Ocorrência de erros no preparo e na administração de medicamentos em unidade de pronto atendimento / Occurrence of errors in the preparation and administration of medications in an emergency care unit

Objetivo: caracterizar os erros durante o preparo e a administração de medicamentos injetáveis em unidade de pronto atendimento. Método: estudo transversal descritivo realizado em unidade de pronto atendimento. Foi realizada a coleta de dados por observação direta, não participante, durante 30 dias consecutivos e os dados foram analisados por estatística descritiva. Resultados: foram observadas 751 doses durante o processo de preparo e administração de medicamentos. Os principais erros foram ausência de higienização das mãos, desinfecção de frascos ampola e bancada, falha na informação sobre o medicamento administrado e na identificação do paciente e verificação de alergia medicamentosa. Conclusão: os erros no processo de preparo e administração de medicamentos ocorrem frequentemente em unidade de pronto atendimento. O estudo indica e reforça a necessidade de reestruturação do serviço de emergência para uma prática segura e oferece subsídios para planejar a educação permanente e a formação de novos profissionais.

Objective: to characterize errors during the preparation and administration of injectable drugs in an emergency care unit. Method: descriptive cross-sectional study carried out in an emergency care unit. Data collection was performed by direct non-participant observation, for 30 consecutive days and the data were analyzed using descriptive statistics. Results: 751 doses were observed during the drug preparation and administration process. The main errors were lack of hand hygiene, disinfection of vials and countertops, failure to provide information on the administered drug and patient identification and verification of drug allergy. Conclusion: errors in the medication preparation and administration process often occur in an emergency care unit. The study indicates and reinforces the need to restructure the emergency service for a safe practice and offers subsidies to plan permanent education and the training of new professionals.

Risk reduction in a cancer chemotherapy production unit: Contribution of an automated drug dispensing system.

OBJECTIVE: The purpose of our study was to evaluate the contribution of an automated drug dispensing system in securing cancer chemotherapy production process at the pharmacy of the National Institute of Oncology in Rabat. METHODS: The failure modes and effects analysis method was applied to the chemotherapy production process in two phases: Phase 1, using an open shelf for storage then phase 2, using an automated drug dispensing system. The failure modes were defined and their criticality indexes was calculated on the basis of the likelihood of occurrence, the potential severity for the patients and/or the impact on the process and the detection probability. The criticality indexes of the two phases were prioritized and compared. RESULTS: We identified 35 failure modes for phase 1 and 37 for phase 2. The sum of criticality indexes was 5957 and 4586, respectively, for phase 1 and phase 2, corresponding to a criticality reduction of -23%. The greatest improvements concerned that the needed drug is missing during the picking, storage of potential expired drugs, and double compounding. CONCLUSION: Our study highlighted the contribution of automated drug dispensing system in risk minimization. The use of automated drug dispensing system is a part of security improvement in chemotherapy production unit.

Uso de tarjetas de medicación en el manejo de estado epiléptico en un servicio de emergencias. Mejoras en prescripción, preparación y administración de drogas / Use of medication cards in the management of statu epilepticus at an emergency department. Improvements in drug prescription, preparation and administration

Introducción: Los errores de medicación (EM) causan una elevada morbimortalidad y generan costos innecesarios. El servicio de emergencias (SE) presenta un mayor riesgo de EM que otras áreas. El desarrollo de una herramienta que estandarice el uso de fármacos podría mejorar la seguridad y el proceso de medicación. Objetivos: Evaluar las mejoras en el proceso de medicación mediante el uso de tablas de medicación (TM) durante la atención del estado epiléptico (EE). Materiales y métodos: Se realizó un estudio de tipo antes y después no controlado. La intervención fue el desarrollo e implementación de TM. Se relevó in situ la prescripción, preparación y administración de fármacos incluidos en las TM durante segunda quincena de Octubre y mes de Noviembre 2016, previo a la implementación de la herramienta, y en el mismo período de 2017, luego de la inducción e implementación de las tablas. Se registraron los EM y se categorizaron de acuerdo a la etapa del proceso en que ocurrieron. Resultados: En el período pre-intervención se realizaron 14 registros, 86% (12) tenía al menos un error; 57% (8) errores en la etapa de prescripción, 57% (8) en la de preparación y 21% (3) en la de administración. En el período post-intervención se realizaron 17 registros, 12% (2) tenía por lo menos un EM. No se registraron errores en la fase de prescripción, hubo 12% (2) de errores de preparación y 6% (1) de administración. Conclusión: La implementación de las TM para la estandarización del uso de fármacos en EE resultó una medida muy positiva, mejorando la seguridad en el proceso de medicación (AU)

