Investigation Interoperability Problems in Pharmacy Automation: A Case Study in Saudi Arabia

The aim of this case study is to investigate the nature of interoperability problems in hospital systems automation. One of the advanced healthcare providers in Saudi Arabia is the host of the study. The interaction between the pharmacy system and automated medication dispensing cabinets is the focus of the case system. The research method is a detailed case study where multiple data collection methods are used. The modelling of the processes of inpatient pharmacy systems is presented using Business Process Model Notation. The data collected is analysed to study the different interoperability problems. This paper presents a framework that classifies health informatics interoperability implementation problems into technical, semantic, organisational levels. The detailed study of the interoperability problems in this case illustrates the challenges to the adoption of health information system automation which could help other healthcare organisations in their system automation projects

The drug logistics process: an innovation experience

Purpose - The purpose of this paper is to present the latest innovations in the drug distribution processes of hospital companies, which are currently dealing with high inventory and storage costs and fragmented organizational responsibilities. Design/methodology/approach - The literature review and the in-depth analysis of a case study support the understanding of the unit dose drug distribution system and the subsequent definition of the practical implications for hospital companies. Findings - Starting from the insights offered by the case study, the analysis shows that the unit dose system allows hospitals to improve the patient care quality and reduce costs. Research limitations/implications - The limitations of the research are those related to the theoretical and exploratory nature of the study, but from a practical point of view, the work provides important indications to the management of healthcare companies, which have to innovate their drug distribution systems. Originality/value - This paper analyzes a new and highly topical issue and provides several insights for the competitive development of a fundamental sector

Evaluating information flow in medication management process in Australian acute care facilities: A multi-professional perspective

Over the years, various interventions have been introduced to improve the medication management process. While these interventions have addressed some aspects predisposing the process to inefficiencies, significant gaps are still prevalent across the process. Studies have suggested that the goal of optimal medication therapy is achievable when information flow integrates across the various medication management process phases, stakeholders and departments involved as the patient moves through the process. To provide a cross-sectional view of the process, this study utilised a systemic philosophy to evaluate the information flow integration across the process. The research approach adopted for this study takes a positivist paradigm, which is guided by the cause and effect (causality) belief. It explored numeric measures to evaluate the relationship between constructs that assessed information flow principles (accessibility, timeliness, granularity and transparency) within the medication process and the information integration. The research design was cross-sectional and analytical, and this ensures that findings are relevant to current situations across the Australian healthcare system. Data for this research was collected using an online self-administered survey and the data assessed information flow principles and technologies used in the medication management process. There were 88 participants in this study, including doctors, nurses and pharmacists. The questions and responses were coded for analysis and data analysis techniques used were frequency analysis, Pearson’s chi-square test and multivariate analysis. Findings from this study indicates that the constructs evaluating accessibility, transparency and granularity had moderate associations with the information integration in the medication management process. Further analysis highlighted accessibility as a significant principle in explaining an increase or decrease in information integration in the medication management process. The accessibility construct referring to information retrieval was significant across the two tests conducted. Accessibility is directly related to information sharing and the assessment and monitoring and evaluation phases in the medication management process were identified as having the highest challenges with information sharing. Furthermore, the hybrid (electronic and paper) channel was preferred to support information integration in the medication management process by the participants. Among the technologies evaluated for the medication process, computer-provider-order-entry was found to be statistically significant in explaining an increase in information integration. Overall, results from this study suggest that interventions for the medication management process in Australian acute care facilities should be directed towards improving accessibility, specifically information retrieval and the sharing of information with emphasis on the assessment and monitoring phases. Implementing strategies to address the gaps identified from this research can improve information integration across the process and thereby reducing medication errors, and improving patient care management. Furthermore, the technology adoption across the process highlights that technology adoption across participants’ facilities remains a challenge in Australia

