Nursing Home Implementation of Health Information Technology: Review of the Literature Finds Inadequate Investment in Preparation, Infrastructure, and Training.

Health information technology (HIT) is increasingly adopted by nursing homes to improve safety, quality of care, and staff productivity. We examined processes of HIT implementation in nursing homes, impact on the nursing home workforce, and related evidence on quality of care. We conducted a literature review that yielded 46 research articles on nursing homes' implementation of HIT. To provide additional contemporary context to our findings from the literature review, we also conducted semistructured interviews and small focus groups of nursing home staff (n = 15) in the United States. We found that nursing homes often do not employ a systematic process for HIT implementation, lack necessary technology support and infrastructure such as wireless connectivity, and underinvest in staff training, both for current and new hires. We found mixed evidence on whether HIT affects staff productivity and no evidence that HIT increases staff turnover. We found modest evidence that HIT may foster teamwork and communication. We found no evidence that the impact of HIT on staff or workflows improves quality of care or resident health outcomes. Without initial investment in implementation and training of their workforce, nursing homes are unlikely to realize potential HIT-related gains in productivity and quality of care. Policy makers should consider creating greater incentives for preparation, infrastructure, and training, with greater engagement of nursing home staff in design and implementation

Adoption of Health Information Technology Among US Nursing Facilities

Objectives: Nursing facilities have lagged behind in the adoption interoperable health information technology (i.e. technologies that allow the sharing and use of electronic patient information between different information systems). The objective of this study was to estimate the nationwide prevalence of electronic health record (EHR) adoption among nursing facilities and to identify the factors associated with adoption. Design: Cross-sectional survey. Setting & participants: We surveyed members of the Society for Post-Acute & Long-Term Care Medicine (AMDA) about their organizations’ health information technology usage and characteristics. Measurements: Using questions adopted from existing instruments, the survey measured nursing home’s EHR adoption, the ability to send, receive, search and integrate electronic information, as well as barriers to usage. Additionally, we linked survey responses to public use secondary data sources to construct measurements for eight determinants known to be associated with organizational adoption: innovativeness, functional differentiation, role specialization, administrative intensity, professionalism, complexity, technical knowledge resources and slack resources. A series of regression models estimated the association between potential determinants and technology adoption. Results: 84% of nursing facilities reported using an EHR. After controlling for all other factors, respondents who characterized their organization as more innovative had more than 6 times the odds (adjusted odds ratio = 6.39; 95%CI = 2.69, 15.21) of adopting an EHR. Organization innovativeness was also associated with an increased odds of being able to send, integrate, and search for electronic information. The most commonly identified barrier to sharing clinical information among nursing facilities with an EHR was a reported absence of interoperability (57%). Conclusions/Implications: An organizational culture that fosters innovation and awareness campaigns by professional societies may facilitate further adoption and effective use of technology. This will be increasingly important as policymakers continue to emphasize the use of EHRs and interoperability to improve the quality of care in nursing facilities

The impact of electronic medication administration records in a residential aged care home

This study aimed to compare between electronic medication administration records and paper-based records in the nursing time spent on various activities in a medication round and the medicationadministration processes followed by nurses in an Australian residential aged care home. It also aimedto identify the benefits and unintended adverse consequences of using the electronic medication admin-istration records.Methods: Time-motion observation, taking of field notes, informal conversation and document reviewwere used to collect data in two units of a residential aged care home. Each unit had one nurse admin-ister medication. Seven nurses were observed over 12 morning shifts. Unit 1 used electronic medicationadministration records and Unit 2 used paper-based records.Results: No significant difference between the two units was found in the nursing time spent on variousactivities in a medication round, including documentation, verbal communication, medication adminis-tration, infection control and transit.Comparison of the medication administration processes between the electronic and paper-basedmedication administration records identified a procedural problem which violated the organization\u27sdocumentation requirement. This problem was documenting before providing medication to a residentwhen using the paper-based records. It was not observed with the electronic medication administrationrecords.Benefits of introducing the electronic medication administration records included improving nurses\u27compliance with documentation requirements, freedom from the error of signing twice, reducing thepossibility of forgetting to medicate a resident, facilitating nurses to record the time of medicationadministration to a resident and increasing documentation space. Unintended adverse consequencesof introducing the electronic medication administration records included inadequate information aboutresidents, late addition of a new resident\u27s medication profile in the records and nurses\u27 forgetting tomedicate a resident due to power outage of the portable device.Conclusions: The electronic medication administration records may not change nursing time spent onvarious activities in a medication round or substantially alter the medication administration processes,but can generate both benefits and unintended adverse consequences. Future research may investigatewhether and how the adverse consequences can be prevented

