TECHNOLOGIES INVOLVED IN THE PROMOTION OF PATIENT SAFETY IN THE MEDICATION PROCESS: AN INTEGRATIVE REVIEW

This study sought to identify technologies existing in the literature and their use in promoting patient safety in the medication process. An integrative review was performed in the following databases: Latin American and Caribbean Health Sciences Literature, Medical Literature Analysis and Retrieval System Online, Spanish Bibliographic Index of Health Sciences, Nursing Database, PubMed Central, Cumulative Index to Nursing and Allied Health Literature, Web of Science and SciVerse Scopus, including articles published between 2013 and 2017. Twenty international articles composed the final sample, ten (50%) published in the year 2014. Eleven technologies were identified, with prevalence of four regarding prescribed steps (36.3%) and four regarding drug administration (36.3%), with the technologies most investigated being: Radio Frequency Identification, Computerized Physician Order Entry and Bar-Code- Assisted Medication Administration.Este estudo buscou identificar na literatura as tecnologias existentes e seu uso na promoção da segurança do paciente no processo de medicação. Trata-se de uma revisão integrativa realizada nas bases de dados: Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature Analysisand Retrieval System Online, Índice Bibliográfico Espanhol de Ciências da Saúde, Base de Dados de Enfermagem, PubMed Central, Cumulative Index to Nursing and Allied Health Literature, Web Of Science e SciVerse Scopus, abrangendo artigos publicados entre 2013 e 2017. Vinte artigos internacionais compuseram a amostra final, sendo dez (50%) publicados no ano de 2014. Onze tecnologias foram identificadas, com prevalência das etapas de prescrição quatro (36,3%) e administração de medicamentos quatro (36,3%), sendo as tecnologias mais abordadas: Radio Frequency Identification, Computerized Physician Order Entry e Bar-Code-Assisted Medication Administration.Este estudio tuvo el propósito de identificar, en la literatura, las tecnologías existentes así como su uso en la promoción de seguridad del paciente en el proceso de medicación. Es una revisión integrativa realizada en las bases de datos: Literatura Latinoamericana y de Caribe en Ciencias de la Salud, Medical Literature Analysisand Retrieval System Online, Índice Bibliográfico Español de Ciencias de la Salud, Base de Datos de Enfermería, PubMed Central, Cumulative Index to Nursing and Allied Health Literature, Web Of Science y SciVerse Scopus, abarcando artículos publicados entre 2013 y 2017. Veinte artículos internacionales hicieron parte de la muestra final, siendo diez (50%) publicados en el año de 2014. Once tecnologías fueron identificadas, con predominancia de las etapas de prescripción, cuatro (36,3%), y administración de medicamentos, cuatro (36,3%), siendo las tecnologías más abordadas: Radio Frequency Identification, Computerized Physician Order Entry yBar-Code-Assisted Medication Administration

Desperdício de medicamentos em ambiente hospitalar : identificação dos pontos críticos no circuito, impacto no consumo de recursos e estratégias de controlo