Introduction: Medication errors (ME) are associated with high morbidity mortality and lead to unnecessary costs. The risk of ME is higher at the emergency department (ED) than in other areas. Developing a tool that standardizes drug use may improve safety and medication processes. Objectives: To evaluate improvements in the medication process by using medication cards (MCs) during status epilepticus (SE) care. Materials and methods: An uncontrolled before-and-after study was conducted. The intervention was the development and implementation of MCs. The in situ prescription, preparation, and administration of drugs included in the MCs was recorded during the second half of October and November 2016, prior to the implementation of the tool, and in the same period of 2017, after the introduction and implementation of the MCs. ME were recorded and categorized according to the stage of the process in which they occurred. Results: In the pre-intervention period 14 episodes were recorded; in 86% (12) at least one error occurred; 57% (8) were ME in the prescription stage, 57% (8) were ME in the preparation stage, and 21% (3) were ME in the administration stage. In the post-intervention period 17 errors were recorded, in 12% (2) at least one ME occurred. No errors were recorded in the prescription stage, 12% (2) were preparation errors, and 6% (1) administration errors. Conclusion: The implementation of MCs for the standardization of medications used in the RU was successful, improving safety in the medication process (AU)

Specialized pharmaceutical care in social health centers in the times of COVID-19.

The COVID-19 pandemic is having a devastating effect on the nursing homes for dependent older people. The difficulty of management of this crisis is aggravated by the frailty of the people served and by the specific characteristics of the care  area, mainly the fact of not being integrated into the health system. The  objective of this work is to describe the pharmaceutical care developed by a  hospital pharmacy service established in a nursing home and, from a more  global perspective, analyze the strengths and weaknesses found from the  various experiences of hospital pharmacy in all spanish autonomous  communities to deal with this pandemic. Specialized pharmaceutical care has  provided rigor in the validation and treatments review processes from a  comprehensive perspective, maximizing safety and collaborating in the  establishment of the therapeutic intensity degree most appropriate to the  individual situation, has ensured the availability of all necessary medications,  has collaborated in the acquisition and management of personal protective equipment, has been able to adapt the dispensation processes to the internal  nursing homes sectorization and has facilitated the coordination between the  nursing home and the health system. It is clear that the crisis casued by COVID- 19 has put relevance of the need to integrate the social-health level into the  health system. And also, the contribution of specialized pharmaceutical care in  improving healthcare coverage and coordination with health services has  highlighted the urgency of developing the current legislation, prioritizing the  establishment of pharmacy services able to provid specialized and specific care  for this area, so that it meets healthcare needs and is integrated into the health  system.

La pandemia COVID-19 está teniendo un efecto devastador en las residencias de personas mayores dependientes. La dificultad de la gestión de la crisis se ve  agravada por la fragilidad de las personas atendidas y por las propias  características del ámbito asistencial, principalmente el hecho de no estar  integrado en el sistema de salud. El objetivo del presente trabajo es describir la  atención farmacéutica especializada desarrollada por un servicio de farmacia  hospitalario establecido en un centro sociosanitario y, desde una perspectiva  más global, analizar las fortalezas y debilidades encontradas desde las diversas experiencias de la farmacia hospitalaria en el conjunto de comunidades autónomas para hacer frente a esta pandemia. La atención  farmacéutica especializada ha aportado rigor en los procesos de validación y  revisión de los tratamientos desde una perspectiva integral, maximizando la  seguridad y colaborando en el establecimiento del grado de intensidad  terapéutica más adecuado a la situación individual de la persona afectada, ha  asegurado la disponibilidad de todos los medicamentos necesarios, ha  colaborado en la adquisición y gestión de los equipos de protección individual, ha  sido capaz de adaptar los procesos de dispensación a la sectorización interna de las residencias y ha facilitado la coordinación entre la residencia y el sistema  de salud. Resulta evidente que la crisis provocada por la COVID-19 ha puesto de relevancia la necesidad de integrar el ámbito sociosanitario en el sistema de  salud. Y asimismo, la contribución de la atención farmacéutica especializada en  la mejora de la cobertura asistencial y de la coordinación con los servicios  sanitarios ha puesto de manifiesto la urgencia de desarrollar la legislación  vigente, priorizando el establecimiento de servicios de farmacia capaces de  proporcionar una atención especializada y específica para este ámbito  asistencial, de forma que cubra las necesidades asistenciales y quede integrada  en la estructura sanitaria.

