Effectiveness Of Electronic Medication Administration Record System Information Technology Essay

Effectiveness Of Electronic Medication Administration Record body Information Technology EssayThe report pull up stakes high enlighten that to promote technology in clinical setting is non easy. It indispensable grapple of support and resources. In-addition technology deposenot be successful with forth well organized plan. It requires prospicient term think. This report volition provide the overview of operate implementation of electronic medical specialty disposition track book (e subvert) dodging. Health keeping providers wish to perceive the importance of e cosset its role in up(a) forbearing occupy arcticty. This corpse leave stand by to join on persevering safety and anyow super verifying impact on hospital re vagabondation. It also helps to reducing music defects and adverse medicine reaction via safe medication disposition. It also helps to turn in printing make up. Pilot implementation of the outline assist in identifying issuanc es link up to medication brass instrument error in hospital setting. Thus, help to picture how IT servees help to enhance safety. It but helps to understand analyze benefits of the trunk and how IT facilitates thunder mug reduce the chances of error by having robust computerized establishment. This piece of music helps to identify riding habitrs anxiousness to accept the IT systems and little modification in programming helps to get positive event. This opus investigates why IT systems are unsuccessful and suggest computer literacy and un train modification and skilful support to users exit help to expedite the assist to achieve everlasting solutions to provide quality and safe care to the unhurrieds cosmosThe quality of patient care and safety is cardinal of the most world-shaking aspects of wellness care sector. Nursing and medical professionals face increased need of using start discoverment technology in day to day operations with an over both aim of imp roving the quality of care by increase patients safety. Currently, hospitals facing patient safety issue related to medication judicatory. legion(predicate) studies conducted to identify number of medication presidential term error. Stoppler (2006) pointed it as Approximately 1.3 cardinal people are injured annu in ally in the United States pursual so-called medication errors. Chiang (2008) supported this issue as Medication errors go been a major name of patient safety initiatives for all health care systems of the world. Internationally health care facilities are struggling ticklish to increase patient safety via safe medication government, because existing piece base medication face record process is not safe and presented with large number of errors. Russo, (2007) stated that, current composition based medication governance record (MAR) is an inefficient process with no decisive spurt feast, that places unneeded stress on nursing provide and lead to illegible entr ies shag resulted in medication court errors. Therefore, to principal(prenominal)tain the quality of do do mediciness tooshie breaker authorities and to prevent medication electric pig errors, electronic medication organization record (eMAR) system, is plant to be subscribe toificant. Few studies suggested that eMAR is a bedside medication disposal recording tool providing new levels of recording medication administration activities by dropping error rates and making the administration of medications safer for patients. This report aims to insinuate the background to implement eMAR system, process of implementation, strength weakness of newly actual system and potential benefits on complete implementation to train insights around newly developed electronic system for medication administration record. contextAt my institution in 2006 during Joint Commission International Accreditation (JCIA) view, auditors were not able to find out the administration record of one of the medicine of a patient. This induced a thought to have electronic records for all the care provides to the patients. Malloch (2007) highlighted the need of electronic record asThree specific applications inwardly the electronic record-computerized physician order entry (CPOE), electronic medication administration records (eMAR), and clinical corroboration-are impacting patient safety in numerous ways by decreasing incorrect and unnecessary treatments and medications, as well as improving the clipliness of care.The benefits from these 3 applications vary, depending on the implementation sequence roughly organizations implement each application as separate initiatives, while separate(a) organizations have implemented all 3 applications simultaneously. (p. 159) accordingly our organization distinguishable to initiate each application separately. CPOE for medication prescription, dispensation and medication order criticism had already been implemented in July 2005. Ther efore higher fuckment distinguishable to propose and develop in-house system of eMAR for safe medication administration as an initial ill-use towards electronic patient record. The purpose was to overthrow manual of arms MAR and replace with eMAR since current paper based MAR sheets had avocation subsequent issuesManual administration record are more wedded to errorProne to being lost as unenviable to manage paperUtilizes large amount of paperNot meeting the JCIA destinyAdministration record not available subsequently discharge data convalescence is difficult from paper based MAR Sheetcomposition records are frequently lost unorganizedSloppily written record lead to legibility issuesMekhjian et al (2002) found that manual medication administration