Posted at 12.15.2018
One of the most crucial and potentially life altering tasks that a nurse must perform is that of medication administration. While the entire process may entail many disciplines, the bedside nurse remains the ultimate stop in a type of checks that occur prior to any medication attaining a patient. The goal of medication administration is to provide recommended medications in a powerful and safe manner. Often times, barriers can be found that avoid the safe supervision of medication such as, but aren't limited to, errors in the translation of physician orders, inappropriate wisdom and lack of attentiveness (Ulanimo, O'Leary-Kelley, & Connolly, 2007). The incorrect supervision of medications may be damaging to the patient as well as the healthcare provider. The undesireable effects from inappropriate administration could in the end include fatality. Research shows that many adverse outcomes in a healthcare facility and in patient good care are due to medication problems (Poon, Keohane, Bane, Featherstone, & Hays, 2008). It really is projected by the Institute of Medicine that, "normally, a hospitalized patient is at the mercy of one medication supervision error each day" (Koppel, Wetterneck, Telles, & Karsh, 2008, p. 408). Medication errors are costly to a business as well. It really is approximated by the Institute of Remedies as well, that a single undesirable event may cost a hospital upwards of in close proximity to 4, 600 us dollars for each event (Ross, 2008). Adverse events together have the potential to cost an organization up to at least one 1. 22 million dollars on a yearly basis (Ross, 2008).
Healthcare organizations and officers have initiated requirements to help with safe patient care and attention, one of which pertains right to medication supervision. The Five Protection under the law of Medication Supervision is the initiative that is guiding the way that nurses and bedside providers administer medications to patients. These privileges ensure that the right patient receives the right medication, to add dose and route, and that it's given at the right time (Fowler, Sohler, & Zarillo, 2009). No matter what measures are being used to concentrate on this problem, there will always be human error. Market leaders in technology have applied something that helps to reduce problems, therefore increasing patient safe practices, when it comes to medication administration. They did so by using a barcode medication supervision system. This technique helps by putting hard stops on different aspects of medication supervision in hopes to diminish the quantity of errors that appear, with patient safety being the ultimate focus.
Barcode medication supervision embodies the principles of the five rights of medication administration by utilizing a systematic and steady process for each and every and every patient. It can so by prompting the nurse to check out the patient's armband to ensure patient identification. After that it pulls that patient up and allows the nurse to access the medication profile (Ross, 2008). The nurse then scans the barcode that is on the medication package verifying they have got the right medication, right dosage and right course. In case the medication complements the ordered dose and route, no further documentation is needed generally. However, it is when there's a discrepancy between these that nurses are made aware of the problem by an alert message that they must act upon to be able to keep (Dasgupta, Jacob, & Dwibedi, 2011). They must also check their own name badge in order to verify or document the professional that is administering the medication (Koppel et al. , 2008). As with any change, some obstacles are present in the initiation of the machine. These can include implementation issues that include staff approval as well as potential for continued error anticipated to staff finding workarounds to different aspects of the supervision. There are also proven benefits with the machine like a decrease in problems and improved efficiency by staff. The alert emails and required action makes it harder for the nurse or provider to forget about warnings which could prevent possible unfavorable events.
An original computerized books search of "barcode medication supervision" using CINAHL and ProQuest resulted in numerous articles. To broaden the research also used were the terms "informatics" and "medication errors". The info extracted from these queries included qualitative and quantitative clinical tests, books reviews, and descriptive research of the medication supervision system. The study led to numerous viewpoints of barcode medication supervision to include the perspectives of multidisciplinary groups, administration as well as obstacles and problems with initial implementation and nursing satisfaction. In all of the different articles that were discovered, there have been some key points that repeated throughout. Those key points discovered were practices used to make the systems successful as well as obstacles that were came across, as specified below.
Implementation. The execution of a new system or process always has its challenges. A significant amount of the study founded dealt with the initial execution barriers and exactly how they were worked well through. Within an article by Ross, the complete implementation process was defined and examined retrospectively. The nursing administrators and bedside nurses as well as IT (IT) and Pharmacy all did the trick together to build a common eye-sight and work in cooperation to make the transition accepted and allow it to succeed, this group was called the collaborative design team (Ross, 2008). This article outlined the procedure of the vendor selection in which conscious decisions were made based mostly upon the different needs of a healthcare facility. Staff contribution was encouraged to make the implementation a success. Staff understanding was taken into account and weighted seriously when it came to choosing the right system. Your choice was made and the look was completed over the course of six months. The point of view of the nursing staff was taken in the highest account and they were involved in the implementation process. Plans were modified and re-written and released to personnel prior to training so that they were aware of the change. "The largest concerns among the list of staff were that the system slowed them down, needed them away from patient care, which the standard clinic dosing times and 'real time' administration would cause issue" (Ross, 2008, p 4). A healthcare facility administrators required this under consideration making process maps and rewriting policies again to make the transition as clean as it can be.
