Jerry Fahrni

Tag: Patient Safety

  • Disinfect your tablet PC without the chemical mess

    Check out the video below from HIMSS 2011 demonstrating a product by Advanced Technical Support, Inc (ATS) called ReadyDock:UV. It’s really quite neat.

    ATS makes a host of ReadyDock products for the entire range of Motion tablet PCs including the LE, C5, F5 and J3400. According to the company website:

    “ReadyDock:UV – Chemical-Free disinfection for the Motion C5 Tablet in 105 seconds Flat! The world’s first and only product offering automated general purpose disinfection for TabletPCs. Disinfect without the mess.

    ReadyDock™ products are used around the globe to support workflow and the overall management of tablet PC applications in hospitals, field service, and other applications that require charging, storage, and security of tablet PCs.”

  • BCMA Technology: Characterization of Med Triggers and Workarounds (Article)

    There’s an interesting article in the February 2011 issue of The Annals of Pharmacotherapy dealing with BCMA and what the author describes as “clinical workarounds”.1

    Abstract

    BACKGROUND: Bar code medication administration (BCMA) technology is gaining acceptance for its ability to prevent medication administration errors. However, studies suggest that improper use of BCMA technology can yield unsatisfactory error prevention and introduction of new potential medication errors.
    OBJECTIVE: To evaluate the incidence of high-alert medication BCMA triggers and alert types and discuss the type of nursing and pharmacy workarounds occurring with the use of BCMA technology and the electronic medication administration record (eMAR).
    METHODS: Medication scanning and override reports from January 1, 2008, through November 30, 2008, for all adult medical/surgical units were retrospectively evaluated for high-alert medication system triggers, alert types, and override reason documentation. An observational study of nursing workarounds on an adult medicine step-down unit was performed and an analysis of potential pharmacy workarounds affecting BCMA and the eMAR was also conducted.
    RESULTS: Seventeen percent of scanned medications triggered an error alert of which 55% were for high-alert medications. Insulin aspart, NPH insulin, hydromorphone, potassium chloride, and morphine were the top 5 high-alert medications that generated alert messages. Clinician override reasons for alerts were documented in only 23% of administrations. Observational studies assessing for nursing workarounds revealed a median of 3 clinician workarounds per administration. Specific nursing workarounds included a failure to scan medications/patient armband and scanning the bar code once the dosage has been removed from the unit-dose packaging. Analysis of pharmacy order entry process workarounds revealed the potential for missed doses, duplicate doses, and doses being scheduled at the wrong time.
    CONCLUSIONS: BCMA has the potential to prevent high-alert medication errors by alerting clinicians through alert messages. Nursing and pharmacy workarounds can limit the recognition of optimal safety outcomes and therefore workflow processes must be continually analyzed and restructured to yield the intended full benefits of BCMA technology.

    The study described in the article utilized a combination of retrospective analysis and direct observation to identify alert triggers generated by a BCMA system. In addition the study looked at various workarounds utilized by nursing as well as pharmacy. The article is a much more limited version of the one by Koppel in 2008.2

    The Annals article identifies some disturbing trends at the Medical University of South Carolina (MUSC) where the study took place. Examples include failure to document override reasons for 77% of alert messages and 468 directly observed workarounds during 121 administration attempts over a 6 hours period. Those number are a sure sign of a poorly designed system and lack of institutional oversight. It certainly has nothing to do with BCMA and the overall effectiveness of the technology. Sounds like some disciplinary action is in order.

    One other thing I found unusual in the article was the classification of pharmacy workarounds. “Specific pharmacy workarounds included duplicate orders, lack of medication order verification, medications within the incorrect section of the eMAR (prn vs standard administration time), and incorrectly timed medications causing administration too late/early for the nursing staff.” I’m not sure how you see this, but a duplicate order isn’t a workaround, it’s an order entry error. Same goes for entering an order as PRN instead of SCH. Not sure what the author had in mind when he made the decision to classify these as workarounds. Weird.

    1. Daniel F Miller, Christopher R Fortier, and Kelli L Garrison Bar Code Medication Administration Technology: Characterization of High-Alert Medication Triggers and Clinician Workarounds Articles Ahead of Print published on 1 February 2011, DOI 10.1345/aph.1P262. Ann Pharmacother ;45:162-168.
    2. Koppel R, Wetterneck T, Telles JL, et al. Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety. J Am Med Inform Assoc 2008;15:408-23.

  • Why not a computerized pharmacist?

    So IBW’s Watson recently competed and won ‘Jeopardy!”. Well, ‘Jeopardy!’ is a lot harder than verifying many medication orders routinely seen by pharmacists in the acute care setting.

    According to a recent article at Network World: “Watson’s ability to analyze the meaning and context of human language, and quickly process information to find precise answers, can assist decision makers such as physicians and nurses, unlock important knowledge and facts buried within huge volumes of information, and offer answers they may not have considered to help validate their own ideas or hypotheses, IBM stated.

