The authors of Computerized Physician Order Entry and Medication Errors in a Pediatric Critical Care Unit explored the effectiveness of computerized physician order entry (CPOE) systems on medication errors. The study’s stated purpose was “to see the impact of CPOE on the frequency of medication errors at the degree of physician ordering in a pediatric critical care unit (PCCU)” (Potts, A.L., Barr, F. E., Gregory, D. F., Wright, L., & Patel, N. R., 2004). The work was set in the PCCU of an academic foundation and included medication errors from the two month period before the implementation of CPOE – October 4, 2001 to December 4 2001 – and a two month period after CPOE – January 4, 2002 to March 4, 2002 – with a one month period in between when no information was garnered in order to acclimate hospital staff (Potts et al., 2004). Each error was categorized into one of three groups: potential adverse drug effects (ADEs), medication ordering errors (MPEs), and rule violations (RVs). The results …show more content…
indicated a 95.9% decrease in total errors with a 40.9% reduction in ADEs, 99.4% in MPEs, and 97.9% in RVs; these statistics are evidence of a very significant decrease in the number of medication errors with the function of a CPOE system, which coincides with the findings in each previously mentioned sources (Potts et al., 2004). Yet some other article, Guidelines for Preventing Medication Errors in Pediatrics, offers guidelines for preventing medication errors in pediatric hospitalized patients; it recommends using organizational systems, educational organizations, and manufacturing and regulatory organizations to help block the occurrence of medication mistakes.
A computerized physician order entry (CPOE) system can provide many enhancements to preventing medication mistakes. Using the CPOE will allow all health maintenance providers to have an easily accessible list of all current medications the patient is on and will reduce the process of ordering a medication for a patient, which will lessen the probability of an error occurring throughout the procedure. This organization will also allow pharmacists, nurses, and physicians a form of communication by electronic means. In summary, the combined effort of healthcare professionals and electronic support can greatly reduce medication
mistakes. A final written report found that medication errors affect 1 in 10 pediatric patients each year and are often times the easiest mistakes to fix due to specific weight and size calculations (Walsh et al., 2008). Thither are many schemes being implemented in medical settings worldwide to help cut these problems. The most dominant of these organizations is the Computerized Physician Order Entry (CPOE). On The Effects of Computer Order Entry on Prevention of Serious Medication Errors in Hospitalized Children, researchers considered how the implementation of this system changed the rate of medication errors in pediatric patients in the Boston Medical Center PICU, NICU, and on regular surgical and medical pediatric wards (Walsh et al., 2008). This time-series analysis included 627 pediatric patients (Walsh et al., 2008). The researchers used references such as 12672 medication orders written over 3234 patient-days in order to decipher the amount of medication errors made, and with this data 156 errors were found (Walsh et al., 2008). Of these 156 errors, 70 were serious medication errors (Walsh et al., 2008). In general, there was a 40% decrease in reported medication errors and a 41% decrease in potentially dangerous errors after the implantation of the CPOE; however, throughout the entire study this system only accounted for an overall 7% fall in serious medication errors (Walsh et al., 2008). Overall, the CPOE system has significantly reduced medication errors in pediatric units, which also suffers – and is supported by – each previously noted article
During the 1980’s and 90’s there were many studies done that showed that medical errors were occurring in inpatient and outpatient settings at a very high rate. Computer Provider Order Entry (CPOE) systems were designed to reduce or eliminate mistakes made by using hand written orders. The CPOE system allows users to directly enter their orders into the system on computers which are then sent directly to the healthcare providers that will be implementing the orders. Previously orders were placed by writing on order sheets on patient charts. This was sometimes done by the doctor or by a nurse acting on behalf of the doctor. Order sheets were then signed by the doctor and then the information was input into the patient’s record. This left room for error due to misreading bad handwriting, confusing medications with similar names, etc.
Springfield General Hospital (SGH) is committed to high quality healthcare for patients, and providing tools to support physicians, nurses and pharmacists. SGH leadership approved the computerized physician order entry (CPOE) system as a solution to reduce prescription errors, and the results of the CPOE project are disappointing. The data show increased prescribing errors after implementing the CPOE; resulting in increased costs for adverse drug events, rather than the planned cost reduction (Spector, 2013). This change management plan provides the SGH board of directors and executive management team pragmatic steps to increase quality for patients by assessing the root issue of hospital
For my research paper, I will be discussing the impact of medication errors on vulnerable populations, specifically the elderly. Technology offers ways to reduce medication errors using electronic bar-coding medication administration (BCMA) systems. However, skilled nursing facilities (SNFs) are not using these systems. Medication is still administered with a paper or electronic medication administration record (eMAR), without barcode scanning. In contrast, every hospital I have been in: as a patient, nursing student, and nurse uses BCMA systems. The healthcare system is neglecting the elderly. Nursing homes should use BCMAs to reduce the incidents of medication errors.
