ACTION: Locating information and reading to become

THE INFORMATION SEARCH PROCESS informed.

● Is a six stage model of the users’ holistic
experience in the process of information THOUGHTS: Becoming oriented to form a focus
seeking.
Identifies three realms of experience: TASK: Investigate information on the general topic (in
1. the affective (feelings), order to extend personal understanding)
2. the cognitive (thoughts)
3. and the physical (actions) common to each
stage. FORMULATION (turning point of ISP)
HISTORY
● Focused perspective is formed
● ISP is developed by Carol Kuhlthau at
Rutger’s University FEELING: Uncertainty diminished, confidence and
● Goal: Align the Feelings, Action and Thoughts. clarity increases

ACTION: Seeking specific topic to pursue

3 REALM OF ISP THOUGHTS: Identifying and selecting ideas in the
information
● FEELINGS
● ACTIONS TASK: Form a focus from the information encountered.
● THOUGHTS

COLLECTION
THE SIX STAGES OF ISP MODEL ● Is when interaction between the user and the
information system functions most effectively
and efficiently.
INITIATION
FEELING: Confidence increases as uncertainty
● Lack of knowledge/understanding subsides

FEELING: Uncertainty and apprehension ACTION: Selecting relevant information

ACTION: Seeking topics THOUGHTS: Defining, extending and supporting the

focus
THOUGHTS: Contemplating the problem
TASK: Gather information related to the focused topic
TASK: Recognize a need for information
PRESENTING/PRESENTATION
SELECTION ● Is when the search is completed with a new
understanding which enable the person to
● AREA explain his/her learning
● TOPIC ⤍ BEGIN SEARCH ● “Put learning into use”
● PROBLEM
FEELING: Relief and satisfied (disappointment)
FEELING: Uncertainty to optimism
ACTION: Search for available information ACTION: Summary search are noted
THOUGHTS: Weighing the criteria of selecting of
topics THOUGHTS: Culminating the search
TASK: Identify general topic; Identify the approach
TASK: Complete the search and to prepare to present

CRITERIA: SELECTION OF TOPIC

The ISP describes common experiences in the
1. Task requirement process of information seeking for a complex task that
2. Time allotted has a discrete beginning and ending and that requires
3. Personal interest considerable construction and learning to be
4. Information available accomplished. The model reveals a search process in
which a person is seeking meaning in the course of
seeking information. From the user’s perspective the
EXPLORATION (most difficult stage) primary objective of information seeking is to
accomplish the task that initiated the search, not
● Inconsistent and incompatible information is merely the collection of information as an end in itself.
encountered The ISP presents seeking information as a means to
accomplish a goal. The model of the ISP is articulated
FEELING: Confusion and doubt in a holistic view of information seeking from the user’s
perspective in six stages

