Question

consider the following case study:

Case Study:

Reduce medication errors with a closed-loop medication administration system Contributors: Kareen Hall-Clarke, MPH, FACHE, CPHIMS, Seneca College, ON & Alstair Forsyth, MHSc, North York General Hospital, ON, Canada North York General Hospital (NYGH) serves the culturally diverse communities of North Toronto and provides acute, ambulatory and long-term care services across three sites serving 400,000 people. In 2007, it embarked on a multi-year clinical transformation project to bring its EHR into the future, from HIMSS Stage 2 to a goal of HIMSS Stage 7. In 2010, NYGH implemented the eCare Project with a primary focus of improving the quality and safety of care. In 2004, the Canadian Adverse Events Study (CAES) 1 reviewed acute care hospitals across the country and found that 7.5% of those had an adverse event and 45% were related to medication services. One of NYGH first eCare initiatives was to redesign its medication administration process. Prior to eCare, the medication process consisted of handwritten physician orders, duplicative manual transcription and shared med carts. This system left a lot of room for error, with 39 percent of errors occurring with medication prescribing and 38 percent occurring with medication administration. After examining the local problem and designing a new workflow to solve that problem, NYGH implemented closed-loop medication administration (CLMA), (See Figure 1). By leveraging information technology CLMA eliminates manual entry and sends an alert if a medication about to be administered does not match the drug, dose, route, timing and/or intended patient indicated in the active orders in the electronic chart. From 2010-2015, NYGH has prevented more than 11,000 medication errors using CLMA.

1 Baker, G. R., P. G. Norton, V. Flintoft, R. Blais, A. Brown, J. Cox, E. Etchells, W. A. Ghali, P. Hebert, S. R. Majumdar, M. O'Beirne, L. Palacios-Derflingher, R. J. Reid, S. Sheps and R. Tamblyn (2004). "The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada." CMAJ Canadian Medical Association Journal 170 (11): 1678-1686.

Answer the following questions:

1. How should medication errors be addressed at each step of the eMAR process: Prescribing, Transcribing, Dispensing and Administration?

2. Why should closed-loop medication administration (CLMA) technologies be the last defense to medication errors in the delivery of optimum patient care and safety?

Answer 1

1. Electronic medication administration record (eMAR) was created to improve the medication phase and to reduce the errors. But still, errors are taken place at each phase of the medication process.

Prescription Phase:

Prescription phase errors can be avoided by choosing correct medication and correct dose based on patient clinical diagnosis, patient characteristics, patient's allergies to medication, and assess the interaction of drugs with other medication.

Transcription phase:

Transcription errors can be avoided by transferring of correct information to the pharmacy. Correct medication name and the correct dose has to be transferred to the pharmacy.

Dispensing Phase:

The pharmacist should dispense the medication by checking to the patient's floor. Avoid sending of multiple patient medication at a time will avoid most of the dispensing error.

Administration Phase:

Before administering the medication, the nurse should follow the rights of medication such as right patient, right medicine, right dose, right route, right documentation to avoid errors. This is one of the important phases where most of the errors are avoided if the nurse follows these rights.

2. Closed-Loop Medication management is an electronic process that improves the process of medication administration. It is e-prescribing form that enhances patient safety and improves efficiency. It has Computerized provider order entry that prevents medical errors in all the phases of the medication process. The barcode unit ensures the presence of the right medication in each phase of the medication process. It also saves the time and energy of nurses and pharmacist.