Medication errors in children alone are alarming, but throw an ambulatory care setting into the mix and it spells disaster. When it comes to children and medication in the ambulatory care setting, the dosage range is drastically out of range compared to those that are treated in the hospital setting (Hoyle, J., Davis, A., Putman, K., Trytko, J., Fales, W. , 2011). Children are at a greater risk for dosage errors because each medication has to be calculated individually, and this can lead to more human error. The errors that are occurring are due to lack of training, dosage calculation errors, and lack of safety systems. Medication errors in children who are receiving ambulatory care can avoided by ensuring correct dosage calculation, more in-depth training of personal and safety systems in place.
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
Most undergraduate nursing students are not being properly educated on proper medication administration. Clinical instructors and registered nurses need to be updated on medication administration reporting, so students do not develop bad habits when they become registered nurses. Registered nurses must also continue their education on med error prevention to prevent future errors. Another significant problem with registered nurses was that they did not have positive attitudes when reporting an error. Once these negative attitudes were changed, more errors were reported (Harding & Petrick, 2008). The three main problems that cause medication errors...
Some method such as audits, chart reviews, computer monitoring, incident report, bar codes and direct patient observation can improve and decrease medication errors. Regular audits can help patient’s care and reeducate nurses in the work field to new practices. Also reporting of medication errors can help with data comparison and is a learning experience for everyone. Other avenues that has been implemented are computerized physician order entry systems or electronic prescribing (a process of electronic entry of a doctor’s instructions for the treatment of patients under his/her care which communicates these orders over a computer network to other staff or departments) responsible for fulfilling the order, and ward pharmacists can be more diligence on the prescription stage of the medication pathway. A random survey was done in hospital pharmacies on medication error documentation and actions taken against pharmacists involved. A total of 500 hospital were selected in the United States. Data collected on the number of medication error reported, what types of errors were documented and the hospital demographics. The response rate was a total of 28%. Practically, all of the hospitals had policies and procedures in place for reporting medication errors.
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
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.
Furthermore, short staffing affects the quality direct care each patient receives. The National Coordinating Council for Medication Error Reporting and Prevention (2012) states an estimated 98,000 individuals die every year from medical errors in the United States. One out of many significant tasks nurses do within their scope of practice is medication administration. Research shows a relationship between short staffing on medication errors: the longer the hours nurses work, the higher the chances of medication errors (Garnett, 2008). (include definition of medication error) Administering medications requires knowledge of patient rights, pharmacological information on the drug, adverse effects, proper dosage calculations, and hospital protocols. When nurses are assigned more patients, they are pressured to give due medications on time. Sometimes due to hunger or fatigue, nurses give the wrong medication to the wrong patient (Frith, Anderson, Tseng, & Fong, 2012).
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.
Scott, D. M., Friesner, D. L., Rathke, A. M., & Doherty-Johnsen S. (2014). Medication error reporting in rural critical access hospitals in the North Dakota telepharmacy project. American Journal of Health-System Pharmacy, 71 (1), 58-67. The authors reported on a 17-month study done where remote pharmacists used telepharmacy technology to review medication orders, identify quality-related events and code clinical interventions. The results of the study show that the North Dakota Telepharmacy model is helpful in resolving quality- related events in critical access hospitals in rural areas. Also, during the study the use of telepharmacy services became more widespread, leading researchers to believe that physicians became more comfortable using the new technology to enhance patient safety.
Section F: Implementation Plan Setting and Access Implementing CPOE is challenging and requires significant planning to do it right. The methods and the efficient equipment that required for implementation of the e-prescription system need a comprehensive coverage of the organizational setting in a hospital. There is a need to get a sign-off from all the possible stakeholders of the system such as prescribers, doctors, physicians, pharmacy, some potential patients, imaging center, transaction hub, and database engineers. So, the approval form should prepare after finalizing the approach by knowing the pros and cons and the views of all the stakeholders in the hospital (Kierkegaard, 2012). Hospitals should adopt robust project management techniques
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...