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Reducing Medication Errors with Automation Essay Sample

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Reducing Medication Errors with Automation Essay Sample

Bradley’s was an editorial on the unending talks on computerized physician order entry. It furthered the claims on how the process can be beneficial, as expected and endorsed by its promoters. The article discussed that the process may appear easy, but it requires careful planning and implementation for its expected effects to happen. More than the automation, it is important for the users to pay close attention to avoid medication errors. This and the security and safety standards are the most important factors in putting the process to success. 

Bradley stresses as well that despite the given benefits of automation, there is still indeed chance for it to have flaws. The discussion found its focal point on an earlier discussion on the topic. The premise was on an article about automation of medical records which, in the end, still concluded that such an advancement in medicine has a future.

Charters, K.G. (2003). Nursing informatics, outcomes, and quality improvement, 14(3), 282-294.

This article talks about the desire of the nursing industry to improve their profession by use of nursing informatics which includes standardized lingo, databases, research in command, and technological tools. It has been said in the article that the lack of shared information and the differences in nursing language is a major barrier to nursing informatics. To overcome such concern, it was recommended that documentation of information be undertaken.

Dang, D., et al., (2007). Quest for the ideal: A redesign of the medication use system, 22(1), 11-17.

Dang and other authors stated that many medication systems in existence at present are hard to follow and use, and are easily susceptible to errors. With this, the article prescribed the idea that automation is the way to go for an accurate and efficient medication process for the sake of the patient’s safety. An ideal design of the model system has been suggested in the article being that which is a collation of many different suggestions of the ideal system as described by the users. However, the study showed that the idealized design being discussed is easier discussed than implemented due to the many limitations at hand. Still, it is a good start for improving the medication system in the health care industry.

Hughes, R.G. and Ortiz, E. (2005). Medication errors: Why they happen and how they can be prevented, March 2005, 14-24.

Medication Errors stated that it is the leading medical error in the healthcare industry, contributory to many fatal cases of medical malpractice. The error may happen in any of the stages of medication: ordering, transcribing, dispensing, administering, or monitoring. The discussion went as far as how prevalent the errors were (five per 100 administrations), the types and causes, and the most common error-associated drugs. The article stressed the importance of having the prescribing clinician to be accurate and well informed with the full case of the patient, accurate dispensing and administration, and also an informed patient who is aware and inquisitive about the drugs being given to him. Above all, it is the safety of the patient which should come first at all times at that all errors should be reported and corrected as early as possible.

Laing, K. (n.d.). The benefits and challenges of the computerized electronic medical record, 25(2), 41-45.

Laing’s article discusses the importance of using electronic medical records for a more effective and efficient care of patients. The account, which classified the progress of endoscopy records as example, shows that an electronic medical record provides for critical patient information that is standardized and organized as well as easily accessible across the healthcare field compared to the practice of recording medical data on paper mostly by long hand. It lengthily described the contents of a medical record, such as the cases underwent by the patient, treatments and medications given, documentation of processes done to the patient, and referential study for medical researches as well as billing and charging claims and standardization.

Implementing electronic medical records require a comprehensive plan. Standardization of terminology and system, accuracy, and completeness is of utmost importance. However, many people fear that electronic medical recording may lead to privacy issues, especially that it makes the data available to people who gains access to them regardless of who they are and what they do. Still, many believe that electronic medical recording may even be safer in terms of privacy than paper records. The government put importance to confidentiality of data in electronic medical records, resulting to the Health Insurance Portability and Accountability (HIPAA) Act. In the part of recording facilities and users, limitation of use, password protection, and policy development is also needed. Since medical records contain essential information, a plan for disaster and recovery is also to be considered.

Lee, T. (2006). Nursing administrators’ experiences in managing PDA use for inpatient units, 24(5), 280-287.

