Computer programs used in the field of hospital pharmacy for the management of dangerous drugs: systematic review of literature

Background: This review wants to highlight the importance of computer programs used to control the steps in the management of dangerous drugs. It must be taken into account that there are phases in the process of handling dangerous medicines in pharmacy services that pose a risk to the healthcare personnel who handle them. Objective: To review the scientific literature to determine what computer programs have been used in the field of hospital pharmacy for the management of dangerous drugs (HDs). Methods: The following electronic databases were searched from inception to July 30, 2021: MEDLINE (via PubMed), Embase, Cochrane Library, Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences (LILACS) and Medicine in Spanish (MEDES). The following terms were used in the search strategy: "Antineoplastic Agents," "Cytostatic Agents," "Hazardous Substances," "Medical Informatics Applications," "Mobile Applications," "Software," "Software Design," and "Pharmacy Service, Hospital." Results: A total of 104 studies were retrieved form the databases, and 18 additional studies were obtained by manually searching the reference lists of the included studies and by consulting experts. Once the inclusion and exclusion criteria were applied, 26 studies were ultimately included in this review. Most of the applications described in the included studies were used for the management of antineoplastic drugs. The most commonly controlled stage was electronic prescription; 18 studies and 7 interventions carried out in the preparation stage focused on evaluating the accuracy of chemotherapy preparations. Conclusion: Antineoplastic electronic prescription software was the most widely implemented software at the hospital level. No software was found to control the entire HD process. Only one of the selected studies measured safety events in workers who handle HDs. Moreover, health personnel were found to be satisfied with the implementation of this type of technology for daily work with these medications. All studies reviewed herein considered patient safety as their final objective. However, none of the studies evaluated the risk of HD exposure among workers.Partial financial support for translation and publication was received from the Alicante Biomedical and Health Research Institute (ISABIAL).S

The perceived benefits of healthcare information technology adoption: construct and survey development

This paper is a part of a large study, which examines healthcare professionals’ attitudes regarding the adoption, use and perceived benefits of healthcare information technology (HIT). To date, literature on HIT has shown many important benefits related to quality and efficiency as well as limitations related to generalization and to a lack of empirical data on benefits. The aim of this paper is to develop a survey instrument focused the perceived benefits of HIT adoption. We exhaustively reviewed the construct of perceived benefits in various research areas to identify established approaches to predicting individual’s intentions to adopt technology. The items of perceived benefits taken from previous studies were developed and modified, and three benefit dimensions (direct, indirect and strategic benefits) were described. The questionnaire addressed the following issues: demographic information, perceived benefits of computerized physician/provider order entry (CPOE), and intent to adopt CPOE. We present a survey instrument containing the perceived benefits construct targeting healthcare executives. This is developed and validated by the translational validity test that attempts to assess the degree to which we accurately translated our construct into the operationalization. The Importance of the instrument for perceived benefits of HIT adoption as well as its limitations is also presented

Impact of a Localized Lean Six Sigma Implementation on Overall Patient Safety and Process Efficiency

Continuous quality improvement tools have been widely used in the Healthcare Industry to increase efficiency and patient safety as well as to reduce cost. This research explores the impact of a Lean Six Sigma (LSS) process improvement initiative on the overall process efficiency and patient safety in the Labor and Delivery (L+D) units of a large hospital provider. This study focuses on the application of a modeling and simulation methodology to investigate the influence of a localized process improvement intervention on the overall L+D unit output by considering patient flow, system capacity, and unit performance. The simulation models capacity profiles and patient flow through the system to determine patient throughput and waiting times. Baseline data was obtained from information systems logs from two Sentara Healthcare. Finally, the simulation analysis provides evidence to support decision making regarding process improvement implementation across the evaluated scenarios; the results evidence a significant time reduction, not only in the registration process but also in the “Time to Arrive to the Physician.

Information technology and medication safety

Medication can harm patients. Measures to prevent medication errors, are often based on information technology (IT)to improve standardization, transparency, documentation and process structure. Despite this potential, medication errors were also reported when using IT-based interventions. The studies in this thesis aim to increase our understanding of the use of IT-based interventions in healthcare to prevent medication errors. We analyzed a significant number of medication errors reported by healthcare professionals from Dutch hospitals and community pharmacies. One in six reported medication errors was found to be IT related. Man- machine interactions played a crucial role in these errors. In almost 80% of the errors people miscommunicated with IT systems, e.g., not knowing how to react to system output or computer failures. Bad software design caused computer input problems. System designers and software programmers should learn from this. Our study in four hospitals in the Netherlands using Bar-Code-assisted Medication Administration (BCMA) systems identified workarounds in more than two-thirds of medication administrations. These were significantly associated with medication administration errors. Workarounds consisted of failures to scan patient wrist bands and medication barcodes, technological difficulties and nurses not following protocols. Our studies highlight the importance of good software design, training healthcare professionals in using IT-based interventions and increasing their awareness of potential IT system imperfections that can harm patients. Optimizing staffing levels can reduce the workload of nurses, potentially preventing workarounds. Finally, performing a prospective risk analysis before the implementation of IT-based interventions can be an excellent opportunity to engage end users

Improving Emergency Department Length of Stay by Reducing Laboratory Turnaround Times

The purpose of this quality improvement project was to improve lab turnaround times to decrease Emergency Department (ED) length of stay. The project participants included registered nurses (RN) and medical doctors (MD) in the ED and medical technologists (MT), medical laboratory technicians (MLT), and phlebotomists in the laboratory. EDs are challenged with diagnosing and treating patients promptly and often encounter delays from outside factors. One of those includes laboratory turnaround times (TAT). Using lean methodology, interventions selected were put into place in an effort to decrease lab TAT. Standard workflows were developed for lab and ED team members. ED RNs began using ED protocols to enter pertinent lab orders during triage after assessing patients. ED RNs collected blood samples when starting their intravenous line, and a 5S was carried out to improve workplace organization. ED RN protocol usage improved by 14.7% the first month of the project and continued to improve for a final improvement of 68% compared to the 50% improvement target. The volume of blood samples collected by RNs improved from an average of 476 per month to 535 per month for an increase of 12% vs. a goal of 10%. Workplace organization improved from 8 points to 20 points compared to a goal of 15-20 points. Lab TAT for arrival to first ordered lab for CBCs, BMPs, and Troponins improved from an average of 20.85 minutes to an average of 18.53 minutes. Lab TAT from labs ordered to collection time for CBCs, BMPs, and Troponins also improved from an average of 19.88 minutes to an average of 17.37 minutes. This project improved the overall lab TAT by 4.82 minutes; however, it did not meet the ED LOS improvement target of 5%.D.N.P