RESUMO - Numa época de constrangimento orçamental, os hospitais do SNS vêm-se na obrigação de melhorar a eficiência de utilização dos recursos disponíveis, por forma a contribuir para o seu equilíbrio financeiro. Cabe a cada prestador analisar a sua posição, avaliar as suas oportunidades e adoptar estratégias que a curto, médio ou longo prazo se traduzam numa efetiva melhoria na eficiência. A análise e o controlo do desperdício associado à prestação de cuidados de saúde apresentam-se, globalmente, como uma dessas oportunidades. Neste trabalho são exploradas oportunidades de redução de desperdício em medicamentos, numa perspectiva meramente operacional, a nível das funções desempenhadas pelos Serviços Farmacêuticos (SF). No hospital em estudo acompanhou-se as diferentes linhas de produção dos SF, nomeadamente as tarefas envolvidas no processo de Distribuição Individual Diária em Dose Unitária, na distribuição de medicamentos para o Serviço de Urgências (SU) e na preparação de citotóxicos e imunomoduladores para o Hospital de Dia de Oncologia. Durante o ano de 2013, os SF devolveram aos fornecedores 0,07% e abateram 0,05% da despesa em medicamentos. A análise dos erros de medicação registados reflete o tipo de distribuição adotado para a maioria dos serviços de internamento do hospital. As melhorias encontradas a este nível passam pelo reforço de recursos humanos a desempenhar as tarefas de dispensa de medicamentos mas também pela implementação de uma cultura de registo de erros e acidentes, baseada no sistema de informação, para que se consiga quantificar o desperdício associado e agir com vista à optimização do circuito. A relação entre o método de distribuição adotado para o SU e a utilização do medicamento neste serviço foi apenas investigada para os medicamentos de registo individual de administração. Foi determinado um índice de eficiência de utilização de 67,7%, entre o dispensado e o administrado. Às discrepâncias encontradas está associado um custo de 32 229,6 € para o ano de 2013. Constatou-se também que, a nível do consumo de citotóxicos e imunomoduladores houve, durante o mês de abril de 2013, um índice de desperdício médio de 14,7%, entre o prescrito e o consumido, que se traduziu num custo do desperdício mensal de 13 070,9 €. Com base no desperdício mensal estimou-se que o desperdício anual associado à manipulação de citotóxicos e imunomoduladores deverá corresponder a 5,5% da despesa anual do serviço com estes medicamentos. Não obstante as limitações encontradas durantes o trabalho, e parte do desperdício apurado ser inevitável, demonstrou-se que o desperdício em medicamentos pode traduzir-se numa fatia não negligenciável mas controlável da despesa do hospital em estudo. No seguimento do seu conhecimento, a sua contenção pode ter um impacto na redução de despesa a curto-médio prazo, sem a necessidade de racionamento da utilização de medicamentos e sem alterar os padrões de qualidade assistencial exigidos pela tutela e pelos doentes. Por último, são apresentadas recomendações para a redução do desperdício em medicamentos, adequadas a cada uma das dimensões analisadas.ABSTRACT - In a time of budget constraints National Health Service (SNS) hospitals are required to improve their resource utilization efficiency in order to maintain financial equilibrium. Each healthcare provider should revaluate its position, analyse the opportunities, and adopt short, medium and long-time strategies to effectively enhance efficiency. Health care-related waste analysis and control appears as one of such opportunities. In this work the reduction of medicines waste is explored, from an operational perspective, as such an opportunity driven by the Hospital Pharmacy Services (HPS). Several lines of work were accompanied in the studied hospital’s Pharmacy Services, namely the processes of Individual Unit Dose Drug-dispensing System, the drug distribution system to the Emergency Department (ER), and the preparation of cytotoxic and immunomodulator drugs for the Oncology Day Hospital. During 2013, 0.07% and 0.05% of the HPS drug expenses were returned to the suppliers and destroyed, respectively. The analysis of the registered medication errors reflected the system adopted for drug distribution to the majority of the hospital’s inpatient services. Performance improvement at this level requires human resource reinforcement, namely at the drug dispensing task, but also establishment of an error/accident recording culture, supported by an information system, so that associated medicines waste is quantified and actions can be taken in order to optimise the circuit. The relationship between the drug distribution system implemented at the ER and the drug utilization by this service was only investigated for the medicines with an individual administration record. An efficiency index of 67.7% between the drugs dispensed and the drugs administered was determined. These discrepancies translate to a 32 229.6 € cost in 2013. We also found that the average waste index associated to the cytotoxic and immunomodulator drugs consumption, during April of 2013, was 14.7%. The difference between prescribed and consumed drug quantities related to a mensal waste cost of 13 070.9 €. Based on the mensal waste cost we estimated an annual waste cost of approximately 5.5% of the annual cytotoxic and immunomodulator PS’s drug consumption. Despite the limitations encountered during this investigation and considering that part of the analysed waste is inevitable, this work still demonstrates that drug waste is a non-negligible but manageable part of the hospital expenditure. Following its knowledge, waste containment can, on a short to medium-term, impact on expenditure reduction without the need of drug use rationing and without altering the quality standards required by the government and patients. Finally, a few recommendations for drug waste reduction are presented for each analysed dimension

