Impact assessment of an automated drug-dispensing system in a tertiary hospital

OBJECTIVE: To evaluate the costs and patient safety of a pilot implementation of an automated dispensing cabinet in a critical care unit of a private tertiary hospital in São Paulo/Brazil. METHODS: This study considered pre- (January-August 2013) and post- (October 2013-October 2014) intervention periods. We considered the time and cost of personnel, number of adverse events, audit adjustments to patient bills, and urgent requests and returns of medications to the central pharmacy. Costs were evaluated based on a 5-year analytical horizon and are reported in Brazilian Reals (R$) and US dollars (USD). RESULTS: The observed decrease in the mean number of events reported with regard to the automated drug-dispensing system between pre- and post-implementation periods was not significant. Importantly, the numbers are small, which limits the power of the mean comparative analysis between the two periods. A reduction in work time was observed among the nurses and administrative assistants, whereas pharmacist assistants showed an increased work load that resulted in an overall 6.5 hours of work saved/day and a reduction of R$ 33,598 (USD 14,444) during the first year. The initial investment (R$ 206,065; USD 88,592) would have been paid off in 5 years considering only personnel savings. Other findings included significant reductions of audit adjustments to patient hospital bills and urgent requests and returns of medications to the central pharmacy. CONCLUSIONS: Evidence of the positive impact of this technology on personnel time and costs and on other outcomes of interest is important for decision making by health managers

An Inhaler Tracking System Based on Acoustic Analysis:Hardware and Software

In treating asthma and chronic obstructive pulmonary disorder (COPD), acquisition of authentic and effective feedback from patients on regimen adherence is difficult. Face-to-face and oral reporting methods do not satisfy current intelligent medication best practices. This paper presents a system to track and analyze daily inhaler usage. A portable electronic device that attaches to the inhaler uses an accelerometer and capacitive sensors to detect users’ motion and an embedded digital microphone to capture sounds while the inhaler is in use. In terms of analysis, sound features are extracted, and breath phases are identified by employing a hidden Markov model with a Gaussian mixture model. A feature template is also constructed and used to search for and identify “canister pressed” events. The system provides objective feedback, quantifying asthma, and COPD patients’ adherence to medication regimens. Although interest in asthma adherence to medication regimens is growing, there is still a relative paucity of research and, indeed, compliance devices in this area; the tracking system can help doctors better understand the patient’s condition and choose an appropriated treatment plan. At the same time, patients can also improve their self-management by system feedback

In what way do Nepalese cultural factors affect adherence to antiretroviral treatment in Nepal?

Individuals’ self administration of medication is an essential component of disease management because incorrect and incomplete medication can result in increased morbidity, mortality and healthcare costs and also spreads drug resistance. Its impact is necessarily wider than just medical and includes the cultural and managerial considerations which govern success in medical interventions. This review paper is aimed at how Nepalese cultural factors (beliefs, religious practices, customs and traditions) may affect adherence to antiretroviral (ARV) medication among people living with Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Results: Cultural factors (individual beliefs and perceptions) are notoriously complex concepts and shape people’s identities and influence their attitude and behaviours. The individual behaviours and beliefs about health and seeking treatment can adversely affect health care utilization and adherence to medication. These factors create a complicated and unforgiving environment for patients who are struggling to endure a chronic, life-threatening illness with life-long treatment. We cannot disregard patients’ cultural beliefs or practices in order to provide ARV treatment and their adherence because patients and clinicians come from different cultural groups. Conclusion: It is the purpose of this paper to contribute to the policy makers by exploring the pertinent cultural factors relating to the uptake of ARV treatment and its adherence

Electronic Medical Record in the Simulation Hospital: Does It Improve Accuracy in Charting Vital Signs, Intake, and Output?

