Increasing barcode medication administration (BCMA) to improve patient safety

Purpose: Medication errors frequently have catastrophic consequences for the patients, and place an enormous financial burden on our health care system. The Institute of Medicine Report, “To Err is Human” published in 1999, estimated that medication errors account for more than 7,000 deaths annually, and many of them are preventable. Errors may happen at different stages of the medication use process, but most commonly take place at the point of administration. Barcode medication administration (BCMA) technology requires the nurse to scan the patient’s wrist band to ascertain the correct patient, and the medication barcode, to verify the right medication, dose, route and time, which are recognized as the “Five Rights” of medication administration. BCMA implementation has demonstrated to significantly reduce errors at the point of administration. The Leapfrog Group, a national organization and coalition of public and private purchasers of employee health coverage has developed a national standard for BCMA which requires both, patient and medication scans in 95% of medication administrations in units where this technology has been implemented. The purpose of this study was to increase the rate of patient and medication scanning to meet the Leapfrog standard. Methods: A prospective review of medication and patient scanning compliance was conducted for a 16 month period from January 2018 to April 2019. Two computer reports were generated monthly. One report was used to identify the number of medication doses administered and the percentage of medications and patients scanned by hospital unit. The second report was used to identify the medications and patients not scanned, and staff members scanning less than 50% of the medications or patients. Each unit leader was provided instructions on how to generate the scanning report for their area. Compliance data was presented to the hospital leadership and to the Medication Safety Committee where barriers to compliance were identified and discussed. Committee members were tasked with disseminating the information and educating the staff. Areas of the hospital with low scanning rates were toured, and opportunities for improvement were identified and addressed. Targeted one-on-one education was provided to staff members with low compliance. Findings: During the study period a total of 1,035,951 medications doses were administered. Hospital-wide medication and patient scanning compliance increased from 82% to 92% and from 83% to 93% respectively, resulting in a 12% improvement in the process or 124, 314 additional doses scanned. Barriers to scanning identified included insufficient number of scanners in the Emergency Department and medication barcodes not scanning properly. Discussion/Conclusions: Barcode medication scanning is a safety measure that has shown to reduce medication errors at the point of administration. Interventions such as raising awareness of the importance of this measure, securing leadership support, targeted individual staff education, and identifying and addressing barriers to scanning are tools that can be successfully implemented to in-crease compliance. Implications for Practice: 1. Medication errors can have catastrophic consequences for patients and place a huge financial burden on healthcare systems. 2. Barcode medication administration can reduce medication errors

Quantum phase transitions of atom-molecule Bose mixtures in a double-well potential

The ground state and spectral properties of Bose gases in double-well potentials are studied in two different scenarios: i) an interacting atomic Bose gas, and ii) a mixture of an atomic gas interacting with diatomic molecules. A ground state second-order quantum phase transition (QPT) is observed in both scenarios. For large attractive values of the atom-atom interaction, the ground-state is degenerate. For repulsive and small attractive interaction, the ground-state is not degenerate and is well approximated by a boson coherent state. Both systems depict an excited state quantum phase transition (ESQPT). For the mixed atom-molecule system the critical point of the ESQPT displays a discontinuity in the first derivative of the density of states.Comment: 25 pages, 18 figures. RevTex 4.1 (version to appear in Phys. Rev. E

Excited-state quantum phase transitions in a two-fluid Lipkin model

Background: Composed systems have became of great interest in the framework of the ground state quantum phase transitions (QPTs) and many of their properties have been studied in detail. However, in these systems the study of the so called excited-state quantum phase transitions (ESQPTs) have not received so much attention. Purpose: A quantum analysis of the ESQPTs in the two-fluid Lipkin model is presented in this work. The study is performed through the Hamiltonian diagonalization for selected values of the control parameters in order to cover the most interesting regions of the system phase diagram. [Method:] A Hamiltonian that resembles the consistent-Q Hamiltonian of the interacting boson model (IBM) is diagonalized for selected values of the parameters and properties such as the density of states, the Peres lattices, the nearest-neighbor spacing distribution, and the participation ratio are analyzed. Results: An overview of the spectrum of the two-fluid Lipkin model for selected positions in the phase diagram has been obtained. The location of the excited-state quantum phase transition can be easily singled out with the Peres lattice, with the nearest-neighbor spacing distribution, with Poincar\'e sections or with the participation ratio. Conclusions: This study completes the analysis of QPTs for the two-fluid Lipkin model, extending the previous study to excited states. The ESQPT signatures in composed systems behave in the same way as in single ones, although the evidences of their presence can be sometimes blurred. The Peres lattice turns out to be a convenient tool to look into the position of the ESQPT and to define the concept of phase in the excited states realm

A symmetry adapted approach to vibrational excitations in atomic clusters

An algebraic method especially suited to describe strongly anharmonic vibrational spectra in molecules may be an appropriate framework to study vibrational spectra of Na$^+_n$ clusters, where nearly flat potential energy surfaces and the appearance of close lying isomers have been reported. As an illustration we describe the model and apply it to the Be$_4$, H$_3^+$, Be$_3$ and Na$_3^+$ clusters.Comment: 8 pages with 2 tables, invited talk at `Atomic Nuclei & Metallic Clusters: Finite Many-Fermion Systems', Prague, Czech Republic, September 1-5, 199

Comment on ``Boson-realization model for the vibrational spectra of tetrahedral molecules''

An algebraic model in terms of a local harmonic boson realization was recently proposed to study molecular vibrational spectra [Zhong-Qi Ma et al., Phys. Rev. A 53, 2173 (1996)]. Because of the local nature of the bosons the model has to deal with spurious degrees of freedom. An approach to eliminate the latter from both the Hamiltonian and the basis was suggested. We show that this procedure does not remove all spurious components from the Hamiltonian and leads to a restricted set of interactions. We then propose a scheme in which the physical Hamiltonian can be systematically constructed up to any order without the need of imposing conditions on its matrix elements. In addition, we show that this scheme corresponds to the harmonic limit of a symmetry adapted algebraic approach based on U(2) algebras.Comment: 9 pages Revtex, submitted February 199

Length-weight relationships of coral reef fishes from the Alacran Reef, Yucatan, Mexico

Length-weight relationships were computed for 42 species of coral reef fishes from 14 families from the Alacran Reef (Yucatan, Mexico). A total of 1 892 individuals was used for this purpose. The fish species were caught by different fishing techniques such as fishhooks, harpoons, gill and trawl nets. The sampling period was from March 1998 to January 2000

A symmetry-adapted algebraic approach to molecular spectroscopy

We apply a symmetry-adapted algebraic model to the vibrational excitations in D_3h and T_d molecules. A systematic procedure is used to establish the relation between the algebraic and configuration space formulations. In this way we have identified interaction terms that were absent in previous formulations of the vibron model. The inclusion of these new interactions leads to reliable spectroscopic predictions. We illustrate the method for the D_3h triatomic molecules, H_3^+, Be_3 and Na_3, and the T_d molecules, Be_4 and CH_4.Comment: 16 pages with 4 tables, invited talk at `Symmetries in Science IX', August 6-10, 199