A Novel Method for Assessing Medication-Related Adverse Outcomes in a Community Hospital

The use of medications for hospitalized patients is universal, and unfortunately medication-related adverse outcomes are common. The accurate assessment of medication-related harm in hospitalized patients is foundational to the development of an effective hospital medication safety program. Every hospital has its own unique fingerprint of harm, accurate determination of the nature of medication-related harm specific to each hospital is necessary to facilitate prevention of that harm with specific and effective interventions. This project has provided a community hospital with its first systematic methodology for assessing medication-related harm. The methodology is adapted from that used in a recent national-level study. Several commonly accepted methods of assessment of medication-related adverse events are in use, but no single method is capable of giving a complete picture of harm at the hospital level. Using a method nearly identical to one employed in large national studies the author examined rates and types of medication-related adverse outcomes in a California community hospital. The hospital had about one-third the national rate of adverse events. An incidental finding was a 4-year pattern of increasing incidence of adverse outcomes followed by 2 years of declining incidence of adverse outcomes. The information gained from the novel assessment method provided a clearer picture of patient harm, a basis for a more effective medication safety plan, and promoted interprofessional collaboration

Leveraging RFID in hospitals: patient life cycle and mobility perspectives

The application of Radio Frequency Identification (RFID) to patient care in hospitals and healthcare facilities has only just begun to be accepted. This article develops a set of frameworks based on patient life cycle and time-and-motion perspectives for how RFID can be leveraged atop existing information systems to offer many benefits for patient care and hospital operations. It examines how patients are processed from admission to discharge, and considers where RFID can be applied. From a time-and-motion perspective, it shows how hospitals can apply RFID in three ways: fixed RFID readers interrogate mobile objects; mobile, handheld readers interrogate fixed objects; and mobile, handheld readers interrogate mobile objects. Implemented properly, RFID can significantly aid the medical staff in performing their duties. It can greatly reduce the need for manual entry of records, increase security for both patient and hospital, and reduce errors in administering medication. Hospitals are likely to encounter challenges, however, when integrating the technology into their day-to-day operations. What we present here can help hospital administrators determine where RFID can be deployed to add the most value

The Building Blocks of Interoperability. A Multisite Analysis of Patient Demographic Attributes Available for Matching.

BackgroundPatient matching is a key barrier to achieving interoperability. Patient demographic elements must be consistently collected over time and region to be valuable elements for patient matching.ObjectivesWe sought to determine what patient demographic attributes are collected at multiple institutions in the United States and see how their availability changes over time and across clinical sites.MethodsWe compiled a list of 36 demographic elements that stakeholders previously identified as essential patient demographic attributes that should be collected for the purpose of linking patient records. We studied a convenience sample of 9 health care systems from geographically distinct sites around the country. We identified changes in the availability of individual patient demographic attributes over time and across clinical sites.ResultsSeveral attributes were consistently available over the study period (2005-2014) including last name (99.96%), first name (99.95%), date of birth (98.82%), gender/sex (99.73%), postal code (94.71%), and full street address (94.65%). Other attributes changed significantly from 2005-2014: Social security number (SSN) availability declined from 83.3% to 50.44% (p<0.0001). Email address availability increased from 8.94% up to 54% availability (p<0.0001). Work phone number increased from 20.61% to 52.33% (p<0.0001).ConclusionsOverall, first name, last name, date of birth, gender/sex and address were widely collected across institutional sites and over time. Availability of emerging attributes such as email and phone numbers are increasing while SSN use is declining. Understanding the relative availability of patient attributes can inform strategies for optimal matching in healthcare

Performance Measures Using Electronic Health Records: Five Case Studies

Presents the experiences of five provider organizations in developing, testing, and implementing four types of electronic quality-of-care indicators based on EHR data. Discusses challenges, and compares results with those from traditional indicators

Combined information from Raman spectroscopy and optical coherence tomography for enhanced diagnostic accuracy in tissue discrimination

We thank the UK EPSRC for funding, the CR-UK/EPSRC/MRC/DoH (England) imaging programme, the European Union project FAMOS (FP7 ICT, contract no. 317744) and the European Union project IIIOS (FP7/2007-2013, contract no. 238802). We thank Tayside Tissue Bank for providing us with the tissue samples under request number TR000289. K.D. is a Royal Society-Wolfson Merit Award Holder.Optical spectroscopy and imaging methods have proved to have potential to discriminate between normal and abnormal tissue types through minimally invasive procedures. Raman spectroscopy and Optical Coherence Tomography (OCT) provides chemical and morphological information of tissues respectively, which are complementary to each other. When used individually they might not be able to obtain high enough sensitivity and specificity that is clinically relevant. In this study we combined Raman spectroscopy information with information obtained from OCT to enhance the sensitivity and specificity in discriminating between Colonic Adenocarcinoma from Normal Colon. OCT being an imaging technique, the information from this technique is conventionally analyzed qualitatively. To combine with Raman spectroscopy information, it was essential to quantify the morphological information obtained from OCT. Texture analysis was used to extract information from OCT images, which in-turn was combined with the information obtained from Raman spectroscopy. The sensitivity and specificity of the classifier was estimated using leave one out cross validation (LOOCV) method where support vector machine (SVM) was used for binary classification of the tissues. The sensitivity obtained using Raman spectroscopy and OCT individually was 89% and 78% respectively and the specificity was 77% and 74% respectively. Combining the information derived using the two techniques increased both sensitivity and specificity to 94% demonstrating that combining complementary optical information enhances diagnostic accuracy. These results demonstrate that a multimodal approach using Raman-OCT would be able to enhance the diagnostic accuracy for identifying normal and cancerous tissue types.Publisher PD

Medication administration errors for older people in long-term residential care

Background Older people in long-term residential care are at increased risk of medication errors. The purpose of this study was to evaluate a computerised barcode medication management system designed to improve drug administrations in residential and nursing homes, including comparison of error rates and staff awareness in both settings. Methods All medication administrations were recorded prospectively for 345 older residents in thirteen care homes during a 3-month period using the computerised system. Staff were surveyed to identify their awareness of administration errors prior to system introduction. Overall, 188,249 attempts to administer medication were analysed to determine the prevalence of potential medication administration errors (MAEs). Error classifications included attempts to administer medication at the wrong time, to the wrong person or discontinued medication. Analysis compared data at residential and nursing home level and care and nursing staff groups. Results Typically each resident was exposed to 206 medication administration episodes every month and received nine different drugs. Administration episodes were more numerous (p < 0.01) in nursing homes (226.7 per resident) than in residential homes (198.7). Prior to technology introduction, only 12% of staff administering drugs reported they were aware of administration errors being averted in their care home. Following technology introduction, 2,289 potential MAEs were recorded over three months. The most common MAE was attempting to give medication at the wrong time. On average each resident was exposed to 6.6 potential errors. In total, 90% of residents were exposed to at least one MAE with over half (52%) exposed to serious errors such as attempts to give medication to the wrong resident. MAEs rates were significantly lower (p < 0.01) in residential homes than nursing homes. The level of non-compliance with system alerts was low in both settings (0.075% of administrations) demonstrating virtually complete error avoidance. Conclusion Potentially inappropriate administration of medication is a serious problem in long-term residential care. A computerised barcode system can accurately and automatically detect inappropriate attempts to administer drugs to residents. This tool can reliably be used by care staff as well as nurses to improve quality of care and patient safety