Lee’s article discussed the growth of technology use in the health care industry. It posed concerns on the administration of technological advancements to health facilities as well as challenges that may be encountered. The use of the personal digital assistant (PDA) has been a focal point for the study. A study of 31- to 55-year-old respondents were made and delivered results such as the limitations of using the PDA, knowledge in the use of such, and the nurses’ perceptions in its use. The study proved that the PDA, and technology as a whole, plays an integral role in helping nurses manage their critical health-care role.

Low, D.K. and Belcher, J.V.R. (2002). Reporting medication errors through computerized medication administration, 20(5), 178-183.

This article claims that there is an increase in fatal medication errors, affecting the health service field at a great scale. A study has been made as to how the errors happen, at which point (mostly by the administration stage), and how it can be possibly prevented especially by correct use and aid of technology. Automation has been considered a considerable way to reduce the risks of errors, and the errors per se. Change, as the article states, is part of the nursing process as it enters a new age.

Moody, L. E., et al. (2004). Electronic health records documentation in nursing: Nurses’ perceptions, attitudes, and preferences, 22(6), 337-344.

Electronic Health Records Documentation in Nursing talks on the study made on electronic medical recording aimed at evaluating the existing medical records system and the view of nurses who are using the system for which 100 nursing personnel were surveyed. Administration of the test and the results was also discussed in the article. Among the results discussed were with regard to the respondents’ environment, attitudes on the current system to which 99% of the respondents shared that it enabled help to patients and health care providers when needed, and analysis of its efficiency in improving patient care.      

Stetina, P., Groves, M., and Pafford, L. (2005). Managing medication errors: A qualitative study, 14(3), 174-178

This article is a study on ongoing medication errors and how it can be effectively managed. It states that because the medication process involves many different people of different departments and jobs, errors often happen. However, they must be prevented and managed properly for the benefit of the patient. Interviews with health care providers specially nursing personnel who are directly involved in medical reporting were made for the study. Results were identified and discussed. In conclusion, reduction of medication errors is the one way to keep patients safe, and reporting medication errors is a way to do so. The article suggests a process in which errors may be systematically reported for the benefit of the patients.

Ulanimo, V.M., O’Leary-Kelley, C., and Connolly, P.M. (2007). Nurses’ perceptions of causes of medication errors and barriers to reporting, 22(1), 28-33.

This article is another study on the nursing personnel and their views on the causes of medication errors and why most cases are not reported. The article collated different sources which gave several causes of medication errors and why nurses are aloof at reporting them. The chief cause has been found to be that the nurse failed to check the name band, which constituted 45.8% of the answers from the survey conducted. The study also showed that 92% of nurses are aware how a medication error can occur, which is important knowledge for them to also prevent the errors. The article showed a situation where nurses are getting by with the dilemma of medication errors in a real setting. Based on the article, a good way to battle such dilemma was a storage-retrieval system for the records—and one which is better than the existing process.

VanOyen Force, M., et al. (2006). Effective strategies to increase reporting of medication errors in hospitals, 36(1), 34-41.

The article speaks about medication errors in hospitals, why many nurses do not report such errors, and how they can be encouraged to do so for the benefit of their patients. It has been said that many creators and users of medical records report mostly technical errors but not input and data errors, which may be costly for patients for whom these information are applied. The article discussed the most common medical recording errors, performance deficit being the most common, and the factors to which these errors occur. The errors were studied as categorized into fur parts of the medical recording process: ordering transcription, dispensing, and administration or monitoring. To encourage reporting of these types of errors, a comfortable, non-blame culture should be introduced. The culture should be corrective and not punitive, putting the focus on the safety of the patient and not punishing the person who commits a recording error. It is important for the administration to lead this culture, and allow it to evolve. It was also discussed how preventive measures can be used. On top of all efforts for a more accurate electronic medical recording process, monitoring is also essential and continuous follow through on following set policies, developing it, and supervision should be systematically implemented. 

