEPS REQUIRED IN THE
CARE OF THE PATIENTS, THE HEALTHCARE INDUSTRY
IS AN INHERENTLY ERROR PRONE PROCESS THAT IS
FRAUGHT WITH OPPORTUNITIES FOR MISTAKES TO
INTRODUCTION OCCUR
 THE HEALTHCARE INDUSTRY MUST PLACE SAFETY AS
THE NATIONAL PRIORITY AND WORK DILLIGENTLY
TOWARD THIS GOAL.
  CONSUMERS BECOME CONCERNED THAT HOSPITALS
ARE LESS THAN SAFE BECAUSE OF MEDIA REPORTS
REGARDING TRAGIC EVENTS AND CAUSES MANY
DEATH.
INFLUENCES ON  1995- TELEVISION AND NEWSPAPERS REPORT THAT
THE ADOPTION TRAGIC DEATH OF A PATIENT TO A PREVENTABLE
ADVERSE DRUG EVENT. DUE TO AN INADVERTENT
OF TECHNOLOGY ADMINISTRATION OF A MASSIVE OVERDOSE OF A
CHEMOTHERAPY AGENT OVER 4 DAYS
1997- ACCORDING TO AMERICAN MEDICAL ASSOCIATION REPORT,
MEDICATION ERRORS RELATED TO THE MISINTERPRETATION OF PHYSICIAN’S
PRESCRIPTION WERE THE SECOND MOST PREVALENT EXPENSIVE CLAIM
LISTED ON MALPRACTICE CASES FILED OVER A 7 YEAR PERIOD ON 90 000
MALPRACTICE CLAIMS BETWEEN 1985 TO 1992
  FACTORS THAT DEMONSTRATE THE NEED FOR A
SHIFT IN THE SYSTEM:
 ACCESSING PATIENT INFORMATION SPREAD ACROSS
MULTIPLE ORGANIZATIONS THAT MAY BE UNAVAILABLE
 THE STRUCTURE OF THE PATIENT’S RECORD OFTEN
MAKES IT DIFFICULT TO LOCATE VALUABLE
CPOE INFORMATION.
 IILLEGIBLE HANDWRITTEN ENTRIES BY HEALTHCARE
PRACTITIONERS.
 FOR THOSE PATIENTS WITH CHRONIC OR COMPLEX
CONDITIONS, THE RECORD CAN INCREASE TO
MULTIPLE VOLUMES OVER MANY YEARS.
  BARRIERS THAT LEAD TO INEFFECTIVE
COMMUNICATION OF MEDICATION ORDERS
 ISSUES WITH ILLEGIBLE HANDWRITING
CPOE  USE OF DANGEROUS ABBREVIATIONS AND DOSE
DESIGNATIONS.
 VERBAL AND FAXED ORDERS.
  CPOE SYSTEM- SYSTEM USED FOR DIRECT ENTRY OF ONE OR
MORE TYPES OF MEDICAL ORDERS BY A PRESCRIBER INTO A SYSTEM
THAT TRANSMIT THOSE ORDERS ELECTRONICALLY TO THE
APPROPRIATE DEPARTMENT.

 POTENTIAL ENHANCEMENTS CPOE CAN OFFER;:

 ALLOW PHYSICIANS OR PRESCRIBER TO ACCESS RECORDS
FROM THEIR OFFICE OR HOME.
 PRESCRIBER SELECTABLE STANDARDIZED SINGLE ORDERS
WHAT IS CPOE? OR ORDER SETS.
 MENU-DRIVEN ORGANIZATION-SPECIFIC LIST OF
AND ITS MEDICATIONS ON FORMULARY
 PASSIVE FEEDBACK SYSTEMS THAT PRESENT PATIENT-
BENEFITS? SPECIFIC DATA IN AN ORGANIZED FASHION SUCH AS: TEST
RESULTS, CHARGES, REFERENCE MATERIALS, PROGRESS
NOTES.
 ACTIVE FEEDBACK SYSTEMS TO PROVIDE CLINICAL
DECISION MAKING TOOLS BY PROVIDING SPECIFIC
ASSESSMENTS OR RECOMMENDATIONS THROUGH ALERTS
AND REMINDERS OR EVEN THERAPEUTIC SUGGESTIONS AT
THE TIME THE ORDER IS GIVEN.
  IMPROVE QUALITY, PATIENT OUTCOMES, AND SAFETY
BY A VARIETY OF FACTORS:
 INCREASING PREVENTIVE HEALTH GUIDELINE
COMPLIANCE BY EXPOSING PRESCRIBERS TO
ADVANTAGES REMINDER MESSAGES TO PROVIDE PREVENTIVE CARE
BY ENCOURAGING COMPLIANCE WITH
OF CPOE RECOMMENDED GUIDELINES