    From IBM: “… a doctor considering a patient’s diagnosis could use Watson’s analytics technology, in conjunction with Nuance’s voice and clinical language understanding solutions, to rapidly consider all the related texts, reference materials, prior cases, and latest knowledge in journals and medical literature to gain evidence from many more potential sources than previously possible. This could help medical professionals confidently determine the most likely diagnosis and treatment options.””
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  • Practice Fusion EHR gets allergy alerts

    I am a fan of web-based healthcare applications, including EHRs. I especially like the web-based EHR available from Practice Fusion. The application is full featured, easy to use and free. I spent a little time playing with it back in June 2010. One of the things I noted during my review was that “there appears to be no cross checking between allergies and newly entered medications.” As a pharmacist this was pretty important. Well, I’m happy to say that allergy checking no longer appears to be an issue.

    EHR Bloggers: “We’re excited to bring you a major new feature for your EHR account today: drug-drug and drug-allergy interaction alerts. It’s a frequently requested enhancement and also a big step towards Meaningful Use. And, like all our features, this clinical decision support system (CDSS) is entirely free.

    Drug Interaction Alerts
    You will now be automatically alerted when a drug you are adding, prescribing or refilling interacts with another drug or with an allergy listed in the patient’s chart. The following video shows you how to set permissions, heed alerts and override alerts. “

    To gain access and begin using the Practice Fusion EHR simply sign up for a free account here. I would encourage any practitioner that needs a robust, easy to use EHR system to give Practice Fusion a look. It’s a solid application.

    I was going to try the new feature for myself, but forgot my credentials; how embarrassing.

  • “What’d I miss?” – Week of January 30, 2011

    As usual there were a lot of things that happened over the past week, and not all of it was related to pharmacy automation and technology. Here are some of the things I found interesting.
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  • Do smaller hospitals get the shaft when it comes to automation and technology?

    I’ve worked in several acute care hospitals during my career, from the small one horse operation that did little more than care for minor inconveniences, to larger, multi-pharmacy facilities that handled everything from pneumonia to severe trauma. As I’ve mentioned elsewhere on this blog each one of those pharmacies offered a slightly different way of doing things. Granted, some were variations on a similar approach, but they were all different.

    However, one trend I’ve discovered across the range of facilities is that the smaller the hospital, the less automation and technology the pharmacy has. Why? It’s quite simple. Automation and technology is expensive. It’s also time consuming to plan for, implement and maintain. Of course another argument is that smaller hospitals - and therefore smaller pharmacies – need fewer technological advances. That doesn’t make much sense to me. I agree that a small 50 bed hospital pharmacy may not need a giant robot to fill their med carts, but they can certainly benefit from clinical decision support, pharmacy surveillance software, bar code medication administration (BCMA), computerized provider order entry (CPOE), automated dispensing cabinets (ADCs), smartpumps, mobile devices, so on and so forth. The problem is that much of this technology is expensive and takes a sizable chunk out of smaller budgets.
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  • “What’d I miss?” – Week of January 9, 2011

    As usual there were a lot of things that happened during the week, and not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting.
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  • S.A.L.A.D.

    Sound-Alike, Look-Alike Drugs (SALAD) have recently floated to the top of my attention with the release of the Institute for Safe Medication Practices (ISMP) recommended list of Tall Man Letters for look-alike drugs. I mentioned the new list on Twitter which resulted in a short, but interesting conversation with some colleagues.

    SALADs have been problematic for quite some time and many solutions have been proposed, including Tall Man Lettering, physical separation of look-alike drugs, printing of both brand and generic names on packaging and storage bins, use of colorful warning labels, and so on and so forth. The problem with all these solutions is human involvement. Working in acute care pharmacy has taught me over and over again that all the above systems may decrease error, but certainly don’t eliminate them.
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  • Integration of medical device data into EMRs

    EMR Daily News: “Recording and charting changes in vital signs has been identified as one of the core areas that will be measured for meaningful use incentives. The new Intelligent Medical Devices HIMSS Analytics white paper, sponsored by Lantronix (NASDAQ: LTRX), and posted on the HIMSS Analytics website, details progress on these efforts. The research suggests that just one-third of hospitals in the HIMSS Analytics sample on medical device utilization indicated they had an active interface between medical devices at their organization and their electronic medical record (EMR).”
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  • Cool Technology for Pharmacy – Sproxil

    Counterfeit drugs are not only big business, they’re dangerous to consumers as well. Counterfeit medications have no quality assurance program, which means they can contain contaminants, sub-therapeutic levels of the active ingredient, the wrong active ingredient, or even no active ingredient at all. Thus they can cause more harm than good. While these medications can certainly cause problems here in the United States, it’s really the developing countries that are taking a beating.
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