TITLE: Reducing Medication Errors with Automation

PROBLEM DESCRIPTION

            Patients needing health care and attention know who to talk to, and who to trust. However, everyday the risk of medical errors exist and the most common is the medication error. According to Stetina, et al. (2005), errors may occur from prescription to transcription, to dispensing and administration, and even in the monitoring stage, with the chances of it to be detected, corrected, or properly managed being poor. Moreover, the line of error in a health care process is so thin that a minimal error may be fatal for the patient—there was a death toll of 7,391 in 1993 resulting from medication errors (Stetina, et al., 2005)—and bad for the reputation of his clinician or hospital.

This paper aims to expound on the medication errors occurring at an alarming frequency in the health care industry. Sources say that medication errors are among the most prevalent medical malpractice. Sources assert approximately one in every five has an error, 7% of which can lead to adverse drug effects and the possibility of death (Dang, et al., 2007). Many studies have been done to explain such finding, and most results have found that limitation on information is the most probable reason for such an error to happen.

SOLUTION DESCRIPTION

            Automation is posed to be one of the solutions to fight medication errors. Laing (n.d., p.41) states that endoscopists who have used such systems experienced an interface which made data collection and retrieval easy. With an electronic medical record system, patient information such as cases underwent, medications taken, operations made, consultations, processes, and even things as simple as allergies will be organized into a database that is centralized, standardized, and accessible to the right people using the right access policy. With automation, a person taking part in the health care of a person shall have information on demand where he or she can check and counter-check medications and prescription and question any errors that may occur. However, privacy issues always ensue when it comes to talks on automation. Safety of data from prying eyes and also from acts of nature is a major concern though measures have been thought of and taken by the government and private institutions involved in the electronic medical recording system (Laing, n.d., p. 42).

In studying automation in relation to reducing medication errors, there are things to consider. It is important to know how well automation will be received by its expected users, who are nursing personnel. Also, how well privacy questions can be addressed. Ultimately, it is also important how automation has affected the medication process in health care facilities already using it.

IMPLEMENTATION PLAN

            Automation is nothing new in the health care field. Even Florence Nightingale fronted the need for such a system, though at the time limitations of hardware, software, and structuring does not yet exist (Bradley, 2005). To lay out the automation plan, a facility with enough number of patients and using electronic medical record system shall be a subject for the study. Nursing personnel will also be needed to know how well they receive such a system in their routine and how it affected their effectiveness and efficiency.

Bradley (2005) suggested an implementation guide in carrying out automation to reduce medication errors. She states that such an undertaking is not easy. However, it may be a big help to reduce medication errors based on studies. Basis studies were made on actual implemented automation systems, making them reliable.

 EVALUATION PLAN

An interview with a manager or supervisor of a hospital or facility will help for a qualitative research. It is also important to survey nurse managers and nurses who are directly using the record system to know their perceptions on the system and possibly come up with a list of its advantages and needed improvements. Their first-hand views and opinions will be obtained and recorded.  This will be used to evaluate the effectiveness of the system.

After such quantitative and qualitative evaluation, the paper will be able to communicate pertinent information in planning and implementing as well as monitoring an automation plan for health care facilities that are not already using such. The audience will know what to expect. Aspirants will also have an idea of how to start on the project. The maintenance and follow-through shall also be discussed.

DISSEMINATION PLAN

            To receive professional feedback on the project, the final paper shall be presented to nurse managers and facility or hospital administrators. Audience should be a mixture of people exposed to the system, and those who are not. A PowerPoint presentation will be made for the project. Hard copies of the paper will also be distributed for the audience in advance, before the presentation is scheduled. The presentation will enable the audience to know how automation helps in reducing medication errors. Questions will also be welcomed and, finally, suggestions by means of distributing suggestion slips after the presentation shall be made for the improvement of the plan. 

INTRODUCTION

The rise on medication errors have been occurring at an alarming rate. Thousands are risked into dying each year for medication malpractice. This raises the need for a system in medication that will reduce the error and protect the welfare of the patients. This also paved the way for many institutions to embrace the thought of automation, where a database of all patient information is set in an organized structure available in a user-friendly interface to all its users.