ROLE OF AFFECT IN INFORMATION SEEKING
BEHAVIOR
The ISP is a process of seeking meaning not just
finding and reproducing information. This is a process
of construction involving exploration and formulation
that rarely proceeds directly from selection to
collection. Experience influences the decisions and
choices a person makes throughout the process of
information seeking. Studies of the ISP in the
workplace reveal that a person’s experience of the
stages in the ISP is related to how much the person
knows about the problem and the degree of
construction that should be undertaken during
information seeking. In more routine tasks, where the
goal is to answer a simple question or to monitor
periodic change, people do not usually experience
stages in their information seeking. In more complex
tasks, where the goal requires considerable
construction and learning, people are likely to
experience a process as described in the ISP model.
FOCUS FORMULATION AS A PIVOTAL POINT IN
THE ISP
The formulation of a focus or personal perspective is
a pivotal point in the ISP. Focus formulation calls for
reflective thinking about the information encountered in
the exploration stage of the ISP that provides a
direction for the completion of the search. A focus is a
guiding idea to concentrate on to complete the search
and accomplish the task. People often find the period
preceding formulation of a focus the most difficult
phase in the search process. Exploration is a difficult
stage because uncertainty commonly increases, rather
than gradually decreases, during this time.
Peoples can experience anxiety and frustration as
they encounter information from many different
perspectives, much of which may not be compatible
with their specific constructs and personal knowledge.
The connection between feelings and formulating is
evident from the rise in confidence that parallels
increased clarity as formulation unfolds. Formulation,
the central task in the ISP, is frequently misunderstood
when the search process is thought of as merely a
process of collection not a construction activity.
PRINCIPLE OF UNCERTAINTY FOR INFORMATION
SEEKING
Uncertainty is a cognitive state that commonly causes
affective symptoms of anxiety and lack of confidence.
Uncertainty and anxiety can be expected in the early
stages of the ISP. The affective symptoms of
uncertainty, confusion and frustration are associated
with vague, unclear thought about a topic or question.
As knowledge states shift to more clearly focused
thoughts, a parallel shift occurs in feelings of increased
confidence. Uncertainty due to a lack of
understanding, a gap in meaning, or a limited construct
initiates the process of information seeking
THE PRINCIPLE IS EXPANDED BY SIX
COROLLARIES:
SIX COROLLARIES OF THE PRINCIPLE OF
UNCERTAINTY
1. Process Corollary
The process of information seeking involves
construction in which the person actively pursues
understanding and meaning from the information
encountered over a period of time. The process is
commonly experienced in a series of thoughts and
feelings that shift from vague and anxious to clear and
confident, as the search progresses.
2. Formulation Corollary
Formulation is thinking, developing an understanding
and extending and defining a topic from the information
encountered in the early stages of a search. The
formulation of a focus or a guiding idea is a critical,
pivotal point in the ISP when a general topic becomes
clearer and a particular perspective is formed as the
person moves from uncertainty to understanding.
3. Redundancy Corollary
The interplay of seeking what is expected or redundant
and encountering what is unexpected or unique results
in an underlying tension of the ISP. Redundant
information fits into what the user already knows and is
readily recognized as being relevant or not. Unique
information is new and extends knowledge and does
not match the person’s constructs requiring
reconstruction to be recognized as useful. Too much
redundant information leads to boredom, whereas too
much unique information causes anxiety. The lack of
redundancy in the early stages of the ISP may be an
underlying cause of anxiety related to uncertainty.
Uncertainty may decrease as redundancy increases.
4. Mood Corollary
Mood, a stance or attitude that the person assumes,
opens or closes the range of possibilities in a search.
An invitational mood leads to expansive, exploratory
actions, whereas an indicative mood fosters conclusive
actions that lead to closure. The person’s mood is
likely to shift during the ISP. An invitational mood may
be helpful in the early stages and an indicative mood in
the later stages. A person in an invitational mood
would tend to take more expansive, exploratory
actions, while a user in an indicative mood prefers
conclusive actions that lead to closure.
AUTOMATED DISPENSING CABINETS
5. Prediction Corollary
● secure storage cabinets typically located
The ISP is a series of personal choices based on the decentrally on patient care units capable of
person’s predictions of what will happen if a particular handling most unit-dose and some bulk
action is taken. People make predictions derived from (multiple-dose) medications due to storage
constructs built on past experience about what limitation.
sources, information and strategies will be relevant and CAROUSEL AUTOMATION
effective. These predictions lead to the choices they
● a medication storage cabinet with rotating
make in the stages of the ISP. People develop
expectations and make predictions about the sources shelves used to automate dispensing.
used or not used, the sequence of source use, and the CENTRALIZED ROBOTIC DISPENSING
information selected from the sources as relevant or SYSTEM
irrelevant. Relevance is not absolute or constant but
varies considerably from person to person. ● centrally located devices designed to automate
the entire process of medication dispensing
6. Interest Corollary including medication storage, distribution,
restocking, and crediting of unit dose
Interest increases as the exploratory inquiry leads to medications.
formulation in the ISP. Motivation and intellectual
engagement intensify along with construction. MEDICATION ERROR
Personal interest may be expected to increase as
uncertainty decreases. The person’s interest and ● any preventable event that may cause or lead
motivation grows as the search progresses. Interest is to inappropriate medication.
higher in later stages after the person has formed a
focus and has enough understanding of the topic to SUPPLY CHAIN MANAGEMENT
become intellectually engaged.
● the management of pharmaceutical
order-to-pay process including management of
inventory and distribution of supplies
throughout the medication use process.

