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The Uses Of Computers In Pharmacy
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The subspecialty in pharmacy I choose is hospital pharmacy. As a current employee at the University of Utah inpatient pharmacy, I see the implementation of the concepts of pharmacy informatics discussed in class. Pharmacy informatics enables me to practice pharmacy quickly, safely, and in the best interests of the patient. The computerized physician order entry allows for less error and requires less interpretation by the pharmacy staff. This saves the pharmacists time which they can allocate to verifying more orders.
Having a computer system with the ability to verify a drug ordered via the NDC number and implementing a final check by a pharmacist is a great contributor to patient safety. Pharmacy informatics provides us with the computer systems, databases, and interfaces to ensure the patient is getting the correct drug in the correct strength at the correct time for the disease.
The medication use cycle consists of prescribing, dispensing, administration, and monitoring.(1) As mentioned previously, the computerized physician order entry communicates the order to the pharmacy. This order absolutely cannot be dispensed until a pharmacist verifies the order, whereby it is sent to the work path to be pulled. The interface between these two systems is crucial to the retrieval of the drug for administration. The next step is administration to the patient by the nurse. The nurse relies on the electronic medical record to indicate what drug is needed for a patient and the time of administration. This again relies on a crucial interface between the system in which the pharmacist verifies the order and its subsequent appearance on the electronic medical record. Depending on whether the medicine cabinet has the drug or th...
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...le of standards and vocabulary is crucial for clinical decision support (CDS) to function properly. The basis of the “knowledge” possessed by the CDS is the ontology programmed within it. It lacks the ability to critically think and only possesses the knowledge programmed within it via standards. If one system is using one vocabulary and trying to communicate with another system which is using a different vocabulary, the system will not understand. This can result in medication errors or lack of proper medication therapy and management.
References
1. Lombardi, P.T. (2000). “Closing the Loop – Implementing Quality Improvement Processes and Advances in Technology to Decrease Medication Error.” MedScape Today.
2. Van der Maas, A.F. et al. (2001). “Requirements for Medical Modeling Languages.” J Am Med Inform Assoc. 2001 Mar-Apr; 8(2): 146–162.
In conclusion, clinical decision support systems provide a mechanism for improving the quality of care services when integrated with evidence-based practice and clinical guidelines. These systems would particularly improve health care quality when combined with evidence-based medicine. This process may also include the use of databases and condition-specific clinical guidelines to improve their effectiveness and efficiency.
I am truly amazed by the positive impact of bar-code medication administration (BCMA). Since we have a fully integrated electronic health record, it is a true closed loop-system, with medication order entry, pharmacy validation of medications, and clinical decision support. Implementing technology such as BCMA is an efficient way to improve positive identification of both the patient and medication prior to administration. It is estimated that the bar-code medication charting can reduce medication errors by 58% (Jones & Treiber, 2010). Even though we have good adoption of BCMA, nurses still make drug administration errors. In many of the cases, errors are caused by nurses, because they do not validate and verify. The integration of technology
This technology assist the nurse in confirming patients identify by confirming the patients’ dose, time and form of medication (Helmons, Wargel, & Daniels, 2009). Having an EHR also comes with a program that allows the medical staff to scan medications so medication errors can be prevented. According to Helmons, Wargel, and Daniels (2009) they conducted an observational study in two medical –surgical units one in the medical intensive care (ICU) and one in the surgical ICU. The researchers watched 386 nurses within the two hospitals use bar code scanning before they administrated patients’ medications. The results of the research found a 58 % decrease in medication errors between the two hospitals because of the EHR containing a bar code assisted medication administration
According to Accuracy at Every Step: The Challenge of Medication Reconciliation (n.d.), the most challenge is called medication reconciliation, which is a formal steps of gathering information related to the patient’s medication with accurate current medication list and compared to the doctor’s admission, transfer and discharge orders. Its aim is to prevent medication errors. There are three steps process- Verification (gather medication history), Clarification (confirm the medication with doses, properly) and Reconciliation (documenting with medication information). This challenge is important to obtain accurate information on all patients entering the hospital. Information technology may play an important role in improving
medications is more than the act of getting drugs to a patient. The delivery of medication is directly tied to the charge for the medication. Thus the responsibility for charging or crediting medication belongs to technicians. This aspect of their job is strictly governed by federal regulations. These laws hold the technician directly responsible for the accuracy of a patient’s account’s charge and credit transactions. Because every dose is related to a specific day and time, when technicians credit they must apply that change to the corresponding dose. Assignificant as accuracy is to the patient’s account, accuracy in the making of their medications is even more important.
