A Secure Intelligent Decision Support System for Prescribing Health Medications

The process of electronic approach to writing and sending medical prescription promises to improve patient safety, healthoutcomes, maintaining patients’ privacy, promoting clinician acceptance and prescription security when compared with thecustomary paper method. Traditionally, medical prescriptions are typically handwritten or printed on paper and handdeliveredto pharmacists. Paper-based medical prescriptions are generating major concerns as the incidences of prescriptionerrors have been increasing and causing minor to serious problems to patients, including deaths. In this paper, intelligent eprescriptionmodel that comprises a knowledge base of drug details and an inference engine that can help in decision makingwhen writing a prescription was developed. The research implements the e-prescription model with multifactorauthentication techniques which comprises password and biometric technology. Microsoft Visual Studio 2008, using C#programming language, and Microsoft SQL Server 2005 database were employed in developing the system’s front end andback end respectively. This work implements a knowledge base to the e-prescription system which has added intelligence forvalidating doctor’s prescription and also added security feature to the e-prescription system..Key words: e-Prescription, biometrics prescription, secured prescription, intelligent systems. DSS

Transforming Healthcare Quality through Information Tehnology

Information and information exchange are crucial to the delivery of care on all levels of the health care delivery system—the patient, the care team, the health care organization, and the encompassing political-economic environment. To diagnose and treat individual patients effectively, individual care providers and care teams must have access to at least three major types of clinical information—the patient’s health record, the rapidly changing medical-evidence base, and provider orders guiding the process of patient care. In this frame, Information Technology can help healthcare organizations improve the quality of care that they provide, improve patient safety, improve cost-effectiveness, accelerate the translation of research findings into practice, improve care for the medically underserved, increase consumer involvement, improve accuracy and privacy, and increase their ability to monitor health nationally. Consequently, in the present article are presented some implementations of Information and Communication Technologies in the Health Care field.Healthcare; Quality; Information and Communication Technologies

Developing Policies and Guidelines to Prevent Medication Errors and ADEs in Nursing Homes

According to the National Patient Safety Foundation, more than 1.5 million Americans are affected by medication errors because of varied factors including miscommunication, bad handwriting, name confusion, poor packaging, and metric or other dosing unit errors. This project addressed medication errors and adverse drug events by developing policy and practice guidelines to support and aid the utilization of health information technology (HIT) systems in addressing medication errors and adverse drug events at a local nursing home in Cincinnati, Ohio. The National Quality Strategy Framework was used by a team of interdisciplinary stakeholders as a guide for the development of policies and practice guidelines. An interdisciplinary project team of institutional stakeholders was led by the DNP student through a review of literature to assess the effectiveness of current policies and guidelines and explore areas for improvement. New policy, practice guidelines, and educational materials were developed, along with plans for implementing and evaluating the policies in the institution. Policy and practice guidelines were shared with 4 scholars possessing expertise in health information technology to validate content of the products. Feedback was used to inform revision and preparation of final policy, practice guidelines, educational materials, and plans for implementation and evaluation. The implementation plan advocates a process that includes multiple stakeholders and institutional preparatory stages. The evaluation plan addresses multiple outcomes related to efficiency and patient safety, and proposes both intermediate and long-term evaluation based on comparisons of pre-post metrics routinely collected by the institution. Following implementation and evaluation, dissemination of results of the project may stimulate positive social change by reducing medication errors in similar health care institutions that adopt related measures

Eventos adversos causados por medicamentos en un hospital centinela del Estado de Goiás, Brasil

This was a retrospective, descriptive and documental study with the aim of identifying adverse drug events which occurred in the medication administration process and to classify these medication errors. This study was developed in the internal medicine unit of a general hospital of Goiás, Brazil. Report books used by nursing staff from the period 2002 to 2007, were analyzed. A total of 230 medication errors were identified, most of which occurred in the preparation and administration of the medications (64.3%). Medication errors were of omission (50.9%), of dose (16.5%), of schedule (13.5%) and of administration technique (12.2%) and were more frequent with antineoplastic and immunomodulating agents (24.3%) and anti-infective agents (20.9%). It was found that 37.4% of drugs were high alert medications. Considering the medication errors detected it is important to promote a culture of safety in the hospital.Trata-se de estudo retrospectivo, documental e descritivo que teve como objetivo identificar os eventos adversos a medicamentos, ocorridos no processo administração de medicamentos, e classificar os erros de medicação. Este estudo foi desenvolvido na unidade de clínica médica de um hospital geral de Goiás, Brasil. Foram analisados os livros utilizados pela equipe de enfermagem, no período de 2002 a 2007, para registros de passagem de plantão. Identificaram-se 230 erros de medicação, sendo a maioria no preparo e administração de medicamentos (64,3%). Os erros de medicação foram de omissão (50,9%), de dose (16,5%), de horário (13,5%) e de técnica de administração (12,2%), sendo mais frequentes com antineoplásicos e imunomoduladores (24,3%) e anti-infecciosos (20,9%). Constatou-se que 37,4% dos medicamentos eram potencialmente perigosos. Considerando os erros de medicação detectados, é importante promover cultura de segurança no hospital.Se trata de un estudio retrospectivo, documental y descriptivo que tuvo como objetivo identificar los eventos adversos causados por medicamentos ocurridos en el proceso de administrarlos y clasificar los errores de medicación. Este estudio fue desarrollado en la unidad de clínica médica de un hospital general de Goiás, Brasil. Fueron analizados los libros utilizados por el equipo de enfermería, en el período de 2002 a 2007, en los registros de traspaso de plantón. Fueron identificados 230 errores de medicación, siendo la mayoría en la preparación y administración de medicamentos (64,3%). Los errores de medicación fueron de omisión (50,9%), de dosis (16,5%), de horario (13,5%) y de técnica de administración (12,2%), siendo más frecuentes con antineoplásicos e inmunomoduladores (24,3%) y antiinfecciosos (20,9%). Se constató que 37,4% de los medicamentos eran potencialmente peligrosos. Considerando los errores de medicación detectados es importante promover una cultura de seguridad en el hospital

