We have so much technology around these days. I mean we have real-time patient monitoring, near field communication, telemedicine, smartphones, music and video in the cloud, and so on ad infinitum. So why is it that hospital pharmacies use the same old horizontal hoods that they’ve always used?
Prevalence of medication administration errors in two medical units with automated prescription and dispensing [Article]
From the Journal of the American Medical Informatics Association1. I was a little shocked by the number of errors, but as you can see in the abstract below, and in the title, the errors were during the administration phase of the medication use process. Seems a bit odd to look at medication errors during administration when talking about automated prescribing and dispensing. I’m sure there is an explanation in the full article. However that requires a subscription. Interesting nonetheless:
Abstract
Objective To identify the frequency of medication administration errors and their potential risk factors in units using a computerized prescription order entry program and profiled automated dispensing cabinets.Design Prospective observational study conducted within two clinical units of the Gastroenterology Department in a 1537-bed tertiary teaching hospital in Madrid (Spain).
Measurements Medication errors were measured using the disguised observation technique. Types of medication errors and their potential severity were described. The correlation between potential risk factors and medication errors was studied to identify potential causes.
Results In total, 2314 medication administrations to 73 patients were observed: 509 errors were recorded (22.0%)—68 (13.4%) in preparation and 441 (86.6%) in administration. The most frequent errors were use of wrong administration techniques (especially concerning food intake (13.9%)), wrong reconstitution/dilution (1.7%), omission (1.4%), and wrong infusion speed (1.2%). Errors were classified as no damage (95.7%), no damage but monitoring required (2.3%), and temporary damage (0.4%). Potential clinical severity could not be assessed in 1.6% of cases. The potential risk factors morning shift, evening shift, Anatomical Therapeutic Chemical medication class antacids, prokinetics, antibiotics and immunosuppressants, oral administration, and intravenous administration were associated with a higher risk of administration errors. No association was found with variables related to understaffing or nurse’s experience.
Conclusions Medication administration errors persist in units with automated prescription and dispensing. We identified a need to improve nurses’ working procedures and to implement a Clinical Decision Support tool that generates recommendations about scheduling according to dietary restrictions, preparation of medication before parenteral administration, and adequate infusion rates.
1. J Am Med Inform Assoc. 2012 Jan 1;19(1):72-8. Epub 2011 Sep 2.
Cool Pharmacy Technology – Eyecon Pill Counter
- Scan the bottle
- Pour the tablets onto the Eyecon Pill Counter counting platter. The Eyecon Pill Counter uses “Machine vision technology” to count the tablets.
- Package the tablets
That’s pretty simple. Sure beats the heck out of counting the tablets by hand. 5…10…15…20….
More information on the Eyecon Pill Counter can be found here.
What do pharmacists want?
It’s a simple question with a simple answer. In today’s pharmacy environment pharmacists want to do more “clinical” activities and distance themselves from the physical pharmacy. See, I told you it was simple.
For the last several months I’ve been listening to people tell me what pharmacists, and pharmacies, want. I find it interesting that most of the opinions differ from mine. No big deal as opinions are opinions, remember? But today I had a brief, albeit passionate discussion over what pharmacists want. The people telling me what pharmacists wanted weren’t healthcare professionals. They were engineers, sales people, etc. I know that comes off a bit elitist, but it’s not. I don’t pretend to know what an engineer knows, so perhaps they shouldn’t pretend to know what I know. Fair? I think so.
Cool Pharmacy Technology–Apoteca
I have a soft spot for robotics, especially for IV preparation. I’m not quite sure that pharmacy is ready to fully embrace the idea, but we’re well on our way.
APOTECAchemo is an IV preparation robot modeled in the image of i.v.STATION. Prior to yesterday I had not heard of APOTECA. Fortunately someone visiting my site left me a link to the U.S. website. The site contains limited information with the exception of the video below. However, a quick internet search led me to the Loccioni Humancare website where I was able to find additional information.
HIMSS11 Interoperability Showcase – Omnicell video
Omnicell is pushing interoperability with pharmacy information systems. Interesting stuff.
Check out the demonstration video below. I love the “vending machine” style dispensing idea. It’s something I’ve been waiting to see for a few years now.
