THE ROLE OF TECHNOLOGY

IN MEDICATION-USE
PROCESS
• THE HEALTHCARE INDUSTRY IN AN INHERENTLY ERROR-PRONE PROCESS THAT
IS FRAUGHT WITH OPPORTUNITIES FOR MISTAKES TO OCCUR.
• BETWEEN 44,000 AND 98,000 PATIENTS DIE EACH YEAR IN THE UNITED STATES
FROM PREVENTABLE ERROR. THESE DEATHS WERE THE RESULTS OF
PRACTITIONER INTERACTIONS WITH “BAD SYSTEMS’.
 TECHNOLOGY AND HEALTHCARE

• THE MAJORITIES OF TECHNOLOGY ACQUISITIONS HAVE CONSIDERED OF BASIC

STAND-ALONE COMPUTER SYSTEMS, WHICH WERE PRIMARILY USED FOR DATA
INPUT OR INCREASE EACH DEPARTMENTS EFFICIENCY WITH FINANCIAL
ACCOUNTABILITY MEASURES.
• THESE COMPUTERS WERE GENERALLY INSTALLED IN THE PHARMACY,
RADIOLOGY, AND LABORATORY DEPARTMENTS AND COULD ALSO BE FOUND IN
THE ADMINISTRATION AND BUSINESS OFFICES.
• STUDIES HAVE SHOWN THAT AS A RESULT OF POOR HANDWRITING, 50% OF ALL
WRITTEN PHYSICIAN ORDERS REQUIRE EXTRA TIME TO INTERPRET. SIXTEEN
PERCENT OF PHYSICIAN HAS ILLEGIBLE HAND WRITING.
• ILLEGIBLE HANDWRITING ON MEDICATION ORDERS HAS BEEN SHOWN TO BE A
COMMON CAUSE OF PRESCRIBING ERRORS AND THE PATIENT INJURY AND DEATH
HAVE ACTUALLY RESULTED FROM SUCH ERRORS.
 COMPUTERIZED PRESCRIBER ORDER ENTRY
(CPOE)
• THE USE OF CPOE SYSTEM HAS THE POTENTIAL TO ALLEVIATE MANY OF THESE
PROBLEMS.
• CPOE CAN BE DEFINED AS A SYSTEM USED FOR DIRECT ENTRY OF ONE OR MORE
TYPES OF MEDICAL ORDERS BY A PRESCRIBER INTO A SYSTEM THAT TRANSMITS
THOSE ORDERS BY ELECTRONICALLY TO THE APPROPRIATE DEPARTMENT.
 OTHER POTENTIAL ENHANCEMENTS THAT EVEN A BASIC CPOE
SYSTEM COULD OFFER TO FURTHER ENHANCE SAFE MEDICATIONS
ORDERING PRACTICES INCLUDING FEATURES UNIQUE TO THE
ACUTE-CARE SETTING, AMBULATORY CARE SETTING OR BOTH:

• ALLOW FOR PRESCRIBERS TO ACCESS RECORDS AND ENTER ORDERS FROM

THEIR OFFICE OR HOME
• PRESCRIBERS SELECTABLE STANDARDIZED SINGLE ORDERS OR ORDER SET
• PASSIVE FEEDBACK SYSTEMS THAT PRESENT PATIENT-SPECIFIC DATA IN AN
ORGANIZED FASHION SUCH AS TEST RESULTS, CHARGES, MATERIALS, AND
PROGRESS NOTES, OR ACTIVE FEEDBACK SYSTEMS.
 BAR CODE-ENABLED POINT -OF- CARE
TECHNOLOGY
• FOR MORE THAN 20 YRS. BAR CODE TECHNOLOGY HAS CLEARLY
DEMONSTRATED ITS POWER TO GREATLY IMPROVE PRODUCTIVITY AND
ACCURACY IN THE IDENTIFICATION OF PRODUCTS IN A VARIETY OF BUSINESS
SETTINGS, SUCH AS SUPER MARKETS AND DEPARTMENT STORES.
           ONE STUDY NOTED FIVE SIGNIFICANT
NEGATIVE EFFECTS THAT OCCURRED DURING
THE IMPLEMENTATION OF A BPOC SYSTEM:
• NURSES WERE SOMETIMES CAUGHT “OFF GUARD” BY THE PROGRAMMED AUTOMATED ACTIONS
TAKEN BY THE BPOC SOFTWARE.
• HE BPOC SEEMED TO INHIBIT THE COORDINATION OF PATIENT INFORMATION BETWEEN PRESCRIBES
AND NURSES WHEN COMPARED TO A TRADITIONAL PAPER-BASED SYSTEM.
• NURSES FOUND IT MORE DIFFICULT TO DEVIATE FROM THE ROUTINE MEDICATION ADMINISTRATION
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 FEW MINUTES LATE.
• NURSES USED STRATEGIES TO EFFICIENCY THAT CIRCUMVENTED THE INTENDED USE OF BPOC.
 NEW TYPES OF MEDICATION ERRORS

• OMISSIONS
• EXTRA DOSE
• WRONG DRUG
• WRONG DOSE
• UNAUTHORIZED DRUG
• CHARTING ERRORS
• WRONG DOSAGE FORM
 AUTOMATED DISPENSING CABINETS

• THE ADC IS A COMPUTERIZED POINT-OF-USE MEDICATION-MANAGEMENT

SYSTEM IS DESIGNED TO REPLACE OR SUPPORT THE TRADITIONAL UNIT-DOSE
DRUG DELIVERY SYSTEM.
• MANY HEALTHCARE FACILITIES HAVE BEEN REPLACED MEDICATION CARTS OR
OPEN UNIT-STOCK SYSTEMS WITH ADC’S.
 THE RATIONALES BEHIND THE WIDE
ACCEPTANCE OF THIS TECHNOLOGY ARE THE
FOLLOWING:
• IMPROVING PHARMACY PRODUCTIVITY
• IMPROVING NURSING PRODUCTIVITY
• REDUCING COSTS
• IMPROVING CHARGE CAPTURE
• ENHANCING PATIENT QUALITY AND SAFETY
 “SMART” INFUSION PUMP DELIVERY SYSTEM

• INFUSION PUMP WITH DOSE CALCULATION SOFTWARE, SOMETIMES REFERRED

TO AS “SMART PUMPS’, COULD REDUCE MEDICATION ERRORS, IMPROVE
WORKFLOW, AND PROVIDE NEW SOURCE OF DATA FOR CONTINUOUS QUALITY
IMPROVEMENT BY IDENTIFYING AND CORRECTING PUMP-PROGRAMMING
ERRORS.
HEALTHCARE STANDARDS