Wireless technology had to be upgraded so that the systems that were in patient rooms were able to operate and function well. IT still left logs for personnel to report problems. Prior to the roll away, each employee was necessary to take a four hour course for education on the new system. To also make the move smoother, super users were positioned on the machine for two weeks to aid in staff issues and questions. Regular meetings were performed after implementation as well to regularly work on issues that were developing with the system. Staff was maintained up to date on these by a 'Barcode Bulletin Plank' that was within each product (Ross, 2008). The execution of the new system was successful due to the collaboration that happened between all of the disciplines. "We found that collaboration was critical to your success. Our barcode implementation has improved not only patient basic safety but also how our outsourced IT utilizes its resources and time" (Ross, 2008, p. 7).
In another article by Wakefield, Ward, Loes and O'Brien, talked about was the implementation of the barcode medication administration in critical access private hospitals. The barcode medication supervision system that was put in place here helped to keep up accuracy in all of the associated critical access clinics while reshuffling the medication inventory process (Wakefield, Ward, Loes, & O'Brien, 2010). The barcode system also helped maintain precision in billing. Often times, before the implementation, medications were dispensed and not charted, therefore creating it impossible to expenses the patient or insurance for services rendered. All of the critical access nursing homes that were reviewed in this article have had the opportunity to maintain their target of a 90 percent scanning rate (Wakefield et al. , 2010). Nursing staff also remains happy with the change. "All interviewees mentioned that the utilization of the BCMA devices and change in workflow have been generally well-received by the nurses, and also have prevented medication supervision problems" (Wakefield et al. , 2010, p. 585).
Acceptance. It is popular that in order to make a system function to its full capacity and potential, buy in from staff must be obtained. Several articles were within research talking with nursing and staff satisfaction when it came to barcode medication supervision. In a time motion research completed by Poon, et. al, nursing satisfaction and workflow was detected within the system. Concern was reviewed that with the nursing scarcity, the barcode system would decrease nursing staff down, which would impede them from completely looking after their patients in the capacity that they deserved (Poon et al. , 2008). The analysis was occur a 735 foundation hospital on the nine month period to explore medical workflow within the barcode supervision system. Baseline observations were taken before the roll-out as well as after. In these situations, an observer, after allowed consent by the individual, adopted the nurse into the room and discovered her action when administering medication. It was found following the completion of the study that time allocated to medication administration did not change significantly among the list of nursing devices from before to after (Poon et al. , 2008). The amount of time spent with management of medical professional order decreased by 11 minutes over an eight hour switch, actually saving the staff more time than before. This study completely helped to alleviate nursing staffs' fears about increasing their workflow and helped to build acceptance surrounding the implementation.
Fowler, Sohler and Zarillo also put together several aspects that deal with nursing satisfaction as it pertains to barcode medication supervision. This review used a comparative, descriptive design to answer several questions about nursing satisfaction and the system. Personnel was surveyed prior to implementation as well as three and six months after. The study completed showed merged feelings. The staff was dissatisfied prior to implementation and stayed after the research. They do however rate that these were highly satisfied with the safeness that the barcode system helped bring into medication supervision and they portrayed that it made it easier to allow them to practice the five privileges of medication supervision (Fowler et al. , 2009). The authors recommend continued surveys be completed to see if time helped to increase satisfaction or new employees helped to improve the overall satisfaction.
Reduction in Problem. Mistakes in medication administration can be devastating to an individual as well as to the nurse. It's been investigated as to the reasons medication errors appear. These discoveries are talked about in this article by Ulanimo, O'Leary-Kelley and Connolly. It has been found that most medication problems are anticipated to, "lack of attentiveness, inappropriate view and skipped or mistaken physicians purchases" (Ulanimo et al. , 2007, p. 29). The creators used a descriptive style review to answer the study questions that that they had posed. The sample contains 61 documented nurses at a Veterans Affairs hospital in California. The nurses were asked to come back a survey as to what they thought were the major cause for medication mistakes. The main and number 2 reasons were inability to check patient identity and they occurred when nurses were worn out and exhausted (Ulanimo et al. , 2007). All of the nurses surveyed decided that the amount of administration errors has decreased because the hospital put in place the barcode supervision system. This analysis shows that while mistakes still occur, the nursing staff believes that their current practice of barcode supervision truly will prevent or reduce errors.