The paper will briefly discuss the definition of electronic medical records. It will cover how it is both beneficial and challenging for the health care practitioners and other record users. It will also study sources on how automation may be implemented. Questions on how it has helped the institutions already using it and its effects on the nursing and medication routine will also be answered. The literature review will focus on eleven articles which discussed in detail the many aspects of medical automation: reasons for the undertaking, implementation, benefits, challenges, and perceptions and evaluation.

LITERATURE REVIEW

Hughes and Ortiz (2005, p. 14) claim that there are over 100 medication errors in each case which can be prevented, 1% of which leads to adverse drug events. The number, it was said, could have been higher if potential errors were not managed properly. An 86% increase rate can be expected when nurses do not intercept medication errors. The same source presented that the errors occur mostly in prescribing, administering, dispensing, and taking the medicines.

Like Hughes and Ortiz, Low and Belcher (2002, p. 178) presents an estimation of medical errors being between 44,000 and 98,000. This is up by 257% in 1993 compared to the records a decade ago in 1983. The study stated that in 2001, more than 51% of registered nurses committed medication errors. The authors also stated that the most common errors were wrong time of dosages and omitted dosages. This makes administration the more common error and challenging the above statement that it is in prescription where most errors transpire.

Stetina, et al. (2005, p. 174) also supports Hughes and Ortiz by stating that up to 98,000 of hospital deaths result from preventable medication errors. Again, this is an alarming statistic. This is mainly blamed to the fact that the medication process, as mentioned, goes through different people and processes. Thus, medication error can happen at any point.

 Reporting medication errors is a major factor influencing the rate in which the mistakes occur. Many nurses who commit errors do not have the confidence to report that an error was committed. There are different reasons: fear of disciplinary actions, loss of job, poor evaluation, and showing a sign of incompetence. This leads to unreported and unmanaged medication errors. (Low and Belcher, 2002, p. 178)

VanOyen Force, et al. (2006, p. 34) share the same view. They state that most errors are not reported because of the nurses’ regard to their self esteem. This results to a need for a systematic reporting of errors where the persons who committed mistakes will not be blamed but rather supported for intercepting more probable errors as a result. This further implies why automated medication is necessary, and how it can be beneficial to reduce errors in the stages of medication. These data proves how a comprehensive system is needed in medication administration. Low and Belcher (2002, p. 179) discussed the Bar Code Medication Administration System (BCMA) where a bar coded bracelet worn by the patient is scanned and automatically notes the prescriptions needed, prints a tag of the dosages and dosage times, and other medication details reducing the chances of a nurse to commit an error. Similar technological structures and advancements were being utilized in many institutions country-wide. However, beginning to implement such complicated system is a tedious task and careful planning and transition is necessary.

Nurses and other health care participants need a system to store and retrieve patient information that will be safe and secure. With an electronic medical record system or a simple automated medication, patient records including cases, payments, quality of care, medications, and other information is stored, organized, and ready for use at a push of a button. Furthermore, using electronic systems reduces the time of medication in all stages of its processes, the costs of operation. More importantly, the quality of care that can be offered to patients is not compromised. (Laing, n.d., p. 42)

The major constraint for a facility to undergo automation is the costs of starting such endeavor. Hardware and software needed for the project can be expensive (Moody et al., 2004, p. 337). Bradley (2005, p. 113) discusses in her editorial how even an automated medication system still pose the risk for error. These errors, though, may be prevented if the users pay full attention to what they are doing. This denies the fact that errors in such level could be unanticipated.

Dang, et al. (2007, p. 11) had such errors in automation in mind as they made a study on the redesigning of medication systems. They hoped that the study hopefully results in an ideal structure. The ideal structure is error-free in both its structure (hardware and technological aspects) and use (human element). In achieving this balance, there will be less medication errors, even the errors encountered in using electronic medical record processes.

