Closed-Loop Medication System: Leveraging Technology to Elevate Safety.

BACKGROUND: Healthcare organizations have long been dependent on the vigilance of nurses to identify and intercept medication errors before they can adversely affect patients. New technologies have been implemented in an effort to reduce medication errors; however, few studies have evaluated the long-term effects of technology-based interventions in reducing medication errors. AIM: The aim of this study was to evaluate the effects of barcode medication administration (BCMA) and the closed-loop medication system (CLMS) interventions on medication errors and adverse drug event (ADE) rates. METHODS: An autoregressive integrated moving average model for interrupted time series design was used to evaluate the impact of the BCMA and CLMS interventions on the monthly reported medication error and ADE rates at Humber River Hospital between September 2013 and August 2018. Descriptive statistics were generated to evaluate the types of error and their gravity. RESULTS: A total of 1,712 medication errors and ADEs were reported in the five-year study period. The results of the interrupted time series indicated that the introduction of the BCMA intervention was associated with a statistically significant gradual decrease in reported medication error and ADE rates at 0.002 percentage points per month (p = 0.003). The introduction of the CLMS intervention was associated with an immediate absolute decrease in reported medication error and ADE rates of 0.010% (p = 0.020). CONCLUSIONS: The findings from this study support the adoption of both BCMA and CLMS interventions to prevent medication errors. Staged implementation of CLMS allows time for learning and incorporating barcode scanning. Interprofessional and cross-functional collaboration is necessary to successfully integrate the requirements of each respective discipline and service in the CLMS.

Smartphone Technology: Enabling Prioritization of Patient Needs and Enhancing the Nurse-Patient Relationship.

BACKGROUND: Mobile health (mHealth) is a rapidly growing field with the potential to transform healthcare delivery. Smartphone technologies have been developed and integrated into the patient call bell system for healthcare staff to receive calls; however, there is a lack of high-quality evidence to support the implementation and evaluate the effectiveness of these devices in a healthcare setting. AIM: The aim of this study is to explore nurses' perceptions of smartphone technology devices in enhancing the nurse-patient relationship and improving nursing workflows. METHODS: A semi-structured focus group and interviews were used to illicit nurses' experiences with smartphone technology. Interviews were audio recorded, transcribed and subjected to a content analysis to identify emerging themes from the data. RESULTS: Interviews with nurses provided insight into the benefits and challenges of smartphone use in the clinical setting. Multiple benefits were identified by nurse participants, including time management and convenience, prioritization, patient safety and enhancement of the nurse-patient relationship. CONCLUSION: There are multiple benefits of smartphone technology for both nurses and patients. Hospitals proposing to introduce smartphone technology need to educate patients and families about the clinical use of smartphones to avoid unfavourable perceptions. Smartphone technology must be interoperable with the electronic medical record to optimize interprofessional communication and exchange of patient information.

A comparison of hospital-acquired pressure injuries in intensive care and non-intensive care units: a multifaceted quality improvement initiative.

Hospital-acquired pressure injuries (HAPI) are a significant cause of morbidity and mortality, and represent a major health concern worldwide. Patients suffering from HAPI report a poor quality of life on several dimensions of health. Moreover, HAPI is reported to lengthen in-hospital stay in the acute setting, posing significant healthcare resource utilisations and costs. Given the clinical and economic burden of HAPI, recent best practice guidelines provide recommendations to reduce the prevalence of pressure injuries. Humber River Hospital (HRH), a large community hospital in Toronto, Canada, has a daily census of approximately 500 patients. The aim of this project was to reduce the prevalence of HAPI within the intensive care unit (ICU) and non-ICU setting at HRH within a 1-year period. Using the International Pressure Injury/Ulcer Prevalence (IPUP) Survey we established a baseline prevalence of HAPI of 27.6% (n=315) for non-ICU and 30% for ICU (n=33) patients at our institution in 2015. Using the Plan-Do-Study-Act (PDSA) method for quality improvement, we implemented a multifaceted approach aimed at improving equipment, digital documentation and education on risk assessment, prevention and treatment strategies. Over multiple PDSA cycles, our prevalence of HAPI reduced to 16% for non-ICU patients with no changes to the HAPI prevalence in ICU patients in 2016. Sustainability continues with HAPI prevalence currently at 10% in 2017 for non-ICU patients, which outperforms the Canadian prevalence (13.7%) by census size for 2017. However, the prevalence of HAPI in the ICU increased to 45% in 2017 despite multiple quality improvement initiatives, suggesting critically ill patients represent a unique challenge for reducing HAPI for these patients at our institution.