SYSTEMS:  IDENTIFYING PATIENTS NEEDING UPDATED

IMMZUNIZATIONS OR VACCINATIONS
 SUGGESTING CANCER SCREENING AND DIAGNOSIS
REMINDERS AND PROMPTS.
  REDUCTIONS IN THE VARIATION IN CARE TO
IMPROVE DISEASE MANAGEMENT BY IMPROVING
FOLLOW UP OF NEWLY DIAGNOSED CONDITION BY:
 REMINDER SYSTEMS TO IMPROVE PATIENT
CONTINUATION MANAGEMENT

…  AUTOMATING EVIDENCED-BASED PROTOCOLS

 ADHERING TO CLINICAL GUIDELINES
 PROVIDING SCREENING INSTRUMENTS TO HELP
DIAGNOSIS DISORDERS.
  ORDER SYSTEMS CAN IMPROVE DRUG PRESCRIBING
AND ADMINISTRATIONS BY:
 IMPROVING ANTIBIOTIC DOSAGE
 SUGGESTING WHETHER CERTAIN ANTIBIOTICS OR
THEIR DOSAGES ARE APPROPRIATE FOR USE
CONTINUATION  MEDICATION REFILL COMPLIANCE CAN BE INCREASE
USING REMINDER SYSTEMS TO INCREASE ADHERENCE
… TO THERAPIES.
 DRUG DOSING COULD BE IMPROVED, ESPECIALLY FOR
THOSE ON MEDICATIONS WHOSE DOSING IS BASED ON
LAB RESULTS, SUCH AS HEPARIN OR WARFARIN, TO
MAINTAIN ANTICOAGULATION CONTROL.
  BPOC CAN IMPROVE MEDICATION SAFETY THROUGH
THE FF:
BAR CODE-  THE SYSTEM HELPS TO VERIFY THAT THE RIGHT DRUG IS
BEING ADMINISTER TO THE RIGHT PATIENT AT THE
ENABLED RIGHT DOSE BY THE RIGHT ROUTE AND AT THE RIGHT
TIME
  1. ON ADMISSION, PATIENTS ARE ISSUED AN
INDIVIDUALIZED BAR CODE WRISTBAND THAT UNIQUELY
IDENTIFIES THEIR IDENTITY.
 2. WHEN A PATIENT IS TO RECEIVE A MEDICATION,
NURSES SCANS THEIR BAR CODED EMPLOYEE
IDENTIFIER AND THE PATIENT’S BAR CODE WRISTBAND
TO CONFIRM THEIR IDENTITY.

STEPS IN USING  3. PRIOR TO MEDICATION ADMINISTRATION, EACH BAR

CODED PACKAGE OF MEDICATION TO BE
THE BPOC ADMINISTERED AT THE BEDSIDE IS SCANNED.
 4. THE SYSTEM CAN THEN VERIFY THE DISPENSING
AUTHORITY OF THE NURSE, CONFIRM THE PATIENT’S
IDENTITY, MATCH THE DRUG IDENTITY WITH THEIR
MEDICATION PROFILE IN THE PHARMACY INFORMATION
SYSTEM, AND ELECTRONICALLY REPORT THE
ADMINISTRATION OF THE MEDICATION IN AN ONLINE
MAR
  INCREASED ACCOUNTABILITY AND CAPTURE OF
CHARGES FOR ITEMS SUCH AS UNIT-STOCK
MEDICATIONS.
 UP-TO-DATE DRUG REFERENCE INFORMATION FROM
ONLINE MEDICATION REFERENCE LIBRARIES.
LEVELS OF  CUSTOMIZABLE COMMENTS OR ALERTS AND
FUNCTIONALITY REMINDERS OF IMPORTANT CLINICAL ACTIONS THAT
NEED TO BE TAKEN WHEN ADMINISTERING CERTAIN
(FEATURES) MEDICATIONS.
 MONITORING THE PHARMACY AND THE NURSE’S
RESPONSE TO PREDETERMINED RULES OR
STANDARDS IN THE RULES ENGINE SUCH AS ALERTS
OR REMINDERS FOR THE PHARMACIST OR NURSE.
  RECONCILIATION FOR PENDING OR STAT ORDERS.
 CAPTURING DATA FOR THE PURPOSE OF
CONTINUATION RETROPECTIVE ANALYSIS OF AGGREGATE DATA TO
MONITOR TRENDS.
…  VERIFYING BLOOD TRANSFUSION AND LABORATORY
SPECIMEN COLLECTION IDENTIFICATION.
  NURSES WERE SOMETIMES CAUGHT OFF GUARD BY
THE PROGRAMMED AUTOMATED ACTIONS.
 THE BPOC SEEMED TO INHIBIT THE COORDINATION
OF PATIENT INFORMATION BETWEEN PRESCRIBERS
AND NURSES WHEN COMPARED TO A TRADITIONAL
PAPER-BASED SYSTEM