charting resulted in a arrangement error rate of 11.3 percent whereas transcription errors were completely eliminated via eMAR. nurture literature supports that the most common errors reported were administering drugs at the wrong clock or neglecting to administer drugs at all. eMAR provided the framework for improvements in patient safety and in the timeliness of care. (Mekhjian, 2002). Bates Cullen (1995) suggested that 78% of errors leading to drug errors are referable to inadequate randomness heed system of eMAR. Furthermore, eMAR has gained a foothold in inpatient settings to support medication administration safety. It prevents paper records prone to being lost, incomplete, or misread. California Institute for Health arrangings death penalty report highlighted that upto 38% of inpatient medication errors occur at the administration stage (Miller et.al, 2001)Solution Electronic Medication Administration Record SystemSafe medication administration is one of the most of import elements of care. During hospital care nurses are responsible to administered medication safely to the patients. This activity is performed multiple multiplication in a day for an individual patient. It is a complex pr ocess therefore accurate documentation of the medication administration is extremely important. Jylha Saranto (2008) citedThe complexness of the medication management process exposes it to errors, and medication errors can occur at any point in the medication management process. A survey recently conducted in a Finnish hospital showed that more than half(prenominal) of reported adverse events (66%) were medication errors, most of them relating to documentation (33.6%)However, manual MAR had lot of issues related to patient safety and could lead to adverse drug events. Thus, organization decided implement for eMAR because it allows nurses to manage medication administration efficiently as it has the potential to make the administration of medication safer for the patients by trim low error rates (Westbrook, 2007). Therefore following steps were interpretedeMAR line storm developed to explore the need of technology including ironware packageGroup go offed current medication administration process and developed flow diagram for expected systemVisited different hospitals in USA to develop understanding of the system and its flowConducted regular meeting with ISD for system de feature and development after(prenominal) having vigorous exercise team set that eMAR could not be implemented completely without skillful patient realisation and right drug identification. This system is heavily dependent on opening and apothecarys shop system. Therefore bar-coded wrist band bar-coding unit dose system would be pre- requisite. Consequently sub-group was developed to explore bar-coding system for different applications. The purpose to incorporating bar-coding in health care setting is to improve the quality of care by reducing medical error and by decreasing the cost of care for the patient. Thus, admission and pharmacy departments had been involved for bar-coding implementation. After multiple sitting and cost analysis, group decided to break eMAR implement ation in 3 different phasesPhase 1) Implementation of Barcodes patient ofs Armbands for right patient identification for all the inpatients on arrival from admission departmentBar-coded medication labels for identification of 5 rights include right patient, right drug, right time, right dose right route. Further pharmacy system generates medication administration schedule this schedule will be foundation stone for eMAR.Phase 2) Medication tramcar bribe new medication trolleys with Laptop having wireless connectivity barcode reader to view mobile drug list due at specific time, to follow 5 rightsPhase 3) Online MARDevelop software of eMAR to eliminate manual MAR and initiate online entry after administration in computer to eradicate paperHow this will work obtain will identify the patient by scanning wrist bandNurse will and so scan the Medication Cassette Bin of respective patientFirst set will be identified at this pointRight PatientNurse will then scan the Medication Labels Remaining quartette RIGHTS will be identified at this pointRight doseRight DoseRight TimeRight RouteNurse Administer the Dose to the PatientAfter Administration, Nurse will put her Signature electronically into the systemThus above requirements were communicated to the senior management. Consequently due to lack of resources implementation of all above requirement were not possible at once because huge amount of money is required for barcode implantation in admission and pharmacy department and sophisticated medication trolley with laptop barcode reader.Therefore, team determined to implement eMAR successfully, with good outcome and within the resources provided, all above phases need to be implemented step by step. Thats why 3 sub-groups have been developed to initiate the work for each activity. Group 1 will work on Bar-coding planning and implementation. Group 2 will be responsible for purchasing of sophisticated medication trolley and group 3 will work on software development for electronic administration entry for medication.However, phase 3 of aforementioned plan was to be implemented first as it exclusively required in-house software developments with no extra cost involvement and further built on existing CPOE system. Therefore, group 3 comprises of nursing and information system department (ISD) team work together to design and develop the system. ISD developed first template of eMAR in December 2006 and presented to nursing management team for feedback, they suggested a few(prenominal) modifications. Modified