Technology Target Studies: Technology Solutions to Make Patient Care Safer and More Efficient

Presents findings on technologies that could enhance care delivery, including patient records and medication processes; features and functionality nurses require, including tracking, interoperability, and hand-held capability; and best practices

Eventos adversos a medicamentos em um hospital sentinela do Estado de Goiás, Brasil

This was a retrospective, descriptive and documental study with the aim of identifying adverse drug events which occurred in the medication administration process and to classify these medication errors. This study was developed in the internal medicine unit of a general hospital of Goiás, Brazil. Report books used by nursing staff from the period 2002 to 2007, were analyzed. A total of 230 medication errors were identified, most of which occurred in the preparation and administration of the medications (64.3%). Medication errors were of omission (50.9%), of dose (16.5%), of schedule (13.5%) and of administration technique (12.2%) and were more frequent with antineoplastic and immunomodulating agents (24.3%) and anti-infective agents (20.9%). It was found that 37.4% of drugs were high alert medications. Considering the medication errors detected it is important to promote a culture of safety in the hospital.Se trata de un estudio retrospectivo, documental y descriptivo que tuvo como objetivo identificar los eventos adversos causados por medicamentos ocurridos en el proceso de administrarlos y clasificar los errores de medicación. Este estudio fue desarrollado en la unidad de clínica médica de un hospital general de Goiás, Brasil. Fueron analizados los libros utilizados por el equipo de enfermería, en el período de 2002 a 2007, en los registros de traspaso de plantón. Fueron identificados 230 errores de medicación, siendo la mayoría en la preparación y administración de medicamentos (64,3%). Los errores de medicación fueron de omisión (50,9%), de dosis (16,5%), de horario (13,5%) y de técnica de administración (12,2%), siendo más frecuentes con antineoplásicos e inmunomoduladores (24,3%) y antiinfecciosos (20,9%). Se constató que 37,4% de los medicamentos eran potencialmente peligrosos. Considerando los errores de medicación detectados es importante promover una cultura de seguridad en el hospital.Trata-se de estudo retrospectivo, documental e descritivo que teve como objetivo identificar os eventos adversos a medicamentos, ocorridos no processo administração de medicamentos, e classificar os erros de medicação. Este estudo foi desenvolvido na unidade de clínica médica de um hospital geral de Goiás, Brasil. Foram analisados os livros utilizados pela equipe de enfermagem, no período de 2002 a 2007, para registros de passagem de plantão. Identificaram-se 230 erros de medicação, sendo a maioria no preparo e administração de medicamentos (64,3%). Os erros de medicação foram de omissão (50,9%), de dose (16,5%), de horário (13,5%) e de técnica de administração (12,2%), sendo mais frequentes com antineoplásicos e imunomoduladores (24,3%) e anti-infecciosos (20,9%). Constatou-se que 37,4% dos medicamentos eram potencialmente perigosos. Considerando os erros de medicação detectados, é importante promover cultura de segurança no hospital

An Evaluation of Robotics in Nursing Homes to Reduce Adverse Drug Events

Adverse drug events (ADE) cause many deaths annually in addition to affecting the quality of life of many others. The descriptive mixed methods approach, specifically exploratory case study and experimental design that guided this research utilized the survey and focus group methods to evaluate perceptions about robotic technology (RT) to reduce the rate of ADEs in U.S. nursing homes (NH). There is a lack of scholarly research into whether a conceptual approach rooted in RT can be implemented to assist with drug administrations in NHs. The purpose of this study was twofold. The first purpose was to evaluate the causes of ADEs specifically related to tablets, capsules, and pills. The second purpose was to evaluate the perceptions of nurses and administrators relative to the use of RT to assist in reducing ADEs. In the quantitative part, the sample means from 102 surveys from nurses and administrators were evaluated with the t test and the paired t test; while in the qualitative part, survey results, reported errors, and focus group data was assessed collectively. The research results did not indicate any new causes of ADEs and showed that the participants had a favorable perception of RT. Based on the results of this research, RT may be tailored in such a way that it can significantly reduce ADE occurrences for citizens in U.S. NHs

