Evidence-Based Research Group Project Marcie Chenette Dulcebelle Pearson Melanie Underwoood
Transcript
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Evidence-Based Research Group Project Marcie Chenette
Dulcebelle Pearson Melanie Underwoood Marcie Chenette Dulcebelle
Pearson Melanie Underwoood
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Introduction Medication errors are largely one of the things
that caregivers are very concerned about when providing care for
clients especially because of the high risk of harm that it can
cause. Even though these errors are fairly preventable, 7,000
fatalities each year are estimated to be the cause of medication
errors and this number does not include disabilities (Crane &
Crane, 2006). It was found that 34% of errors happen during
administration and only less than 2% were caught before it happened
(Daniels, Helmons, & Wargels, 2009).
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Introduction To help minimize errors when administering
medication, bar- code-assisted medication administration (BCMA) has
been developed as a safety barrier between the nurse and patient
should the medication error reach the bedside. BCMA aids the nurse
in confirm the patients identity as well as identifying the
medication for appropriate dose, time and form and route (Daniels
et al., 2009).
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Statement of the Problem Although errors can happen in any area
of the whole process of ordering, transcribing and administering
medication, the focus of this project is to obtain research based
evidence during the administration phase which is mostly done by
nurses. The objective is to address the question : "Do staff nurses
on a medical/ surgical floor, utilizing computerized medication
administration systems experience a DIFFERENCE in the number of
medication errors compared to the paper based MAR system?"
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Articles being examined Case Study on the Use of Health Care
Technology to Improve Medication Safety Effect of bar code assisted
medication administration on medication administration errors and
accuracy in multiple patient care areas. Preventing Medication
Errors in Hospitals through a Systems Approach and Technological
Innovation: A Prescription for 2010 The Effect of Hospital
Electronic Health Record Adoption on Nurse-Assessed Quality of Care
and Patient Safety
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Findings related to the Question ARTICLE: Effect of bar code
assisted medication administration on medication administration
errors and accuracy in multiple patient care areas. During this
study, BCMA technology proved to show improvements on the
medical-surgical floor in the following areas, patient
identification, charting after administration, availability of MAR
at patients bedside when medications were administered. The goal of
this technology is to decrease unauthorized drug, wrong form, wrong
dose, wrong route, extra dose, and omission types of errors
(Daniels, Helmons, & Wargel, 2009).
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Findings related to the Question ARTICLE: Effect of bar code
assisted medication administration on medication administration
errors and accuracy in multiple patient care areas. Omission type
errors were the most common on the medical-surgical units, which
after the implementation of BCMA was reduce by 58%. Wrong time
errors increased after the start of BCMA likely a result of longer
duration of medication administration. Nurses were often distracted
during medication administration times which can also lead to
increase in time as well as errors (Daniels, Helmons, & Wargel,
2009).
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Findings related to the Question ARTICLE: Effect of bar code
assisted medication administration on medication administration
errors and accuracy in multiple patient care areas. It was noted
that after the implementation of BCMA that nurses were less likely
to educate patients on medication they were being given on the
medical-surgical units (Daniels, Helmons, & Wargel, 2009). The
results of this study emphasizes that BCMA really works and forces
organizations to take a closer look at their medication
administration process. It is shown to be a cost-effective
intervention that makes sense (Daniels, Helmons, & Wargel,
2009).
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Findings related to the Question ARTICLE: Effect of bar code
assisted medication administration on medication administration
errors and accuracy in multiple patient care areas. Conclusion BCMA
has shown a decrease in medication errors in medical-surgical
units, when time error where excluded (Daniels, Helmons, &
Wargel, 2009).
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Findings related to the Question ARTICLE: Preventing Medication
Errors in Hospitals through a Systems Approach and Technology
Innovation: A Prescription for 2010 With EMRs physicians can easily
access a patients medical records to check any current medications
the patient is on, and probe for any allergies or adverse drug
interactions. EMRs can also be made available to the patient via
smart card technology (Crane & Crane, 2006 p.5). One such study
found that compared to paper- based systems, EMRs reduced medical
errors by 55% (Crane & Crane, 2006, p.5).
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Findings related to the Question ARTICLE: Preventing Medication
Errors in Hospitals through a Systems Approach and Technology
Innovation: A Prescription for 2010 Veteran Affairs hospitals use
bar code technology and have seen an 86% reduction in medication
errors. Bar coding technology used in conjunction with EMRs can
prevent even more medication errors (Crane & Crane, 2006, p.5).
Brigham and Womens and its sister hospital, Massachusetts General,
both located in Boston, MA, have demonstrated patient safety
benefits of EMRs. These hospitals have cut frequency of serious
medication errors by 55% and the number of overall medication
errors by 81% (Crane & Crane, 2006, p.6).