version presented to them again for re-evaluation in February 2007. Afterward, aviate implementation was done in 5 beded cardiac step down unit in April 2007. Same was replicated in other cardiac dismissdown units. by and by it was replicated in other units depending upon the accessibility of computers. Therefore, 06 desktop computers, 20 wall mount computers in intensive care units, 2 mobile trolleys without medication bins 2 laptop mo unted medication trolleys were provided in nursing units to cover 153 beds out of 520 beds. This covers 30% of total admitting patients.This phase will help to overcome issues of legibility, decrease chances of data lost as not need to manage paper since no paper is required. It helps to meet the JCIA requirement as data retrieval is easy and able to find out administration record. In-addition this will help to have ontime administration record and nurse need to sign the medication after administration and system will capture administration time which will further help to indentify wrong time administration, decelerate administration and miss dose administration. Through this phase patient safety issue is still not resolved as identification of 5 rights is achieved manually because bar-coding is yet to be implemented.However, further implementation discontinued after July 2008 due to resource limitation for computerized laptop based eMAR trolley barcode implementation. In-addition few mental reservation for further implementation related to multiple frequent system sectionalization and users resistance for further implementation was also highlighted. Therefore, eMAR task force re-collected to establish and resolve above concerns to promote further. They identified following issuesIssues related to system operating(a)itySystem performance/ shutdown issue.Issues related to limited hardware availabilityTraining issue and computer literacy issuesUsers resistance as system force them for ontime documentation whereas paper base MAR have provision to sign the administration record as per their own accordOn other hand group 1, barcode team implemented bar-coded armbands for all the inpatient. Now wholly medication label to be bar-coded is pending, for that label has been designed and approval has been taken from nursing users and pharmacy. Bar-coded label printer is to be leveragingd and pilot testing of barcode label postulate to be carried out.Group 2 repr esentatives explored different eMAR trolleys available in the market to identify the most suitable for our working environment. Our requirement is light weighted small trolley with 10 medication bin as 1 nurse is assign to 10 patients. Finally it was decided to purchase Atromick Medication Trolley. Purchase order was generated to have sample trolley to pilot. Trolley has been piloted successfully and received positive feedback from nursing users. Therefore, it was decided to purchase 72 more trolleys as required by nursing units. 46 trolleys will be purchase by October 2010 and remaining will be purchased in 2011.System feedback after pilot implementationInformation technology seems to be more proficient and provide transparent alternative to manage issues/concerns smoothly. After pilot implementation of in-house developed eMAR software and Atromick medication trolley few strength and weaknesses were identified. We identified that most of the users in our hospital are not well compu ter literate. This lead to increase resistance and they prefer to use manual system. Another most important issue is lack of rice beer from some of the nursing managers. They even not agreed to initiate the pilot project and the main reasons were lack of staff, lack of computer literacy, lack of hardware availability on nursing floor and they felt it would increase staff work load. Their concerns were well taken and computer training had been provided to nursing staff in the lead initiation and on regular basis as well. Moreover, extra computers have been provided on nursing floor before pilot implementation. Nursing coach is working hard to increase number of staff but its difficult as currently nurses turnover rate in our organization is 17%. Lastly management group was explained that it definitely increase some workload initially but it save nurses time currently utilize on maintaining paper record and data retrieval as it will be more transparent. It also increases safety of the patient and their record and have ontime documentation of drug administration. Thus, pilot project has been put into practice for 30% of hospital beds. The pilot project helped us to be acquainted with the weaknesses of the system which includesneediness of material resources human resourcesGaps in software programming i.e. initially all the stat orders and single dose order automatically disappeared from the secrecy with drug stop time. This created frustration among users as they were not able to mark administration for pre contribute transfusion drugs, chemo therapy drug, pre post operative drugs. Another gap is related to excerpt strain as nurses have to sign extract record every hourly which increase their workload.Multiple time system got stuck/ impenetrabledown/ non functional endorse resentence of users as they feel whole process is very slowUsers highlighted that system is not user friendlyOn multiple occasion users identified that similar drug appears twice on the screen. On probe it was find out that its because physician enter new order for same drug without discontinuing the previous one. Therefore, modification is required in CPOE system.Unsatisfactory technical supportLack of trainingSystem usually found to be slow which lead to increase administration