Cool Technology for Pharmacy – Sharp SX Bagger
Some items in a pharmacy are simply difficult to bar-code. Perhaps they’re too small, have an awkward shape or their surface won’t accommodate ink or an adhesive. The problem creates some interesting workarounds, and not always for the better.
One solution is to individually package each item and place the drug information and a bar-code on the outside of the packaging material; overwrapping, if you will. I’ve never been a big fan of overwrapping items because it can be time consuming and cumbersome. Today I ran across a machine that I think offers a genuine option for medications that are difficult to bar-code.
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Why automated medication kiosks could be good for pharmacy practice
I followed a little banter on Twitter this weekend regarding the use of automated dispensing kiosks to dispense medications to patients instead of using a physical pharmacy. There are many pharmacists out there that believe the use of automated medication dispensing in the outpatient arena is bad practice and separates patients from their pharmacists. I don’t share their sentiment. I’ve blogged about these devices before, here and here, and believe they could be used to improve the pharmacist-patient interaction. I actually had the opportunity to watch an InstyMeds Prescription Medication Dispenser in action under a physician dispensing model late last year and thought it was well done.
It is unclear to me why pharmacists fear these machines, but it reminds me of the fear surrounding automated dispensing cabinets during their inception back in the day. Now they’re an integral part of acute care pharmacy practice. Perhaps pharmacists believe that patients won’t get the necessary consultation and instruction that they would had they visited their local retail pharmacy. As one that has worked in a retail pharmacy environment, albeit briefly, I don’t buy into that belief. Under the right set of circumstances, and with thoughtful implementation, kiosks could free up pharmacists to spend more time with patients in emergency departments and urgent care clinics across the country. After all, don’t pharmacists argue for more clinical face time with patients and less association with the physical medication dispensing process? That’s what I’ve been hearing from pharmacists for years.
I would argue that placing kiosks in certain locations could improve medication therapy management and patient compliance. The odds of a mother with a tired, cranky, ill child going out of her way to visit a local retail pharmacy at midnight is much lower than grabbing a prescription at an automated dispensing machine in the urgent care clinic following the child’s exam. It certainly couldn’t hurt. Now throw in a consultation from the pharmacist prior to going to the medication kiosk and you have a winning combination.
Kiosks certainly wouldn’t fit every situation, but there is certainly room in the pharmacy practice model for their thoughtful use. Think about it.
Cool Technology for Pharmacy – Baxa Repeater Pump
The Baxa Repeater Pump is a pretty cool piece of pharmacy technology. The device automates many of the repetitive processes used in filling oral syringes, oral dosage cups, syringes used for injection and reconstituting medications used to mix intravenous medications in the acute care setting. I remember working in a pediatric facility and watching the technicians fill thousands of oral syringes with liquid acetaminophen and ibuprofen for use in automated dispensing cabinets throughout the hospital. With the use of the Syringe Filling Fixture, and the automated pump setting on the Repeater Pump, the technicians could fill a phenomenal number of syringes in a very short period of time. Other times the technicians used the foot pedal on the Repeater Pump in order to control the rate at which the process moved; art in motion. Either way it was a bummer when they were finished as I had to check all those syringes. Regardless, the pump was a valuable piece of equipment when repetitive fluid transfer was required.
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It may be time to consider robotic IV preparation at the bedside
Hospitals make a lot of intravenous (IV) preparations. That makes sense when you consider that most people admitted to the hospital are there because their acute illness requires more care than can be administered at home; not always, but in most cases. This is especially true for patients in the intensive care unit, i.e. the ICU.
A fair number of the medications used in the ICU are prepared on demand for a host of reasons including stability, differences in concentration, difficulty in scheduling secondary to rate variability, etc. Any pharmacist or nurse reading this will understand what I’m talking about. Example medications that fall into this category include drips like norepinephrine, epinephrine, phenylephrine, amiodarone and nitroprusside.
Last year I mused about using devices on the nursing stations designed to package oral solids on demand at the point of care. I still like the idea for several reasons, all of which can be found in the original post. Based on currently available technology the same concept could be applied to preparation of IV products at the bedside. Robotic IV preparation has come a long way and these devices could be used at the point of care to make a nurses, and patient’s, life a whole lot easier. The use of robotic IV preparation at the bedside could reduce wait times for nurses and lesson the workload on pharmacy.
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