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Findings related to the Question ARTICLE: Preventing Medication
Errors in Hospitals through a Systems Approach and Technology
Innovation: A Prescription for 2010 Conclusion: Medication errors
are not inevitable, but are preventable with proper system redesign
and innovative and emerging technologies. Patients deserve to be
safe in our healthcare system (Crane & Crane, 2006, p.7).
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Findings related to the Question ARTICLE: Case Study on the Use
of Health Care Technology to Improve Medication Safety There were
application modifications that needed to be made to the
computerized system but despite functionality issues, the rate of
serious medication errors which are defined as ones that has the
potential to harm the patient dropped by 55% and generally, adverse
drug event rates fell even if the decrease was not statistically
significant (Fiumara et al., n.d.). Transcription error rates also
dropped by 50% after the system was implemented (Fiumara et al.,
n.d.).
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Findings related to the Question ARTICLE: Case Study on the Use
of Health Care Technology to Improve Medication Safety "A follow-up
study conducted at Brigham and Women's Hospital (BWH) to assess the
impact of bar code technology on dispensing errors demonstrated
that the rate of target dispensing errors decreased by 85% and that
the rate of potential ADE's also decreased following implementation
of bar coding technology" (Fiumara et al., n.d., p. 109).
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Findings related to the Question ARTICLE: Case Study on the Use
of Health Care Technology to Improve Medication Safety
Implementation of the "smart pump" technology and including these
in a "closed loop, point-of- care medication administration system"
decreased risk associated with IV infusions (Fiumara et al., n.d.,
p. 112). "Time motion studies demonstrate that there was no
significant change in the time nurses spent on medication
administration before and after implementation of the system"
(Fiumara et al., n.d., p. 112).
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Findings related to the Question ARTICLE: Case Study on the Use
of Health Care Technology to Improve Medication Safety Conclusion:
BWH continues to enhance its system but based on the initial
results, it appears to favor the integrated the computerized
ordering, transcribing and delivery system that it has implemented
(Fiumara et al., n.d.).
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Findings related to the Question ARTICLE: The Effect of
Hospital Electronic Health Record Adoption on Nurse- Assessed
Quality of Care and Patient Safety Only 21 of the 316 hospitals in
the sample had a basic EHR system implemented on all patient care
areas. There were no significant differences between hospitals with
and without a basic EHR in terms of staffing levels (Kutney-Lee
& Kelly, 2010, p.470).
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Findings related to the Question ARTICLE: The Effect of
Hospital Electronic Health Record Adoption on Nurse- Assessed
Quality of Care and Patient Safety Nurses in hospitals with fully
implemented basic EHRs were consistently and significantly less
likely to report unfavorable outcomes in their hospitals than did
nurses in hospitals without fully implemented basic EHRs. Nurses
working in hospitals with a fully implemented basic EHR also
reported fewer frequent medication errors (Kutney-Lee & Kelly,
2010, p.470).
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Findings related to the Question ARTICLE: The Effect of
Hospital Electronic Health Record Adoption on Nurse- Assessed
Quality of Care and Patient Safety The degree to which nurse
leaders support the growth of technology and champion its use in
the clinical setting is bound to affect the success of EHR
implementation and,subsequently patient care (Kutney-Lee &
Kelly, 2010, p.471).
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Findings related to the Question ARTICLE: The Effect of
Hospital Electronic Health Record Adoption on Nurse- Assessed
Quality of Care and Patient Safety Conclusion: Findings suggest
that the implementation of a basic EHR shows promise in bringing
about improved safety for patients (Kutney-Lee & Kelly, 2010,
p.471).
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References Crane, J., & Crane, F. G. (2006). Preventing
medication errors in hospitals through a systems approach and
technological innovation: A prescription for 2010. Hospital Topics,
84(4), 3-8.
http://dx.doi.org/http://dx.doi.org/10.3200/HTPS.84.4.3-8
http://dx.doi.org/http://dx.doi.org/10.3200/HTPS.84.4.3-8 Daniels,
C. E., Helmons, P. J., & Wargels, L. N. (2009). Effect of
bar-code assisted medication administration on medication
administration error and accuracy in multiple patient care areas.
American society of Health-System Pharmacists, 1202-1210. Fiumara,
K., Moniz, T., Churchill, W., Bane, A., Luppi, C., Bates, D., &
Gandhi, T. (n.d.). Case study on the use of health care technology
to improve medication safety. Retrieved from
http://www.jointcommission.org/ Grissinger, M. (2010). The five
rights. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957754/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957754/ Kutney-Lee, A.
K. & Kelly, D. (2010). The effect of hospital electronic health
record adoption on nurse-assessed quality of care and patient
safety. Journal of Nursing Administration, 41(11), 466-472.
doi:10.1097/NNA.0b013e3182346e4b