NEGATIVE  NURSES FOUND IT MORE DIFFICULT TO DEVIATE

FROM THE ROUTINE MEDICATION ADMINISTRATION
EFFECTS SEQUENCE WITH THE BPOC SYSTEM.
 NURSES FELT THAT THEIR MAIN PRIORITY WAS THE
TIMELINESS OF MEDICATION ADMINISTRATION
BECAUSE BPOC REQUIRED NURSES TO TYPE IN AN
EXPLANATION WHEN MEDICATIONS WERE GIVEN
EVEN A FEWE MINUTES LATE
CONTINUATION  NURSES USED STRATEGIES TO INCREASE EFFICIENCY
THAT CIRCUMVENTED THE INTENDED USE OF BPOC
…
  OMISSIONS AFTER THE PATIENT’S BAR CODE
ARMBAND AND MEDICATION HAVE BEEN SCANNED,
THE DOSE IS INADVERTENTLY DROPPED TO THE
FLOOR.
 EXTRA DOSE- AN EXTRA DOSE MAY BE GIVEN WHEN
THERE ARE ORDERS FOR THE SAME DRUG TO BE
TYPES OF ADMINISTERED BY A DIFFERENT ROUTE.

ERROR  WRONG DRUG- IN SITUATIONS WHEN THE NURSE

ADMINISTERS A MEDICATION, WHICH HAS NOT BEEN
LABELED WITH A BAR CODE.
 WRONG DOSE- IN SITUATIONS WHEN THE NURSE
HAS DIFFICULTY IN SCANNING MEDICATION AND
PROCEEDS TO SCAN THE MEDICATION TWICE.
  UNAUTHORIZED DRUG- AN ORDER TO HOLD A
MEDICATION UNLESS A LAB VALUE IS AT A CERTAIN
LEVEL.
 CHARTING ERRORS- DINSTINGUISH THE
INDICATION FOR THE ADMINISTRATION OF THE
CONTINUATION MEDICATION.

…  WRONG DOSAGE FORM- CERTAIN DRUG

SHORTAGES MAY FORCE A PHARMACY TO DISPENSE
A DIFFERENT STRENGTH OR CONCENTRATION
OTHER THAN WHAT IS ENTERED IN THE BPOC
SOFTWARE
  COMPUTERIZED POINT OF USE MEDICATION
MANAGEMENT SYSTEM THAT IS DESIGNED TO
REPLACE OR SUPPORT THE TRADITIONAL UNIT-DOSE
DRUG DELIVERY SYSTEM.
 REQUIRE STAFF ENTER A UNIQUE LOGIN AND
AUTOMATED PASSWORD TO ACCESS THE SYSTEM USING A TOUCH
DISPENSING SCREEN MONITOR OR BY USING FINGER PRINT
IDENTIFICATION.
CABINETS  ONCE LOGGED INTO THE SYSTEM, THE NURSE CAN
OBTAIN PATIENT-SPECIFIC MEDICATIONS FROM
DRAWERS OR BINS THAT OPEN ATER A DRUG IS
CHOSEN FROM A PICK LIST
  IMPROVING PHARMACY PRODUCTIVITY- STREAMLINING OF
THE DISPENSING SYSTEM DUE TO THE REDUCED NUMBER OF
STEPS; ALSO HAS THE POTENTIAL TO REDUCE TIME NEEDED TO
OBTAIN MISSING MEDICATIONS.
 IMPROVING NURSING PRODUCTIVITY- TIME SPENT
GATHERING OR OBTAINING MISSING MEDICATIONS CAN BE
RATIONALE/ REDUCED

WIDE  REDUCING COSTS- REDUCTION IN INVENTORY AND

CONTAINMENT COSTS ASSOCIATED WITH EXPIRED
ACCEPTANCE OF MEDICATIONS.
 IMPROVING CHARGE CAPTURE- ADCs THAT ARE
THIS INTERFACED WITH THE ACCOUNTING DEPARTMENT ALLOW FOR

TECHNOLOGY THE CAPTURE OF ALL PATIENT CHARGES ASSOCIATED WITH

ADMINISTERED MEDICATIONS.
 ENHANCING PATIENT QUALITY AND SAFETY- ADCs THAT
HAVE BUILT-IN DECISION SUPPORT SYSTEMS THAT WARN URSERS
ON DRUG-DRUG INTERACTIONS, DRUG ALLERGY INTERACTIONS,
DRUG-LAB INTERACTIONS, DRUG-DRUG REPLICATIONS.