Impact of discharge medication bedside delivery service on hospital reutilization.

PURPOSE: To evaluate the impact of a medication to bedside delivery (meds-to-beds) service on hospital reutilization in an adult population. METHODS: A retrospective, single-center, observational cohort study was conducted within a regional academic medical center from January 2017 to July 2017. Adult patients discharged from an internal medicine unit with at least one maintenance medication were evaluated. The primary outcome was the incidence of 30-day hospital reutilization between two groups: discharged patients who received meds-to-beds versus those who did not. Additionally, the incidence of 30-day hospital reutilization between the two groups was compared within predefined subgroup patient populations: polypharmacy, high-risk medication use, and patients with a principal discharge diagnosis meeting the criteria set by the Centers for Medicare and Medicaid Services 30-day risk standardized readmission measures. RESULTS: A total of 600 patients were included in the study (300 patients in the meds-to-beds group and 300 patients in the control group). The 30-day hospital reutilization (emergency department visits and/or hospital readmissions) related to the index visit was lower in the meds-to-beds group, but the difference was not statistically significant between the two groups (8.0% in the meds-to-beds group versus 10.0% in the control group; odds ratio, 0.78; 95% confidence interval, 0.45-1.37). There was no significant difference in the 30-day hospital reutilization related to the index visit between the control and meds-to-beds groups within the three subgroups analyzed. CONCLUSION: There was no difference in 30-day hospital reutilization related to the index visit with the implementation of meds-to-beds service in the absence of other transitions-of-care interventions.

Devising of a risk map on the management of high risk alert medication in a high level university hospital.

OBJECTIVE: To classify hospital units into three risk levels in order to define and prioritise  improvement and training measures in each of them. METHOD: The risk map was developed in two phases: First phase involved the setting up of a  multidisciplinary team, a bibliographic search, the identification of medications and of the criteria to  design the map: (1) Location: number of high-alert medications; (2) Staff turnover: the units were  classified in low turnover units = 1, medium turnover units = 2 and high turnover units = 3 according  to data provided by the human resource department; (3) Frequency: quotient between the number of high alert medicactions in each unit and the total of medications used, and (4) Severity: voluntary  survey of professionals. An accumulated risk of severity of each unit was calculated: Σ (severity of the  drug x number of its units). The Neperian logarithm was applied to this value to reduce the  variability of the values. Thus a risk probability index was established = staff turnover x frecuency x  Neperian logarithm of severity. In a  second phase, the units were classified into three groups and the  risk map of high-alert medication was elaborated in the hospital. In it, the units that had a risk  probability index higher than 2.9 were classified as high risk units, those that had between 1-2.9 as  intermediate risk units and those that had less than 1 as low risk units. According to the risk probability index, improvement measures were defined and priorities were set for each of them. RESULTS: A total 447 high-risk medications corresponding to 227 active ingredients were identified  during the study period. The units showing a higher risk were: Intensive Care Medicine (10.51),  Reanimation (4.01), and Palliative Care (3.90). Improvement actions (informative poster, visual  identification, alerts, training and double checks) were defined and prioritised in accordance with the  risk probability index. CONCLUSIONS: Knowing the degree of risk of hospitalization units in the management of high-alert  medications allows for the implementation of improvement plans in relation to the degree of  vulnerability detected.

