Most read posts over the past 7 days:

1. An almost disastrous bar-coding mishap
2. Cool Technology for Pharmacy – Post from before I started putting the name of the cool technology in the blog title. This particular post was from September 10, 2009 and covered the capsule machine.
3. Cool Technology for Pharmacy – Another post from before I started putting the name of the cool technology in the blog title. This particular post was from June 18, 2009 and covered Alaris Smartpumps.
4. Best iPhone / iPod Touch Applications for Pharmacists
5. Quick Hit – Mobile devices in our pharmacy – This post elicited a couple of interesting comments.
6. Curriculum Vitae
7. “What’d I miss?” – Week of June 27
8. Cool Technology for Pharmacy –NDC Translator
9. About -People checking up on me.
10. Motion J3500 gets a wicked update – People are still interested in tablet PCs, even with that other device grabbing all the press.

Top searchterm phrases used over the past 7 days:

1. “ feton capsule filling machine ”
2. “ alaris pumps ”
3. “ cerner and pandora data systems ”
4. “ dell xt2 ”
5. “ alaris pump ”
6. “ capsule machine ”
7. “ alaris infusion pump ”
8. “ pharmacokinetics iphone ”
9. “ free lexi-drugs windows mobile free ”
10. “cloud computing”

Much of the technology in healthcare resembles speed bumps, irritating, but necessary to provide safety along the road. There is a landmark article (JAMA 1995;274:35-43) that takes a detailed look at system failures that contribute to adverse drug events (ADEs) in healthcare. Errors in the article are broken down as follows:

- Prescribing 39% (of these nearly half were intercepted by either pharmacy or nursing)

- Transcribing 12%

- Dispensing 11%

- Administering 38% (only 2% of drug administration errors were intercepted)

Based on the four areas described above – prescribing, transcribing, dispensing, administering – where are the technology speed bumps?

Prescribing – The speed bump here is clearly Computerized Provider Order Entry (CPOE).

Transcribing – Transcription as described in the study included unit secretaries re-writing orders on paper records for nursing. This is completely eliminated by CPOE and an Electronic Health Record (EHR). In addition, transcription errors are reduced by Pharmacy Information Systems (PhIS) like Siemens Pharmacy, MEDITECH, Cerner , etc., Barcode Medication Administration (BCMA) and electronic Medication Administration Records (eMARS).

Dispensing – A solid PhIS can be used to reduce distribution errors secondary to utilizing a standardized method. Automated storage (i.e. Talyst) and automated TPN preparation (i.e. Abacus and ExactaMix by Baxa ) are also helpful in standardizing workflow and decreasing the risk of error by using barcodes. Automated Dispensing Cabinets (ADCs) are helpful when used in combination with PARx to ensure accurate replenishment. Combined with BCMA this closes the circle and provides a nice safety net.

Administering – This is probably one of the most difficult areas in which to implement technology to increase patient safety. However, medication administration becomes important because it is the “last line of defense” prior to a patient receiving a medication. Smart pumps (i.e. Alaris), ADCs (i.e. Pyxis) and BCMA are all important speed bumps in the medication administration phase.

That’s a lot of speed bumps. The important thing to remember is that everything listed above is not designed to irritate you, but rather designed to improve patient safety. For the sake of clarity, perhaps a name change is in order; how about “safety bumps”?

The Alaris System utilizes “smart pumps” combined with software to create limits, called guardrails, on infusion concentrations and rates. There are two types of guardrail limits: a soft stop and a hard stop. A soft stop provides a warning whenever a preset limit is exceeded. When appropriate, the soft stop may be overridden and the infusion given. Hard stops on the other hand provide similar warnings, but cannot be overridden. When a hard stop is reached, the pump must be reprogrammed within the hospital’s guardrail limits before the infusion can begin.

Profiles with libraries containing several hundred medications can be created with medication concentration and infusion rate guardrails specific to each nursing unit. Profiles are designed around specific patient populations, which means profiles for critical care are different than those for general medicine. For example: a patient on a general medicine floor may be eligible for a dopamine infusion with a maximum infusion rate of 10 mcg/kg/min while a patient in a critical care unit may be able to receive dopamine up to a maximum of 20 mcg/kg/min before being stopped by the guardrails software.

The information from both soft stops and hard stops is recorded by the pump’s software and can be used by various departments to track “near misses” and perform education when necessary.