Another important factor to be considered as a challenge in automated medication is the privacy of patients. As patient information becomes available centrally, it becomes susceptible to becoming out in the open with unaccredited users. But Laing (n.d., p. 42) discussed how such issue is being managed. The Health Insurance Portability and Accountability Act and other tight privacy and security measures of information pertaining to patients have been institutionalized and are expected to create a secure atmosphere for the use of automation in the health care system. Even times of disaster and emergencies have been taken into consideration. Back up systems are always required when automation is implemented, and all states are monitored into compliance. In using automated medication and electronic medical records, a standardized nursing jargon should also be introduced so that all entries in the patient reports are understandable to all the users of the records.

Moody, et al. (2004, p. 342) made a study on the perceptions of 100 nurses on using the electronic health records where it turned out that 99 percent felt that electronic records made help available to them when they need it. 96% of the users also felt comfortable using the interface. However, system downtimes and slow information turn-out has frustrated many users. The same study was made by Ulamino, et al. (2007, p. 31). Nurses surveyed by the study noted that the most common medication error happens when the nurse fails to check the patient’s name band against the medication administration record with 45.8% of the respondents. As to barriers to reporting the errors, the chief cause of failure to report such events turned out to be fear of reaction that may be given by the manager as replied by 60% of the respondents.

Nursing administrators’ also had their share of opinion with automation as discussed by Lee (2006, p. 282). The study showed that many respondents felt that paper records appear to be more secure as personal digital assistants have technological limitations that paper records do not have. The training on the use of digital assistants in medication recording was not also satisfactory according to the respondents. However, assigning versed users to be with the less-versed has been a good move. Nurses also felt that many doctors do not approve of them using personal digital assistants, with most doctors thinking that the use of it is outdated. Administrators also feel that the dual charting process (electronic and paper) is tedious for their staff members, and the use of personal digital assistants impeded the speed of making patient information readily available by the middle of the day or before the afternoon shift ends. Wireless transmission of data was said to be the answer for such dilemma.

Charters (2003, p. 282) discussed how important nursing informatics is especially in solving medical errors. One way it is widely useful is when data is stored in paper, and retrieving it had to take time and considerable effort. With nursing informatics, storage and retrieval of patient information will be systematic and organized. These data discussed in detail the aspects necessary in understanding medication automation, with its processes, benefits, challenges, and existing perceptions. These sets of information provide qualitative information that will be essential in proving to the audience of the paper that indeed automation can help reduce medication errors.

PROPOSED CLINICAL PROJECT

The paper is primarily aimed at nurses and nurse managers. Secondary audiences are other parties involved in the creation and use of patient records. The supposed age of audiences is 30 to 45, both male and female, may have no, little, or sufficient knowledge on how electronic medical records work. The audience of the study may also be open to technological advancements or otherwise.

With this profile of the audience in mind, it is necessary to carefully plan out how the project will be proposed. First it is important to state how serious the problem of medication error is currently. Second, how it is affecting the patients and the nursing industry at a large scale. Statistics from trusted sources shall be utilized to show and prove the real state of medication error in the country. These are data that can be used to realistically find a solution to the problem as described.

The solution, electronic recording or automation, should be introduced to the audience. It should be explained in detail. This will avoid the problems that may be due to the variance of the audiences’ knowledge on medication automation. The introduction of solution shall include the benefits, challenges, and pre-meditated plans of action in using the electronic medical records. Existing perceptions on the project, especially of those who are already using it, shall also be presented to give not only theoretical but also a balanced presentation of the benefits and challenges in a working setting.

For a quantitative analysis of the solution being proposed, nurses and nursing administrators already using such system will be surveyed (Appendix A) as to their perceived benefits, problems, and effects from using the automated medication system. If feasible, hospital administrators or stakeholders will also be interviewed to discuss the feasibility of automating an existing medication process, the steps of transition and implementation, and the obstacles that may be encountered, with suggested solutions to lay out such plan.