PHARMACY AUTOMATION SYSTEM TECHNOLOGY

AUTOMATION
● Means self dictated
● The use of largely automatic equipment in a
system of manufacturing or other production
process.
● It is the use of control system such as
computer to control industrial machinery and
processes reducing the human intervention .
● Automation greatly reduces the need for
human sensor and mental requirements as
well as processes and system can also be
automated.
E.g. Telephone operators have been replaced largely
by automated telephone switchboard and answering
machine.
PHARMACY AUTOMATION
● any technology, machine, or device linked or
controlled by a computer and used to do work.
● Automation is designed to streamline and
improve accuracy and efficiency of the
medication use processs.
ADVERSE DRUG EVENT
● an injury resulting from a medication or lack of
intended medication.
● anything that is used to replace routine or
repetitive tasks previously performed by
people, or which extends the capability of
people.
TECHNOLOGIES AND AUTOMATED DEVICES
APPLIED THROUGHOUT THE MEDICATION USE
PROCESS
PRESCRIBING
● Clinical Decision support software
● Computerized prescriber order entry
DISPENSING
● Carousel technology
● Centralized robotic dispensing technology
● Centralized narcotic dispensing and inventory
tracking devices
● Decentralized automated dispensing devices
● Intravenous and total parenteral nutrition
compounding devices
● Pneumatic tube delivery systems
ADMINISTRATION
● Bar code medication administration technology
● Clinical decision support based infusion pumps
MONITORING
● Electronic clinical documentation systems
● Web-based compliance and disease
management tracking systems
ADVANTAGES OF AUTOMATION CONTROL OVER
MANUAL CONTROL

● Processes are controlled more precisely

resulting in more uniform and high quality
product.
● Processes are too fast to be controlled by
manual operators can be easily controlled by
automatic system.
● Automatic control is beneficial in certain
remote, hazardous or routine operations.
● No batch to batch variation, lead to greater
demand for product and higher profits.
● Increase production capacity and flexibility. .
● Decrease labour cost.

GOALS OF AUTOMATION IN PHARMACY

● Freeing pharmacists from labor-intensive

distributive functions
● Helping pharmacists provide pharmaceutical
care
● Reducing costs
● Improving operating efficiencies As the technology behind automated systems has
● Growing revenues continued to advance over the past several years,
● Enhancing safety and quality of care including developments in software, artificial
● Automated medication management systems intelligence and machine learning, a variety of
have been shown to reduce medication errors solutions for pharmaceutical purposes have been
by between 26% and 81% depending on the developed.
setting in which the machines are used.
● Integrating and managing data
● Increasing patient satisfaction with the quality
and delivery of care These automated pharmacy solutions range from
simple packaging technologies to enterprise-level
PHARMACY AUTOMATION perpetual inventory management.

• Involves the automation of common tasks and

processes performed in a pharmacy or other
healthcare settings.
For example, the dispensing of medications has
traditionally been a time consuming and tedious task
performed by pharmacists for several decades.
1970s -
● Some level of pharmacy automation has been
utilized which involved counting technologies
that were used to replace manual counting in
an effort to reduce workload and increase
efficiency.
1980s and 1990s -
● The next generation of high-speed machines
for counting and bottling were developed,
which proved to be easy to use, compact and
cost-effective.
In 2016 -
● Tom Gierwatoski, RPh, installed a ScriptPro
dispensing robot in his Platte Valley Pharmacy
in Brighton, CO.
● Automation allowed him to boost prescription
volume by 50%, freeing up time to expand
compounding and grow nonprescription
services such as durable medical equipment
and diabetic shoe fitting while halving his
dispensing staff.
ADVANTAGES OF PHARMACY AUTOMATION
● Increased Productivity
● Reduced Waste
● Minimized Labor Costs
● Improved Patient Counseling
● Greater Security and Confidentiality
DISADVANTAGES OF PHARMACY AUTOMATION
● Complexity and function variations
● Requires additional staff training and technical
help
● Downtime, system failure and inflexibility
● Cost and space issues
PHARMACY AUTOMATION TRENDS
1. FLEXIBLE CONFIGURATIONS IN A
SMALLER FOOTPRINT.
● Medication drawer designs help to maximize
pharmaceutical availability near the point of
administration.
2. SMARTER DRAWERS
● Pockets are locked when the main drawer is
opened.
● Nurse only has access to the pocket for the
needed patient medication.
 ● Provides warnings if any of the five rights is
OPEN-MATRIX CONFIGURATION compromised.

● Where 25 to 50 pockets are open which gives
the nurse access to multiple medications.
3. VIRTUAL CONTROL
● Latest cabinets are controlled by virtual
consoles
● Provides access to the system from any
computer as long as it is connected to the
internet.
Improved customization of inventory cabinets makes it
possible to place larger and more diverse products on
the floor in a safe and secure fashion.
BAR-CODING AT THE POINT OF CARE (BPOC)
● a process in which the patient and various
patient therapies are documented with a bar
code scanner at bedside.
IMAGER
● an electronic device similar to a scanner that
analyzes an image, including linear and two -
dimensional bar codes, and digitally converts
its data.
LINEAR SYMBOLOGY
● one dimensional bar code consisting of vertical
lines and spaces.