Objetivo: Estratificar las unidades del hospital en tres niveles y elaborar un mapa de riesgos para  priorizar las mejoras y la formación sobre el manejo de medicamentos de alto riesgo. Método: La elaboración del mapa se realizó en dos fases: Primera fase, implicó la creación de un  equipo multidisciplinar, búsqueda bibliográfica, identificación de medicamentos y de criterios para  elaborar el mapa: (1) Localización: número de medicamentos de alto riego; (2) Rotación del personal:  se clasificaron las unidades en rotación baja = 1, media = 2 y alta = 3, según datos de recursos humanos; (3) Frecuencia: cociente entre el número de medicamentos de alto riesgo en  cada unidad y el total de medicamentos utilizados, y (4) Gravedad: encuesta voluntaria a  profesionales. Se calculó un riesgo acumulado de gravedad de cada unidad: Σ (gravedad del  medicamento x número de unidades del medicamento). Sobre este valor se aplicó el logaritmo  neperiano para reducir la variabilidad de los valores. Con ello se estableció el índice de probabilidad  de riesgo = rotación del personal x frecuencia x logaritmo neperiano del riesgo acumulado de  gravedad. En una segunda fase, a partir  de la ponderación de resultados, se clasificaron las unidades  en tres grupos y se construyó el mapa de riesgo de medicamentos de alto riesgo en el  hospital. En este se representaron las unidades que tuvieron un índice de probabilidad de riesgo  mayor de 2,9 como unidades de alto riesgo, las que lo tuvieron entre 1-2,9 como unidades de riesgo  intermedio y las que lo tuvieron menor a 1 como unidades de riesgo bajo. Y según el índice de  probabilidad de riesgo en la unidad, se definieron y priorizaron las medidas de mejora para cada una  de ellas.Resultados: Se identificaron 447 medicamentos de alto riesgo en el hospital, correspondientes a 227  principios activos. Las unidades de mayor riesgo fueron: Medicina Intensiva (10,51),  Reanimación (4,01) y Paliativos (3,90). Se definieron las acciones de mejora por índice de probabilidad de riesgo: póster informativo, identificación visual, alertas, formación y doble  chequeo.Conclusiones: Conocer el grado de riesgo de las unidades de hospitalización en el manejo de  medicamentos de alto riesgo permite aplicar planes de mejora dirigidos en función de la mayor o  menor vulnerabilidad detectada.

Elaboração e validação de checklist para administração de medicamentos para pacientes em protocolos de pesquisa / Elaboración y validación de checklist para la administración de medicamentos para pacientes en protocolos de investigación / Elaboration and validation of a drug administration checklist for patients in research protocols

Resumo OBJETIVO Descrever a elaboração e validação de um checklist como estratégia de administração segura de medicamentos. MÉTODO Estudo de validação por consenso de especialistas conduzido de janeiro a junho de 2018 em um Centro de Pesquisa Clínica de um hospital universitário. O checklist foi validado por três enfermeiros assistenciais, dois técnicos de enfermagem, um farmacêutico, dois enfermeiros professores e um médico professor, todos com ampla experiência na administração de medicamentos e em pesquisa clínica. Para a lista final foi considerado consenso de 100% entre os especialistas. RESULTADOS Elaborou-se um guia composto por seis itens a serem checados pela equipe assistencial antes, durante e após a administração de medicamentos de Pesquisa Clínica. CONCLUSÃO A validação do checklist forneceu elementos norteadores para a prevenção de comportamentos que podem levar ao risco de eventos adversos e também permitiu que as equipes assistenciais buscassem estratégias seguras de cuidado na administração de medicamentos.

Resumen OBJETIVO Describir la elaboración y validación de un checklist como estrategia de administración segura de medicamentos. MÉTODO Estudio de validación por consenso de especialistas conducido de enero a junio/2018 en Centro de Investigación Clínica de un hospital universitario. El checklist fue validado por tres enfermeros asistenciales, dos técnicos de enfermería, un farmacéutico, dos enfermeros profesores y un médico profesor todos con amplia experiencia en administración y supervisión de medicamentos y investigación clínica. Para la lista final se consideró consenso del 100% entre los expertos. RESULTADOS Elaboró ​​un guía compuesto por seis ítems a ser chequeados por el equipo asistencial antes, durante y después de la administración de medicamentos de Investigación Clínica. CONCLUSIÓN La validación del checklist proporcionó elementos orientadores para la prevención de comportamientos que pueden llevar al riesgo de eventos adversos y también permitió a los equipos asistenciales buscar estrategias seguras de cuidado en la administración de medicamentos.