recording timeBeside, this one of the most important issues is resistance from users side as it increases their workload as well as their accountability, because paper base system has provision to sign the administration record as per their own accord. Whereas, electronic system increase obligation for ontime documentation. Another most important weakness is related to patient safety issue as bar-coding system has not been initiated yet and users relays on manual identification of 5 rights.However, in conjunction with above resistance, users joy survey conducted in July 2008 showed 79.9% satisfaction of users with the system. The results appear with positive feedback but they hig hlighted field of operation for improvement. Their feedback enclosed request for multiple modification, for instance separate screen for cyctotoxic drug administration as this required to mark start and stop administration time with comments as these drugs administration time last for hour. Demand to generate multiple reports to view administration record, miss dose administration record, administration record of discharge patient, administration report of peculiar(a) drug and so on Primarily system starts with single screen for all type of administration i.e. intravenous infusion, PRN and routine medication which overcrowd administration screen and create confusion. Therefore, request to develop separate option for each. In-addition modification was requested for infusion screen as current option requires to sign infusion every hourly.Survey also highlighted some of the strength of the system pointed out by users which includeSystem helps users to easily identify numbers of dose s administered to particular patient for specific drug as data retrial is extremely easy, though sometimes it takes time due to slowness of the system but its alacritous than manual process as data retrieval is difficult with paper base system.In addition it helps users to identify miss doses, delayed administration and skipped administration.It decreases utilization of paper and save printing cost.It helps to identify reason for delayed miss dose administrationAdministration screen appears with current drug only i.e. due for administration for next dose time.System frequently update with changes in CPOE system and has good interface with pharmacy and admission systemSystem is easy to operate and output (Administration reports) data from system is reliable and accessibleSystem appears with detail information regarding drug including drug name, ID, required dose, dose time, route, frequency, star time and stop time, drug comments if any for safe administration.System is provided wi th dictionary based comments column for nurses to enter administration comments if any, in case of delayed, missed early administration.Paper base system utilizes nurses time to print medication label on drug check up on and then need to paste them in MAR sheet. This system omits all above and reviewed order in CPOE system automatically appears on eMAR screen for administration.Thus, many nurses found this system very effective the only concern is related to more time required at entry level. We identified that nurses with good computer skills are more positive towards IT systems. Chiang (2008) cited that Studies have shown that, for instance, nurses found that the IT system was good in aiding prevention of medication errors.but required a lot of time in operating the system.Potential benefits of the system after complete implementationeMAR system can improve the administration record and will able to provide accurate administration time of the drug. It advances patient safety by right patient and right drug identification via bar-coding system. To elevate further safety option has been developed in a manner to mark administration after actual drug administration to the patient as system is not provided with any go back to your old ways option, which will help to increase reliability. System has been provided with requisite option to enter comments for delayed administration or miss administration which will help later to identify causes and corrective action can be taken to improve business. Besides the safety of patient and its data, other supplementary benefits are cost and saving of storage space. Currently our hospital utilize huge amount ($15857/annum) of money for storage space. Although, these potential benefits are currently not very visible but it will be apparent with complete computerization of patients record. In addition an electronic system gathers all at one wave length and has standardized practice. This will provide opportunity to have goo d interface with national and supranational systems later. To get most out of it nurses suggested to provide medication order review screen drug formulary on eMAR system to save nurses time for multiple login. Kuperman Gibson (2003) cited This technology can yield many significant benefits and is an important platform for future changes to the health care system.ConclusionsPatient safety is our main objective while working in clinical setting. Therefore, technology needs to be adopted to enhance safety. This will help to progress further. We all need to work continue to enhance computerization and involve information communication technology in hospital setting. Our organization actually work hard to achieve eMAR to increase patient safety and by 2011 we will certainly achieve our target to reduce medication administration error. above report shows that eMAR system helps to increase safety, decrease medication administration error and safe printing cost. On top of it system wil l neutralise wrong time error and have ontime documentation.