The impact of a ward pharmacist in a surgical ward of a private hospital in the Eastern Cape

Medication errors are becoming problematic in both hospital and outpatient settings worldwide. Inappropriate use of medication can cause harm to the patient and maintaining high levels of quality patient care is essential to protect all patients. Clinical pharmacy practice contributes to improved patient care by optimising medication therapy; and promoting health, wellness and disease prevention. The involvement of a pharmacist at a ward level has been shown to improve patient care; reduce mortality and morbidity rates; decrease healthcare costs; minimise medication errors; and improve outcomes of drug therapy. However, clinical pharmacy is a fairly new practice in South Africa and there are limited studies available. This study aimed to evaluate the perceived benefits of a ward-based pharmacist on the provision of pharmaceutical care to patients in a hospital setting and to consequently implement a ward-based pharmacy service. The objectives of the study were: (1) to assess, via a questionnaire, the perceptions and attitudes of medical practitioners and nurses to ward-based pharmacy prior to and after implementation of a ward-based pharmacy service, (2) to implement a ward-based pharmacy service in a selected hospital ward; (3) to document and analyse the nature of the work and activities that a ward pharmacist undertakes, and (4) to document and analyse the frequency and nature of ward pharmacist interventions. The study was conducted in a surgical ward of a private hospital in the Eastern Cape. The study design was an intervention study, using a mixed-methods design, with a convergent approach. A convenience sample of 106 patients was obtained over the eight week study period. Participation was voluntary and confidentiality was maintained at all times. Four data collection tools were used during the study and a pilot study was conducted to ensure their validity and reliability. The quantitative data was analysed statistically while the qualitative questions were analysed through coding the various responses. The results of the study showed that medical practitioners and nurses of a surgical ward had a positive attitude towards ward pharmacy both prior to and after the implementation of a ward pharmacy service. There were ward pharmacist interventions made in 50% (n=106) of the patients who participated in the study. A large percentage (57%; 50; n=87) of the ward pharmacist interventions were pharmacist-initiated interventions to optimise patient care while prescribing errors (51%; 19; n=37) were the most commonly occurring medication error. The majority of the medication items involved in the interventions (34%; 34; n=101) were related to the anti-microbial medication class. Overall, there was a 73% (36; n=49) acceptance rate of the ward pharmacist interventions that were made to both the medical practitioners and nurses. There were a number of factors that had a significant relationship with a ward pharmacist intervention being required which included: (1) number of medication items (p=0.001; Chi² test; p<0.0005 Student’s t-test), (2) length of hospital stay (p<0.0005; Chi² test), (3) presence of one or more chronic disease states (p=0.003; Chi² test) and (4) presence of one or more allergies (p=0.028; Chi² test). The ward pharmacist interventions were shown to be of clinical significance and to have a positive impact on the patients concerned. It can be concluded that the ward pharmacy service was beneficial to the patients, medical practitioners and nursing staff

To investigate the feasibility of predicting, identifying and mitigating latent system failures in a UK NHS paediatric hospital

The aim of this study was to investigate the feasibility of identifying latent system failures in a paediatric National Health Service hospital in the England (NHS). Medicine related errors affect up to 9% of all patients in NHS hospitals. The theoretical basis included error causation theory, the functioning of short-term memory and how the brain manages multiple stimuli. The literature review covered error causation and prevention research, undertaken in healthcare settings and other high-risk industries. The study environment was the dispensary of Birmingham Children’s Hospital (BCH) and a busy ward. The study instrument was non-participant, direct observation of routine dispensing and medicines administration tasks. The first phase identified latent risks in a specific readily observable task set in a specialist paediatric hospital pharmacy department. Having identified a major latent risk, interruption, the investigation then established the significance that interruptions had on operatives. The second phase investigated the efficiency and effectiveness of the current Incident and error reporting system (IR1s) in supporting learning from incidents and changing practice. The first phase identified “interruptions” as a latent error and demonstrated, for what appears to have been the first time in healthcare research, the impact these have on operatives. The second phase confirmed that a gap existed in healthcare error reduction strategies. From the outcomes of the first two phases a completely new strategy, to predict latent system errors and then to reduce them was devised. The strategy was then implemented in another area of the hospital, with different staff, on a high-risk task, IV medicine administration and was shown to reduce medicine errors