Abstract OBJECTIVE To describe the elaboration and validation of a checklist as a strategy for safe drug administration. METHOD It is a Validation study by consensus of experts conducted from January to June 2018, in a Clinical Research Center of a university hospital. The checklist was validated by three nurses, two nursing technicians, a pharmacist, two nurse teachers and one medical teacher, all with extensive experience in drug administration and in clinical research. For the final version of the checklist, a consensus of 100% was considered. RESULTS A guide was prepared consisting of six items to be checked by the care team before, during and after administration of Clinical Research drugs. CONCLUSION The validation of the checklist provided guiding elements for the prevention of behaviors that could lead to the risk of adverse events and also allowed the care teams to seek safe strategies of care in drug administration.

Challenges And Opportunities For Improving Patient Safety Through Human Factors And Systems Engineering.

Despite progress on patient safety since the publication of the Institute of Medicine's 1999 report, To Err Is Human, significant problems remain. Human factors and systems engineering (HF/SE) has been increasingly recognized and advocated for its value in understanding, improving, and redesigning processes for safer care, especially for complex interacting sociotechnical systems. However, broad awareness of HF/SE and its adoption into safety improvement work have been frustratingly slow. We provide an overview of HF/SE, its demonstrated value to a wide range of patient safety problems (in particular, medication safety), and challenges to its broader implementation across health care. We make a variety of recommendations to maximize the spread of HF/SE, including formal and informal education programs, greater adoption of HF/SE by health care organizations, expanded funding to foster more clinician-engineer partnerships, and coordinated national efforts to design and operationalize a system for spreading HF/SE into health care nationally.

What causes medication administration errors in a mental health hospital? A qualitative study with nursing staff.

OBJECTIVE: Medication administration errors (MAEs) are a common risk to patient safety in mental health hospitals, but an absence of in-depth studies to understand the underlying causes of these errors limits the development of effective remedial interventions. This study aimed to investigate the causes of MAEs affecting inpatients in a mental health National Health Service (NHS) hospital in the North West of England. METHODS: Registered and student mental health nurses working in inpatient psychiatric units were identified using a combination of direct advertisement and incident reports and invited to participate in semi-structured interviews utilising the critical incident technique. Interviews were designed to capture the participants' experiences of inpatient MAEs. All interviews were transcribed verbatim and subject to framework analysis to illuminate the underlying active failures, error/violation-provoking conditions and latent failures according to Reason's model of accident causation. RESULTS: A total of 20 participants described 26 MAEs (including 5 near misses) during the interviews. The majority of MAEs were skill-based slips and lapses (n = 16) or mistakes (n = 5), and were caused by a variety of interconnecting error/violation-provoking conditions relating to the patient, medicines used, medicines administration task, health care team, individual nurse and working environment. Some of these local conditions had origins in wider organisational latent failures. Recurrent and influential themes included inadequate staffing levels, unbalanced staff skill mix, interruptions/distractions, concerns with how the medicines administration task was approached and problems with communication. CONCLUSIONS: To our knowledge this is the first published in-depth qualitative study to investigate the underlying causes of specific MAEs in a mental health hospital. Our findings revealed that MAEs may arise due to multiple interacting error and violation provoking conditions and latent 'system' failures, which emphasises the complexity of this everyday task facing practitioners in clinical practice. Future research should focus on developing and testing interventions which address key local and wider organisational 'systems' failures to reduce error.

Evaluation of a Barcode Medication Administration Information System.

