About 9 years ago in to Err is Human the Institute of Medicine recognized the need to improve workflow through technology and reduce Adverse Drug Events. This is still a struggle in several hospitals. Let's talk a bit about the technologies which can help reduce Adverse Drug Events (ADEs), and what is needed for the adoption of these practices.
What causes an Adverse Drug Event
First item to understand is what are the causes of Adverse Drug Events (ADEs) ADEs are caused by one of the following accidents, circumstances or challenges, these are a few not all;- Providers don't have all the patient information when a clinical decision is needed - may be due to missing home medications or just the timing of pushing paper. The clinical decision may also be urgently needed.
- Providers orders are just unreadable, and need to be verified.
- Providers have a lag time from when the order is know to be need, and when the order is documented to be needed. The knowing-ordered gap.
- Paper pushing meets the paper monster. Every once in a while a piece of paper gets "misplaced" in the process.
- The in-house formula and agreeing to use what is in house. Also knowing what is in house, cause that hospital down the street which the physician visited earlier may have different items, and may not
- The time it takes to process an order based on the availability of the meds and location of availability
- Dispensing Errors related to the wrong medication, wrong dose, wrong amount, wrong frequency, wrong time
- Documenting the administration on paper not in a timely manner. Sometimes this needs to be in one place, sometime 2, sometimes 3 or more.
Enlightening and scary, a good topic for all saints day knowing the nurses, pharmacists, and physicians who work diligently everyday to prevent these events - They are saints.
How can technology help
The good news is that technology is out there which can assist. The other good news is that through proper phasing and establishing a collaborative team to make the systems sings. These adverse drug events can be reduced significantly, and other improvement opportunities will come to light.
Common Technology Solutions |
Purpose |
Outcome if adopted |
Pharmacy Ancillary System |
Manages the workflow in the pharmacy has a feed of where patient are in the hospital. It is best to have the same pharmacy system vendor as your hospital information system. |
Most organizations have a pharmacy system. These may even be getting a little old and fully depreciated. |
Smart Pumps (Wired or Wireless) |
Manages the IV and assures the complicated infusion calculation is done by a computer. Newer models are wireless and can interface bi-directionally. |
Reduces IV ADEs and harmful infusion rates |
Automated Dispensing Systems |
These system receive order and exchange cart fill lists. In the pharmacy, carousels and a robot can be used. Up on the floors there is a automated dispensing machine or a locked cabinent |
Reduces the FTE effort for dispensing, and assures the meds are in the right place |
Barcoding the drugs |
A barcode is placed on the drug. |
Improves accuracy with the automatic dispensing system |
electronic Medication Administration Record (eMAR) |
Digitizes the drugs a patient is taking and when the patient has taken them. |
Provides up to date order and administration to all practitioners. |
Repackaging and Re-labeling the meds with 2D barcodes |
Assures all the meds have readable accurate barcodes on them |
A precursor step for barcode medication administration |
Barcode Medication Administration with Positive Patient ID |
The system populates the eMar by having the nurse identified, the patient identified, and drug identified. Barcodes need to be on the nurse's badge, the patient wristband, and the drug. This is one of those implementations were it is expensive, but so worth it.. |
Every effective in eliminating administration errors. |
CPOE |
Computerized Practitioner Order Entry - no more handwritten unreadable orders. |
Eliminates the handwritten orders thereby reducing the ordering and transcribing errors. Also a precursor for Medication Reconciliation |
Electronic Medication Reconciliation |
These system enable the review of home medications and expedite the ordering/reordering while at the hospital. |
Reduces the time spent ordering when incorporated into the ordering process. |
Transformation isn't just about the Technology
There are a lot of business changes to workflow which need to be done to reduce adverse drug events. We need to be congnizant about traversing the change river to assure each piece of the pie is enjoyed and has lasting positive affects.
Implementing and adopting these solutions are a team effort, and the buy-in of all will help make it successful.
Hopefully you enjoyed this post, I'd welcome hearing your insights and suggestions below in the comments. Please check out these other posts, they may pique your interested.
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Welcome to the Healthcare IT Project Management Blog of Elyse Nielsen. This is the place where I share the ideas I have learned, the things I’d like to remember, and my thoughts for a brighter future. Find out more.
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