In a short article compiled by AHRQ, pharmacy workload is evaluated after implementation of barcode medication supervision. Quite often, pharmacists are interrupted by emergent calls, patients or by medical professionals. It is not hard to see with this that the problems from pharmacy syndication can be real and intensely costly. One clinic mentioned in this article lessens their dispensing errors by 63 percent following the implementation of any barcode system. This is so because by the nurse verifying the way and dosage at the bedside, medications are not mistakenly directed at patients if they are the incorrect item ("Studies Examine, " 2008). Within the same research, the largest gain was a decrease in the adverse medication events that saved the hospital 2. 2 million us dollars annually ("Studies Examine, " 2008).
In the study completed by Crazy, Szczepura and Nelson a study was completed over several years' time in the United Kingdom regarding the implementation of barcode medication supervision in a long term care center and the reduction in adverse drug occasions which were seen. The personnel was given a questionnaire and asked to examine their understanding of medication errors. This is completed preceding to, as well as after execution (Wild, Szczepura, & Nelson, 2011). It had been found through the surveys that nursing staff experienced less stress and pressure with the machine. This is so because barcode medication administration was helping to prevent medication mistakes that may have been previously overlooked because of the system alerting when one of the rights was violated or incorrect.
Potential for Continued Problem. At times, users deviate from the written standards when it comes to new or new systems. This can be called a "work around" and is also often seen whenever a staff member is not able to navigate through the system efficiently. This may be due to insufficient knowledge or credited to build flaws in the machine. In the analysis completed by Koppel, et. al, several methods were used to evaluate work around in the medical setting up; observation, interviews and involvement in staff conferences and education (Koppel et al. , 2008). Fifteen different workarounds were known in the analysis that were placed into three different categories. These categories were, omitted steps in the process, those that performed steps out of sequence and the ones that were unauthorized steps completed in the process (Koppel et al. , 2008). At times, the reasoning was due to missing medication, medications that were not bar-coded or possibly home medications that were brought in to consider. Other times, however, personnel was sluggish and did not go in to the room to check wristbands and instead scanned a sticker they continued their person for convenience. It's advocated in the article to continue with observations and keep an eye on compliance to ensure that specifications are being satisfied.
The review of literature shows much offer for the reduction of medication mistakes as information by multiple studies. You can find areas where the system works extremely well such as inpatient medical/operative flooring and in long term care facilities. Assisted living facilities often have hand written Medication Supervision Files (MAR) and the transcription of handwritten instructions leaves much room for mistake. Often times, in the way of the old systems, nursing staff did not even know that errors have been made anticipated to lack of understanding. Now with the barcode medication administration, it leaves smaller room for mistake. With some systems in the long term good care facilities, pictures of the resident come on the screen to give another assurance of reliability since, at times, residents may have problems with memory problems and may struggle to identify themselves.
An area where the system might not work as successfully and could potentially cause delays in good care would maintain an emergency office or in an intensive care unit. In these areas, lifesaving medications may need to be given quickly and on the idea of verbal orders when time does not allow for the accessibility of the order or confirmation by the pharmacy. In these circumstances, there is quite often a pharmacist in the team that is able to be a resource for medication supervision. "Within the emergency section, the timing of activities is really important and circumstances are occasionally such that there is no time to register prescriptions prior to the medications are administered" (Lenderink & Egberts, 2004, p. 186). In these situations, staff should still verify the order and that the five rights are being satisfied by a dialogue with the medical doctor to ensure protection is being achieved.
An first computerized literature search of "family observed resuscitation" using CINAHL and PubMed resulted in numerous articles. Employing this search we were able to obtain numerous studies regarding benefits of family observed resuscitation. To broaden our research we also used the terms "cardiopulmonary resuscitation" and "family presence". The info we extracted from these queries included qualitative and quantitative research studies, books reviews, and a thought analysis review. The research led to numerous viewpoints of family witnessed resuscitation to include the perspectives of both family members as well as medical care professionals.
Barcode medication supervision, as proven by the study, shows great offer in the wonderful world of medication administration. It is a fresh and exciting advancement in technology that private hospitals should implement to be able to decrease undesirable drug occasions and poor outcomes associated with medication administration and the mistake that is associated with this. As technology advances, it is expected that more research will be completed in order to fully see the impact of the system.
It is probable that by implementing barcoded medication supervision into our practice, it'll decrease the range of adverse drug incidents that are seen in the hospital setting. It is evident by the study that is completed that barcode medication administration has true advantage in the safe administration of medications and helps to decrease the problems that may potentially be made additionally. Many systems are new still and it would hold benefit to continue to market research areas weeks and years after implementation. As with any system change, there will always be amount of resistance but what it comes down to is what's best for the patient and what escalates the overall good. In this example, barcoded medication administration is most definitely in the best interest of the patient which will be proven as research persists.