When a medication administration error occurs, patient safety is endangered. Barcode medication administration system usage has been implemented to reduce medication errors. The purpose of this study was to evaluate barcode medication administration system usage outcomes. A survey based on DeLone and McLean's model of information systems success was utilized. The questionnaire, composed of 27 items, explored system quality, information quality, service quality, user satisfaction, and usage benefits. It was completed by 232 nurses. User satisfaction received the highest average score, and quality of information was the most critical factor related to this result (r = 0.83, P < .01). Medication errors occurring before and after barcode medication administration use were collected, and the reasons for errors related to work process were explored. Medication errors decreased from 405 at preimplementation to 314 at postimplementation (t = 77.62, P < .001). The main reason for medication errors related to work process was "not following the standard procedure," followed by "other factors." While technology is deployed to support individual practice, organizational elements also remain important to technology adoption.

Evaluation of medication dose omissions amongst inpatients in a hospital using an electronic Medication Management System.

RATIONALE, AIMS, AND OBJECTIVES: Whilst many dose omissions cause no patient harm, inappropriate dose omissions have been associated with increased length of hospital stay, risk of sepsis, and mortality. This study aimed to comprehensively describe the prevalence and nature of omitted doses overall and of high risk medication dose omissions in an organization using an electronic Medication Management System. METHODS: A retrospective cross-sectional study was undertaken in an Australian tertiary referral health service. All routinely documented electronic inpatient dose administration records from 1st July 2014 to 30th June 2015 were included. Period prevalence and characteristics of dose omissions overall and of high-risk medication dose omissions were determined. RESULTS: During the study period, 3.3 million inpatient doses were scheduled for administration, with doses endorsed as "not given" comprising 6.2% of all scheduled doses. Non-valid dose omissions (medication not available or no justification documented) comprised 1.2% of scheduled doses. Patient refusal accounted for one third of all dose omissions, while for 12% no explanation was provided and 7% were endorsed "medication not available". High-risk medications accounted for 20% of all dose omissions. One in 20 antimicrobial doses scheduled were omitted, and of these, 17% were due to patient refusal. CONCLUSION: The period prevalence of dose omissions in this large study after electronic Medication Management System implementation is similar to that found when paper charts were used. Although most dose omissions appear appropriate, many orders were not given due to patient refusal or with no documented justification. Interventions to minimize unintentional dose omissions are indicated.

Impact of a Barcode Medication Administration System on Patient Safety
.

OBJECTIVES: To determine the impact of barcode medication administration (BCMA) on the incidence of medication administration errors among patients in an onco-hematology day hospital and to identify the characteristics of medication errors in that setting.
. SAMPLE & SETTING: 715 patients treated in the onco-hematology day unit at the Príncipe de Asturias University Hospital in Madrid, Spain.
. METHODS & VARIABLES: A between-groups, pre-/postintervention study was conducted. Administration errors observed in patients with solid tumors (intervention group) were compared with those in patients with hematologic cancer (control group) before and after the introduction of BCMA. Error incidence, type, and severity were assessed, as was length of stay for treatment.
. RESULTS: Use of a BCMA system reduced the incidence and severity of errors in medication administration in the onco-hematology day hospital.
. IMPLICATIONS FOR NURSING: BCMA is a useful technology to check the five rights of medication administration in the onco-hematology day hospital and could help nurses increase the time spent on direct patient care activities. 
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[Impact of an automated dispensing system for medical devices in cardiac surgery department]. / Impact de l'implantation d'armoires sécurisées dédiés aux dispositifs médicaux dans un service de chirurgie cardiaque.

To secure medical devices' management, the implementation of automated dispensing system in surgical service has been realized. The objective of this study was to evaluate security, organizational and economic impact of installing automated dispensing system for medical devices (ASDM). The implementation took place in a cardiac surgery department. Security impact was assessed by comparing traceability rate of implantable medical devices one year before and one year after installation. Questionnaire on nurses' perception and satisfaction completed this survey. Resupplying costs, stocks' evolution and investments for the implementation of ASDM were the subject of cost-benefit study. After one year, traceability rate is excellent (100%). Nursing staffs were satisfied with 87.5% by this new system. The introduction of ASDM allowed a qualitative and quantitative decrease in stocks, with a reduction of 30% for purchased medical devices and 15% for implantable medical devices in deposit-consignment. Cost-benefit analysis shows a rapid return on investment. Real stock decrease (purchased medical devices) is equivalent to 46.6% of investment. Implementation of ASDM allows to secure storage and dispensing of medical devices. This system has also an important economic impact and appreciated by users.