Incorporating business process management, business ontology and business architecture in medication management quality

Managers and care providers in the health sector are expected to deliver safe, efficient and effective services within a resource constrained, complex system. Services are provided through execution of multiple processes. Healthcare organizations tend to be structured in functional based silos with process improvement efforts often focused on individual processes within the discrete silos. This silo based improvement approach fails to take into account upstream and downstream processes executed and managed in other silos. A patient’s journey will typically include processes from multiple silos and therefore, improvement efforts need to focus on end-to-end processes if the goal is to deliver a positive patient experience. In order to optimize processes in a complex adaptive system like healthcare and to effect meaningful change a combination of management disciplines is required. This research explored the use of Business Process Management (BPM), Business Architecture (BA) and Business Process Management Ontology (BPMO) as a comprehensive, integrated approach to design, redesign, evaluate, improve and monitor the safety, efficiency and effectiveness of medication management processes in a multi-site healthcare organization. The contribution of the research was threefold. First, identified benefits of applying BPM, BPMO and BA to increase organization capacity and improve the end-to-end process of medication management; second, demonstrated the application of an ontology and the business layer of enterprise architecture used in other sectors could be successfully utilized in the healthcare sector; and third, developed a process reference model for medication management processes in acute care and long term care facilities.Business Process ManagementBusiness ArchitectureBusiness Ontologymedication managementquality improvemen

Social, Private, and Trusted Wearable Technology under Cloud-Aided Intermittent Wireless Connectivity

There has been an unprecedented increase in the use of smart devices globally, together with novel forms of communication, computing, and control technologies that have paved the way for a new category of devices, known as high-end wearables. While massive deployments of these objects may improve the lives of people, unauthorized access to the said private equipment and its connectivity is potentially dangerous. Hence, communication enablers together with highly-secure human authentication mechanisms have to be designed.In addition, it is important to understand how human beings, as the primary users, interact with wearable devices on a day-to-day basis; usage should be comfortable, seamless, user-friendly, and mindful of urban dynamics. Usually the connectivity between wearables and the cloud is executed through the user’s more power independent gateway: this will usually be a smartphone, which may have potentially unreliable infrastructure connectivity. In response to these unique challenges, this thesis advocates for the adoption of direct, secure, proximity-based communication enablers enhanced with multi-factor authentication (hereafter refereed to MFA) that can integrate/interact with wearable technology. Their intelligent combination together with the connection establishment automation relying on the device/user social relations would allow to reliably grant or deny access in cases of both stable and intermittent connectivity to the trusted authority running in the cloud.The introduction will list the main communication paradigms, applications, conventional network architectures, and any relevant wearable-specific challenges. Next, the work examines the improved architecture and security enablers for clusterization between wearable gateways with a proximity-based communication as a baseline. Relying on this architecture, the author then elaborates on the social ties potentially overlaying the direct connectivity management in cases of both reliable and unreliable connection to the trusted cloud. The author discusses that social-aware cooperation and trust relations between users and/or the devices themselves are beneficial for the architecture under proposal. Next, the author introduces a protocol suite that enables temporary delegation of personal device use dependent on different connectivity conditions to the cloud.After these discussions, the wearable technology is analyzed as a biometric and behavior data provider for enabling MFA. The conventional approaches of the authentication factor combination strategies are compared with the ‘intelligent’ method proposed further. The assessment finds significant advantages to the developed solution over existing ones.On the practical side, the performance evaluation of existing cryptographic primitives, as part of the experimental work, shows the possibility of developing the experimental methods further on modern wearable devices.In summary, the set of enablers developed here for wearable technology connectivity is aimed at enriching people’s everyday lives in a secure and usable way, in cases when communication to the cloud is not consistently available

Can diagnosis-based capital allocation facilitate more appropriate, sustainable and innovative acute care?