4. BETTER INVENTORY MANAGEMENT

● The refill process also is dramatically improved

with smart technology.
● Cabinets are capable of sending a report to the
pharmaceutical wholesaler.

5. CHARGE-CAPTURE ACCURACY (NURSE

STATION)
RADIO FREQUENCY IDENTIFICATION (RFID)
● Charge capture increases accuracy by use of
bar code.
● Involves a process where Nurse Scans the bar
code on the drug and charge capture is
complete.

CHARGE-CAPTURE ACCURACY (OPERATING

ROOM)

● Anesthesiologist access drug by selecting

appopriate boxes in the drawer screen and
drug is y charged.

BAR CODE MEDICATION SCANNING AT THE

POINT OF CARE SCANNER

● an electronic device that analyzes an object,

BAR CODE such as linear bar code, digitally converts it
into data.
● a series of vertical lines and spaces of varying
widths that encode data to be scanned and SYMBOLOGY
decoded through a computer.
● Pattern represented in a bar code that encode
BAR CODE MEDICATION ADMINISTRATION data and allow it to be converted into formation
(BCMA) with the use of a scanner or imager.
● Similar to a computer language.
● an inpatient clinical decision support system to
assist caregivers with the five rights of TWO-DIMENSIONAL (2D) SYMBOLOGY
medication administration.
right patient ● a bar code that may use dots or lines arranged
on the vertical and horizontal axes that can
right drug contain up to several thousand characters.
right dose
right route Unlike 1D barcodes, 2D (two-dimensional) codes
right time. contain information both horizontally and vertically,
allowing them to store much more data.
 THINGS TO CONSIDER IN SETTING UP
WRISTBANDS:

● Placement of barcodes
● Size of bar codes of wristbands
● Comfort to staff scanning.

BARCODE TECHNOLOGY THAT IS USED TO

ASSIST MEDICATIONS OF PATIENTS

● Bar Coding at Point of Care

● Bed Scanning
● Bar Code Medication Administration (BCMA)

BENEFITS OF BCMA

● Capture Medication Errors

● Reduction of Medication Errors
● Reduced Liability

APRIL 26, 2004 - Food and Drug Administration

(FDA) Mandates
● that each unit of a product must
contain NDC in a linear bar code
format.

GLOBAL STANDARD 1 US (GS1 US)

● also known as the European Article Numbering

Uniform Code Council.
● supports the identification and standardization
of bar codes used in e-commerce.

SMART PUMP TECHNOLOGY

CLINICAL ADVISORY

● a decision- making tool that is identified for a

specific medication.
● Nursing guidelines are often created as
advisory.
DATASET

● the recommended parameters for each

medication programmed into the smart pump
software such as dose, dosing unit, rate, or
concentration.
DRUG LIBRARY

● List of medications programmed in the smart

pump software.
● The library includes properties such as name,
dose, and concentration for each medication
listed.

HARD LIMIT

● A dose that serves as the absolute limit (high IOM

or low) for drug administration by the pump.
● Once this hard limit is reached, the dose ● the Institute of Medicine
cannot be overridden, serving as a warning to
the pump user that the dose needs to be
verified prior to drug administration.
PROFILE

● unique set of options and best practice

INFUSION PUMP guidelines for a specific patient population.
● a device that administers drugs or nutrition to a SOFT LIMIT
patient through intravenous, subcutaneous,
intramuscular, intrathecal, epidural, or ● similar to hard limits but can be overridden and
intra-arterial routes. a dose can be programmed for delivery.
● can administer fluids in very controlled
amounts. 2006 PUBLICATION - PREVENTING MEDICATION
ERRORS

● the IOM reported that medication error occurs

in all stages of the medication use process but
most frequently at the prescribing and
administration stages.

STEPS TO IMPLEMENTING SMART PUMP

TECHNOLOGY

1. Establishing a Multidisciplinary Team

● Core Team
● Clinical Team
● Implementation Team

2. Conducting a Failure Mode Effect Analysis (FMEA)

3. Designing and Building the Dataset

SMART PUMP
● a computerized infusion device that can be 4. Quality Assurance Check
programmed to include a specific set of data.
5. Staff Training