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

Automated Medication Dispensing Cabinet and Medication Errors

The number of deaths due to medical errors in hospitals ranges from 44,000 to 98,000 yearly. More than 7,000 of these deaths have taken place due to medication errors. This project evaluated the implementation of an automated medication dispensing cabinet or PYXIS machine in a 25-bed upper Midwestern critical access hospital. Lewin\u27s stage theory of organizational change and Roger\u27s diffusion of innovations theory supported the project. Nursing staff members were asked to complete an anonymous, qualitative survey approximately 1 month after the implementation of the PYXIS and again 1 year later. Questions were focused on the device and its use in preventing medication errors in the hospital. In addition to the surveys that were completed, interviews were conducted with the pharmacist, the pharmacy techs, and the director of nursing 1 year after implementation to ascertain perceptions of the change from paper-based medication administration to use of the automated medication dispensing cabinet. Medication errors before, during, and after the PYXIS implementation were analyzed. The small sample and the small number of medication errors allowed simple counts and qualitative analysis of the data. The staff members were generally satisfied with the change, although they acknowledged workflow disruption and increased medication errors. The increase in medication errors may be due in part to better documentation of errors during the transition and after implementation. Social change in practice was supported through the patient safety mechanisms and ongoing process changes that were put in place to support the new technology. This project provides direction to other critical access hospitals regarding planning considerations and best practices in implementing a PYXIS machine

Effect of a Pharmacy-based Centralized Intravenous Admixture Service on the Prevalence of Medication Errors:A Before-and-After Study

Intravenous admixture preparation errors (IAPEs) may lead to patient harm. The primary aim of this study was to assess the effect of a pharmacy-based centralized intravenous admixture service (CIVAS) on IAPEs. METHODS: We conducted a before-and-after study in 3 clinical wards before CIVAS implementation and in the CIVAS unit 18 months after implementation. Intravenous admixture preparation error data were collected by disguised observation. The primary outcome was the proportion of admixtures with 1 or more IAPEs. Secondary outcomes were the type and potential severity of IAPEs, noncompliance to hygiene procedures, and nursing staff satisfaction with the CIVAS. The primary outcome was analyzed using a multivariable mixed-effects logistic regression model. RESULTS: One or more IAPEs were identified in 14 of 543 admixtures (2.6%) in the CIVAS unit and in 148 of 282 admixtures (52.5%) in the clinical wards (odds ratio, 0.02; 95% confidence interval, 0.004–0.05). The most common IAPE types were wrong solvent or diluent (n = 95) and wrong volume of infusion fluid (n = 45). No potentially harmful IAPEs occurred in the CIVAS unit as opposed to 22 (7.8%) in the clinical wards. Disinfection procedures were better adhered to in the CIVAS unit. Overall nurse satisfaction with the CIVAS increased from a median of 70 (n = 166) 5 months after intervention to 77 (n = 115) 18 months after intervention (P < 0.001) on a 100-point scale. CONCLUSIONS: Centralized intravenous admixture service performed notably better than the clinical wards with regard to IAPEs and noncompliance to hygiene procedures. Nurses were satisfied with the CIVAS. Hence, the implementation of CIVAS is an important strategy to improve medication safety in hospitals

Evaluation of drug administration errors in a teaching hospital

<p>Abstract</p> <p>Background</p> <p>Medication errors can occur at any of the three steps of the medication use process: prescribing, dispensing and administration. We aimed to determine the incidence, type and clinical importance of drug administration errors and to identify risk factors.</p> <p>Methods</p> <p>Prospective study based on disguised observation technique in four wards in a teaching hospital in Paris, France (800 beds). A pharmacist accompanied nurses and witnessed the preparation and administration of drugs to all patients during the three drug rounds on each of six days per ward. Main outcomes were number, type and clinical importance of errors and associated risk factors. Drug administration error rate was calculated with and without wrong time errors. Relationship between the occurrence of errors and potential risk factors were investigated using logistic regression models with random effects.</p> <p>Results</p> <p>Twenty-eight nurses caring for 108 patients were observed. Among 1501 opportunities for error, 415 administrations (430 errors) with one or more errors were detected (27.6%). There were 312 wrong time errors, ten simultaneously with another type of error, resulting in an error rate without wrong time error of 7.5% (113/1501). The most frequently administered drugs were the cardiovascular drugs (425/1501, 28.3%). The highest risks of error in a drug administration were for dermatological drugs. No potentially life-threatening errors were witnessed and 6% of errors were classified as having a serious or significant impact on patients (mainly omission). In multivariate analysis, the occurrence of errors was associated with drug administration route, drug classification (ATC) and the number of patient under the nurse's care.</p> <p>Conclusion</p> <p>Medication administration errors are frequent. The identification of its determinants helps to undertake designed interventions.</p

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