Australians value access to public hospitals with technologically-appropriate clinical care. However, the Australian system of capital funding for public hospitals is not appropriate, effective, equitable, clinically-responsive, patient-centred, evidence-based or sustainable. A new model to effectively fund patient access to efficient public hospitals was developed from international evidence, Australian standards, clinical guidelines and expert clinical interviews. Capital was costed by patient diagnosis group to enable comprehensive funding for public hospital clinical care, for the first time

The appraisal of Facebook online community: An exposition of mobile commerce in social media reviews

Peer reviewe

Design Strategy for Integrated Personal Health Records: Improving the User Experience of Digital Healthcare and Wellbeing

This dissertation addresses the timely problem of designing Integrated Personal Health Records (PHR). The goal is to provide citizens with digital user experiences, sustainable and flexible enough, for gaining control over their personal health information in a seamless way. Most importantly, so that people are able to reflect and act upon their selfknowledge, towards the accomplishment of their good health and wellbeing. Towards this end, the Integrated PHR as an emerging model in the field of Health IT, was the framework that set this research forward on exploring how communication and collaboration between patients and providers can be improved, which naturally impacts the field of HCI. Acknowledging that today patients are the ones who own all that is recorded about their health data, this new model was object of a design strategy that shaped the results presented in this dissertation. These have showed how patients can have more control of their health over time, through a patient-centered, organic system, which has the ability of combining multiple sources of data both from patient and provider side. As this new type of PHR fosters the creation of integrated networks, this milestone was achieved in this research by interacting with cross-channel user experiences that took part of nationwide healthcare ecosystems. The work presented herein, has demonstrated through the analysis and development of two use cases in cooperation with organizations connected to the Portuguese Ministry of Health, how an Integrated PHR can be a powerful personal tool, to be used by the citizen with undeniable value to the demands of an aging society. The use cases structured the thesis into two parts. The first part in collaboration with the Portuguese National Patient Portal, combines an Integrated PHR and incorporates the Portuguese Data Sharing Platform (PDS), which can be used by any Portuguese citizen. This use case study led to a proposal of the portal by also creating a foundational model for designing Integrated PHRs. The second part in collaboration with the Portuguese National Senior Telehealth Program (Saúde 24 Sénior), led to another proposal for an Integrated PHR, applying the outcomes from Part 1 and the requirements that derived from the findings explored in this second use case study. The proposed solution, has the potential to be used by the Portuguese senior community in the scope of home assistive care. Both proposals applied a user experience design methodology and included the development of two prototypes. The engagement of the stakeholders during the two case studies was accomplished with participatory design methods and followed a multidisciplinary approach to create solutions that would meet the human, politics and behavior interdependencies that were inherent to the process of working with large healthcare organizations. The provided contributions from this thesis intent to be part of a transition process that is changing the behavior of the healthcare sector, which is increasingly moving towards the improvement of the patient-provider relationship, patient engagement, collaborative care and positive computing, where digital technologies play a key role

Information Management in Supply Chain Partnering: Improving Maintenance Processes in Dutch Housing Associations

From the article: "Abstract Maintenance processes of Dutch housing associations are often still organized in a traditional manner. Contracts are based on lowest price instead of ‘best quality for lowest price’ considering users’ demands. Dutch housing associations acknowledge the need to improve their maintenance processes in order to lower maintenance cost, but are not sure how. In this research, this problem is addressed by investigating different supply chain partnering principles and the role of information management. The main question is “How can the organisation of maintenance processes of Dutch housing associations, in different supply chain partnering principles and the related information management, be improved?” The answer is sought through case study research.