The study shall be presented using PowerPoint software to the mentioned audience, with hard copies of the paper distributed before the presentation, allowing the audience to pre-meditate questions that may be raised. Questions shall be answered and a feedback slip will be routed as well.

SUMMARY

Medication errors have been a widespread dilemma in the health care industry. Many measures have been taken to reduce if not totally eliminate the occurrence of such errors. Still, many institutions fail to adequately address the problem, resulting in continuing harms and inefficiency of service to patients, the end-users of health service.

Many articles have discussed the rampancy and seriousness of the problem. As many as these discussions are reports and studies on how the problem can be addressed. Many sources prescribe to the idea that automation or the use of electronic medical records can help alleviate the problem.

With automated medication record system, patient information will be available to all users, majority of who are nurses and nursing administrators. Cases, medications, and all other pertinent patient medication information will be available in a structured database that is retrievable and can be easily used with an electronic record system.

Despite these benefits, challenges in planning, implementing, using, and monitoring electronic record systems pose a concern. This diverts attention from the original notion on automation which is to reduce medication errors.

But believers of the system feel that it is still more of a boon than a detriment. It is, as they say, better than paper charting, saves time, saves on long-term costs, and more accurate. However, in implementing such large-scale plan, expenses and resources need to be considered. The transition from manual to automated process should also be taken into account, with trainings, transfer of data, and verification processes as part of the process. Reducing Medication Errors with Automation aims to expound on these facts and answer the questions.

APPENDIX A

Name: ______________________________ Age: _____ Designation: _____ Shift: _____

1. Do you have a computer always available when you need to record patient information? □Yes     □No
2. Do you find the electronic medical record (EMR) system easy to use? □Yes     □No
3. Do you prefer this more than paper charting? □Yes     □No
4. Do you use dual charting? (Electronic and paper) □Yes     □No
5. Do you feel that paper and electronic charting has the same functionality? □Yes

□No: _ paper>EMR   _EMR>paper

6. Have you encountered problems with your use of EMR? □Yes: specify __________________________

□No

7. Was help readily available when you encounter EMR problems? □Yes     □No
8. Do you feel that your institution is maximizing the use of EMR? □Yes     □No
9. Do your recommend such system to institutions not yet using it? □Yes     □No
10. As a whole, what can you say about EMR as compared to paper charting?  


REFERENCES
 

Bradley, V. (2005). Computers, informatics, nursing. Implementation, CPOE, and medication errors, May/June 2005, 113-114, 138

Charters, K.G. (2003). AACN Clinical Issues. Nursing informatics, outcomes, and quality improvement, 14(3), 282-294.

Dang, D., et al., (2007). J Nurs Care Qual. Quest for the ideal: A redesign of the medication use system, 22(1), 11-17.

Hughes, R.G. and Ortiz, E. (2005). AJN. Medication errors: Why they happen and how they can be prevented, March 2005, 14-24.

Laing, K. (n.d.). Gastroenterology Nursing. The benefits and challenges of the computerized electronic medical record, 25(2), 41-45.

Lee, T. (2006). Computers, informatics, nursing. Nursing administrators’ experiences in managing PDA use for inpatient units, 24(5), 280-287.

Low, D.K. and Belcher, J.V.R. (2002). Computers, informatics, nursing. Reporting medication errors through computerized medication administration, 20(5), 178-183.

Moody, L. E., et al. (2004). Computers, informatics, nursing. Electronic health records documentation in nursing: Nurses’ perceptions, attitudes, and preferences, 22(6), 337-344.

Stetina, P., Groves, M., and Pafford, L. (2005). MEDSURG nursing. Managing medication errors: A qualitative study, 14(3), 174-178

Ulanimo, V.M., O’Leary-Kelley, C., and Connolly, P.M. (2007). J Nurs Care Qual. Nurses’ perceptions of causes of medication errors and barriers to reporting, 22(1), 28-33.

VanOyen Force, M., et al. (2006). The journal of nursing administration. Effective strategies to increase reporting of medication errors in hospitals, 36(1), 34-41.

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