Implementation of a new method to track propofol in an endoscopy unit.

AIM: Propofol is a widely used anesthesia induction agent and is easily accessible in most healthcare facilities. Unlike regulated or schedule drugs, propofol is inconsistently tracked, leading to inaccurate inventories, incorrect billing, and unrecognized diversion. The goal of this project was to implement a new method of tracking propofol in a single setting, with the aim of accounting for 100% of the drug. METHODS: For two, 2-week observation periods, data were extracted from an automated medication management system or pharmacy inventory system, anesthesia records, and pharmacy billing sheets for cases in a Gastrointestinal (GI) Endoscopy Unit, and compared pre-implementation and post-implementation of a new tracking and accounting protocol. Variables included amount of propofol inventoried, dispensed, administered, returned, billed, wasted, and missing. RESULTS: Pre-implementation (n = 300), 10% cases had no record of propofol removal from the automated medication system. Of the 90% that did, 25% had an amount signed out that did not match the amount administered. Thirty-one percent of all propofol was unaccounted for during this 2-week period. Furthermore, 19.7% of cases did not have a billing form located. Post-implementation of the process change, unaccounted for propofol decreased to 26% of all cases (P = ns). The percentage of missing billing forms decreased from 19.7 to 5.8% (P = 0.00). CONCLUSION: Data suggest notable amounts of propofol were unaccounted for and not billed for in the GI Endoscopy Unit prior to the protocol change. Post-protocol change data reveal modest improved accounting of the medication and significant cost-capture. Improvements may enhance inventory reconciliation, availability of drug stock, and potentially result in a decreased risk of unrecognized diversion.

DRUGS System Improving the Effects of Clinical Pathways: A Systematic Study.

The aim of the study is to assess the feasibility of Drugs Rational Usage Guideline System (DRUGS)-supported clinical pathway (CP) for breast carcinoma, cataract, inguinal hernia and 2-diabetes mellitus whether the application of such a system could improve work efficiency, medical safety, and decrease hospital cost. Four kinds of diseases which included 1773 cases (where 901 cases using paper-based clinical pathways and 872 cases using DRUGS-supported clinical pathways) were selected and their demographic and clinical data were collected. The evaluation criteria were length of stay, preoperative length of stay, hospital cost, antibiotics prescribed during hospitalization, unscheduled surgery, complications and prognosis. The median total LOS was 1 to 3 days shorter in the DRUGS-supported CP group as compared to the Paper-based CP group for all types (p < 0.05). Totel hospital cost decreased significantly in the DRUGS-supported CP group than that in Paper-based CP group. About antibiotics prescribed during hospitalization, there were no statistically differences in the time of initial dose of antibiotic and the duration of administration except the choice of antibiotic categories. The proportion of DRUGS-supported clinical pathway conditions where a broad-spectrum antibiotic was prescribed decreased from 63.6 to 34.5 % (p < 0.01) in the Paper-based group. While after the intervention, the differences were statistically not significant in unscheduled surgery, complications and prognosis. In this study, DRUGS-supported clinical pathway for breast carcinoma, cataract, inguinal hernia, 2-diabetes mellitus was smoothly shifted from a paper-based to an electronic system, and confer benefits at the hospital level.

Aplicación del modelo de gestión por procesos: el caso de la distribución y dispensación de medicamentos en dosis unitaria diaria. Hospital Italiano Monte Buey. Año 201-2013