The introduction of electronic health records has created a shift in the way nursing care is delivered (McBride, Delaney, & Tietze, 2012; Furukawa, Raghu, & Shao, 2010). A factor which heavily influences a nurse’s ability to navigate and utilize EMR is adequate education in the use of computerized documentation (McBride, et al., 2012). There is an increased risk for error at the bedside without the correct knowledge and skills regarding EMR documentation (Kelly, Brandon, & Docherty, 2011). This skill should be introduced during the pre-licensure education of the nurse. Two groups of associate degree nursing students attending a small community college in Northern California were examined to determine if introduction of EMR in the simulation hospital increased accuracy in documenting vital signs, intake, and output. The first group of students charted using paper- pencil during simulation; the second group used an academic EMR. Each group was evaluated during their preceptor rotation at two local inpatient facilities. Registered nurse preceptors provided information by responding to a 10 question survey regarding the use of student EMR documentation during the 120 hour preceptor rotation. The implementation of the EMR into the simulation hospital, although a complex undertaking, provided students a safe environment in which to practice using technology and receive feedback from faculty regarding accurate documentation

From Insights to INTEL: Evaluating Process Mining Insights with Healthcare Professionals

As healthcare organisations are looking for ways to improve their processes, process mining techniques are increasingly being used. Current process mining methods do not offer support for translating process mining insights into actionable improvement ideas. By performing action research at two healthcare organisations, we introduce and illustrate the INTEL funnel, a novel three-staged method consisting of process familiarisation, domain explanation and improvement ideation. Our method complements existing process mining methods and constitutes the first attempt to open the black box regarding the path from process mining insights to actionable process improvement ideas. In this way, it can contribute to a more systematic uptake of process mining in healthcare practice

Veterans' Health Care: Balancing Resources and Responsibilities

This paper looks at the health care benefits and services administered by the U.S. Department of Veterans Affairs. It examines management strategies adopted within the department to allocate resources, structure benefits, and improve quality. Some recommendations made by the General Accounting Office and the President's Task Force to Improve Health Care Delivery for Our Nation's Veterans are reviewed, in particular the emphasis of the latter on increased collaboration with the Department of Defense. Long-term proposals to balance service commitments and financing also are considered

Pediatric Hematology/Oncology Outpatient Care: the Effect of a Standardized Collaborative Medication Reconciliation Process

Pediatric patients are at an increased risk for medication errors and can benefit from processes that facilitate and promote medication safety (Stone et al., 2010). Medication reconciliation (Med Rec) is a valuable tool in improving patients’ medication safety and reducing adverse drug events (The Joint Commission, 2015). The purpose of this evidence-based practice (EBP) project was to improve the accuracy of the Med Rec process in a Midwestern pediatric hematology/oncology outpatient clinic by developing, promoting, and evaluating a standardized, collaborative Med Rec process. The Stetler EBP model guided the implementation of the intervention, with the goal of integrating current evidence into current practice. Kotter’s Model of Change laid the theoretical foundation for successful implementation of a current practice change. This EBP project intervention included a patient and team member component. The patient component consisted of a verbal call reminder to bring medications to the visit, a patient handout emphasizing the importance of medication safety and reconciliation, and patient education regarding Med Rec process. The team member component included education regarding the importance of the Med Rec process and updates regarding Med Rec accuracy. The outcomes measured included the number, type, and severity of medication discrepancies and the number of voluntarily reported medication errors. Data were collected during Phase 1 (pre-intervention) and Phase 2 (post-intervention) by the physicians and the project leader (PL). These data were analyzed using chi-square tests. The intervention lead to a significant increase in the number of accurate Med Recs reported by the physicians between Phase 1 (n = 50, 70%) and Phase 2 (n = 65, 90.8%) (X2 = 8.167, df = 1, p = .004). An insignificant decrease in the number of accurate Med Recs was reported by the PL between Phase 1 (73.1%) and 2 (72.5%) (X2 = .003, df = 1, p = 0.959). Physicians reported more incorrectness errors in Phase 1 (73.3%) and Phase 2 (83.3%) than incompleteness errors (X2 = .481, df = 1, p = .786). PL reported more incompleteness errors in Phase 1 (71.4%) and Phase 2 than incorrectness errors (81.8%) (X2 = 1.670, df = 2, p = .434). The majority of Med Rec inaccuracies were classified as minor during Phase 1 and 2 by the physicians (X2 = .827, df = 2, p = .363) and the PL (X2 = 1.039, df = 1, p = .308). No inaccurate Med Rec was classified as severe by physicians or the PL. Finally, there were no voluntary medication errors were reported during the duration of the EBP project. Revision and replication of this EBP project would be helpful in further improving Med Rec accuracy in this setting