Evaluación de la seguridad de un programa informático para el registro de la administración de medicamentos en el ámbito hospitalario

La seguridad del paciente ocupa un lugar cada vez más destacado entre los objetivos de calidad de los sistemas de salud. La cadena terapéutica del medicamento en los hospitales es un sistema complejo en el que intervienen muchos profesionales y consta de numerosos procesos y etapas interrelacionados, siempre con el objetivo de hacer un uso de los medicamentos seguro, efectivo, apropiado y eficiente. Aunque los errores de medicación (EM) se pueden producir en cualquier etapa del circuito de utilización de medicamentos, la administración es el proceso más crítico en cuanto a la seguridad del paciente, por dos razones principalmente. Por un lado, se interceptan muy pocos errores de administración potenciales y, por otro lado, la mayoría de estos EM llegan al paciente con mayor probabilidad de causarle daño grave e incluso la muerte. Son pocas las barreras que existen para prevenir este tipo de EM y por ello se deben buscar estrategias para lograr que el proceso de administración de medicamentos sea lo más seguro posible. Diversas organizaciones han emitido recomendaciones para mejorar la seguridad en la administración de los medicamentos, entre estas se encuentran la utilización de nuevas tecnologías como es el registro electrónico de administración de medicamentos (REAM). Aunque las nuevas tecnologías pueden reducir los EM y mejorar la seguridad del paciente, la implementación de una tecnología no está exenta de riesgo, ya que también tiene el potencial de causar nuevos tipos de EM. Por ello, para garantizar que la herramienta para el REAM mejora la seguridad del paciente, es necesario un correcto desarrollo, y una correcta implantación y utilización..

An exploration of the prescribing and administration of medicines in a sample of UK care homes

Residents of care homes are some of the most vulnerable members of society and are particularly susceptible to medicines harm. The safe and effective management of medicines helps to maintain or improve the quality of life of residents. However, there have been concerns surrounding poor prescribing and medicines administration practices within the setting. The aim of this thesis was to explore current prescribing and medicines administration practices in a sample of UK care homes, and to understand whether senior carers could administer medicines safely and effectively. Medicines administration data was extracted from a digital medication management system (PCS™) to explore prescribing patterns, and medicines administration by staff in nursing homes. Semi-structured interviews and surveys were used to explore staff perceptions of senior carers administering medicines under the delegation of nurses. Analysis showed that a significant number of residents were prescribed medicines commonly associated with adverse outcomes in older adults. These included anticholinergic drugs (50%), hypnotics and/or anxiolytics (30%), analgesics (49%), and antimicrobials (24%). Although senior carers were at least as competent as nurses in administering medicines (no statistically significant differences in error rates; pvalue> 0.05), 92% of residents were exposed to medication administration errors during the three-month study period. Interviews and surveys explored staff perceptions of medication administration errors in care homes and a number of themes were identified notably the need for medicines training by senior carers. The findings from this thesis have highlighted that the quality of prescribing and medicines administration remains suboptimal in care homes, and the issues identified may ultimately cause resident harm. New models of care, such as senior carers administering medicines in nursing homes may fail if systemic issues which give rise to such issues are not addressed. Therefore, exploring strategies to efficiently safeguard the quality of medicines management in this setting should be prioritised

Medicines management in care homes

There is an increasing demand on health and social care to provide high quality care to older adults in the UK as the population of this vulnerable group grows. These services should meet the needs of individuals who can have a range of acute and chronic conditions. The capacity for NHS services to meet these demands is limited and therefore care homes provide accommodation and health services to meet this unmet need. In the lay press, there have been concerns regarding medication management in care homes and there is evidence in the literature that this process is sub-optimal. The aim of this thesis therefore was to explore medicines management in care homes focusing on the areas of prescribing, administration and medicines waste. A retrospective analysis of anonymised medication administration records (MAR charts) and an audit of medicines waste was employed to achieve this aim. The analysis revealed that a significant number of residents (84%) were exposed to polypharmacy, potentially inappropriate medications (87%), anticholinergic burden (5% with an AEC score Ñ 5), and a significant number of administration errors (6 administration errors per resident per week). The study also demonstrated a significant volume of wasted medicines in care homes. As a consequence of these issues residents in care homes are potentially exposed to practices that may lead to harm and will likely increase the demand on health and social care resources. Careful consideration of prescribing practices is needed to reduce medicines burden and efforts should be made to embed a multidisciplinary approach to the care residents. In conclusion, further study of the clinical consequences of prescribing and medication errors in care homes should be explored as a matter of urgency and efforts should be made to maximise the therapeutic benefits of medications and reduce the cost of wasted medicines