La distribución y dispensación de medicamentos de uso hospitalarioconstituyen una oportunidad de mejora.Un buen manejo de medicamentos hospitalarios representa unanecesidad para un adecuado y oportuno acceso al paciente que lorequiera.Este trabajo busca realizar un estudio que pueda promover unaadecuada administración en la distribución y dispensación demedicamentos en el ámbito de la farmacia intrahospitalaria delHospital Italiano Monte Buey que permita garantizar la seguridaddel paciente mediante el uso racional y eficiente de los mismosfavoreciendo así la calidad de la atención.El presente estudio se enmarca dentro de la investigación científica,explorativa, descriptiva de corte transversal de naturaleza aplicada.La identificación de los distintos procesos – de gestión - clave y deapoyo, que se integran en la logística de distribución y dispensacióninterna de la Farmacia intrahospitalaria, luego de revisar los distintossistemas de distribución interna con sus ventajas y desventajas, permitenla elaboración del mapa de procesos de la misma con sus correspondientesfichas de proceso y diagrama de flujo.De los resultados obtenidos al analizar el movimiento deampicilina – sulbactam dispensados en el trimestre luego de lapuesta en marcha del sistema de distribución de medicamentos endosis unitaria diaria, se demuestra que se consumieron 91,28% deltotal distribuidos recuperando un 8,71% no utilizados que retornana farmacia, quedando expresado el beneficio del modelos de gestiónpor procesos propuesto con intervención del farmacéutico en lainterpretación del pedido médico, recupero de medicación condisminución del stock y del gasto al no solicitar nuevas compras,todo lo cual impactan en eficiencia y seguridad con eficacia en ladispensación de los medicamentos.

The distribution and dispensation of the medicinal products forhospital use constitute an opportunity for improvement.Good management of hospital drugs represents a need for proper andtimely access to the patient who requires it.This work intends to conduct a study which to promote a properadministration in the distribution and dispensation of medicinalproducts in the hospital pharmacy of Hospital Italiano Monte Buey,that would ensure the safety of the patient through the rational andefficient use of them, favouring the quality of care.This study falls within the scientific, exploratory, descriptive researchof cross section of applied nature.The identification of the various processes – management – keyand support, integrated in the logistic distribution and internalhospital pharmacy dispensation, after reviewing the different systems ofinternal distribution with its advantages, allow the development ofthe process map with its corresponding data sheets of process andflowchart.The results obtained from analyzing the movement of ampicilin –sulbactam dispensed in the quarter after the implementation of thesystem of distribution of drugs in unit dose dayli, is shown that theywere consumed 91,28% of the total distributed recovering 8,71%unused returning to pharmacy, being expressed to the benefit ofthe process management models propored with intervention of thepharmacist in the interpretation of the ordering physician, recoveryof medication with stock and costs decrease by not requesting newpurchases, all which have an impact on efficiency and securityeffectively in the dispensation of drugs.

Impact of an electronic medication administration record on medication administration efficiency and errors.

The study aims were to evaluate the impact of electronic medication administration record implementation on medication administration efficiency and occurrence of medication errors as well as to identify the predictors of medication administration efficiency in an acute care setting. A prospective, observational study utilizing time-and-motion technique was conducted before and after electronic medication administration record implementation in November 2011. A total of 156 cases of medication administration activities (78 pre- and 78 post-electronic medication administration record) involving 38 nurses were observed at the point of care. A separate retrospective review of the hospital Midas+ medication error database was also performed to collect the rates and origin of medication errors for 6 months before and after electronic medication administration record implementation. The mean medication administration time actually increased from 11.3 to 14.4 minutes post-electronic medication administration record (P = .039). In a multivariate analysis, electronic medication administration record was not a predictor of medication administration time, but the distractions/interruptions during medication administration process were significant predictors. The mean hospital-wide medication errors significantly decreased from 11.0 to 5.3 events per month post-electronic medication administration record (P = .034). Although no improvement in medication administration efficiency was observed, electronic medication administration record improved the quality of care with a significant decrease in medication errors.

A case study on parsing chemotherapy related free-text data.

When modelling and simulating healthcare related processes, free-text data is often the only possible source of information. This data may contain vocabulary variations such as mistyped, misspelled and/or abbreviated words. This paper describes a semi-automated approach to free-text normalisation based on a combination of commonly used techniques and local expertise of medical oncology nurses. The approach emphasises the effectiveness of the vocabulary creation process through an interactive software application. When local knowledge is successfully captured, normalisation of large data sets can be done very rapidly with a high accuracy rate achieved. Furthermore, the techniques for localised normalisation can have significant benefits to free-text parsing accuracy when data is aggregated from multiple sites (hospitals). This research may lead to increased understanding of issues associated with chemotherapy related free-text data which in turn may impact patient treatment safety.