Woo, A., Ranji, U., & Salganicoff, A. (2008). Reducing medical errors with technology. Retrieved March, 2012, from http://kaiseredu.org
Implementing technology in a clinical setting is not easy and cannot be successful without a well-organized system. It is important that healthcare providers understand the electronic medication administration record (eMAR) and its role in improving patient safety. One of the most significant aspects of healthcare is the safety of our patients. Medication errors account for 44,000-98,000 deaths per year, more deaths than those caused by highway accidents or breast cancer. Several health information technologies help to reduce the number of medication errors that occur. Once of these technologies is bar-code-assisted medication administration (BCMA). These systems are designed to ensure that the right drug is being administered via the right
Agyemang, REO, and A While. "Medication errors: types, causes and impact on nursing practice." British Journal of Nursing (BJN) 19.6 (2010): 380-385. CINAHL Plus with Full Text. EBSCO. Web. 7 Mar. 2011.
Medication errors made by medical staff bring about consequences of epidemic proportions. Medical staff includes everyone from providers (medical doctors, nurse practitioners and physician assistants) to pharmacists to nurses (registered and practical). Medication errors account for almost 98,000 deaths in the United States yearly (Tzeng, Yin, & Schneider, 2013). This number only reflects the United States, a small percentage in actuality when looking at the whole world. Medical personnel must take responsibility for their actions and with this responsibility comes accountability in their duties of medication administration. Nurses play a major role in medication error prevention and education and this role distinguishes them as reporters of errors.
The main quality initiative affected by this workaround is patient safety. The hospital switched to computer medication administration as opposed to paper medication administration documentation because it is supposed to be safer. So, when the nurse gets the “wrong medication” message the computer thinks something is wrong, this is a safety net that is built into the computer system. If the nurse were just to administer the medication without any further checks, he or she would be putting patient safety on the line. The policy involved that pertains to this workaround is the “8 rights of medication administration”, which are: right patient, right medication, right dose, right route, right time, right documentation, right reason, and right response (LippincottNursingCenter®, 2011). Each nurse it taught these eight rights of medication administration in nursing school, therefore it is a nursing policy. When this workaround occurs the nurse should use his/her judgment before “scan overriding” and ensure these eight checks before administering the
Tzeng, H., Yin, C., & Schneider, T. E. (2013). Medication Error-Related Issues In Nursing Practice. MEDSURG Nursing, 22(1), 13-50.
Electronic-prescribing, often referred to as e-prescribing, is a fairly new, innovative way for physicians and other medical personnel to prescribe medications and keep track of patients’ medical history. Not only has e-prescribing enabled prescribers to electronically send a prescription to the patients’ pharmacy of choice, in the short amount of time it has been available, it has significantly reduced health care costs, not only for the patient, but for the medical facilities as well. In 2003, e-prescribing was included in the Medicare Modernization Act (MMA) which jumpstarted the role of e-prescribing in healthcare. It has proven to significantly reduce the yearly number medication errors and prescription fraud, and its widespread publicity has helped build awareness of e-prescribing’s role in enhancing patient safety. Although it has not been in practice for very long, e-prescribing has already made a positive impact in the field of health care.
O’Shea, E (1999) Factors contributing to medication errors: a literature review. Journal of Clinical Nursing. 8, 5,496-503.
The subspecialty I plan on focusing my career around is medication therapy management (MTM), whether I work in a retail setting or not. Pharmacy informatics will be important to me, as the programs I use to fill prescriptions will also monitor the possible interactions, duplicative therapies, contraindications, etc. of the medications my patients will be receiving. This system will be my resource to ascertain which patients are in need of MTM and why, and by combining the information contained in the pharmacy’s records of the patient with information I may get from the patient’s other health care providers and the patient themselves, I will be able to see what points I need to bring up during an MTM session.
• The computer is becoming the key factor of hospital pharmacy practice. Enhancement of computer technology is essential to assist the hospital pharmacist in keeping all relevant data in order to provide optimal oversight of drug therapy. As more data become available on drugs, the factor which place the patient at risk for developing reactions to drug, pharmacist must place less reliance on committing all facts to memory and recognize that the computer is a necessary solution to optimizing patient care.