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Procedia Computer Science 37 ( 2014 ) 434 – 438

1877-0509 © 2014 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/). Peer-review under responsibility of the Program Chairs of EUSPN-2014 and ICTH 2014. doi: 10.1016/j.procs.2014.08.065

ScienceDirect Available online at www.sciencedirect.com

International Workshop on Intelligent Technologies for HealthCare (ITCare-14)

NFC-Based Framework for Checking the Five Rights of Medication Administration

Maali Alabdulhafith*, Srinivas Sampalli Faculty of Computer Science, Dalhousie Univerity, 6050 University Avenue, Halifax NS B3H 4R2, Canada

Abstract

Medication errors that occur during the medication administration stage are a serious issue in healthcare. The most common types of errors in this stage are wrong patient, wrong medication, wrong time, wrong dose, and wrong route. In this paper, we propose a solution that uses NFC technology to help nurses provide the right patient with the right medication in the right dose at the right time and via the right route during the medication administration stage. © 2014 The Authors. Published by Elsevier B.V. Peer-review under responsibility of the Program Chairs of ICTH-2014. Keywords: NFC; Medication Errors; Five Rights; Medication Administration.

1. Introduction

In the healthcare domain, medication errors are a serious issue that leads to significant clinical consequences [1]. An estimated 70,000 preventable medication errors occur in Canada annually, causing up to 23,750 deaths [2] and making them the third leading cause of death after cancer and heart disease. Medication errors can occur either in the prescribing stage, the dispensing stage, or the administration stage [3][4]. Studies have shown that the percentage of medication errors is highest in the administration stage, reaching up to 61% [5]. Other studies stated that one out of every three Adverse Drug Events (ADEs) was caused by medication errors initiated by nurses [6].

The most common types of errors resulting in patient deaths involved errors around dose, medication, and route. Research showed that 40.9% of medication errors involved wrong dosages, while 16% resulted from giving the wrong medication and 9.5% from using the wrong route [3]. Other research showed that 60% of medication errors are caused mainly from medications being administered at the wrong time, through the wrong route, and in the wrong dose [7]. Another study found that wrong medication is the most common type of medication error [8].

Recently, several wireless technology applications have been developed to prevent medication errors. For example, barcode systems have been deployed in hospitals to help nurses during the medication administration

* Corresponding author. E-mail address: [email protected]

© 2014 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/). Peer-review under responsibility of the Program Chairs of EUSPN-2014 and ICTH 2014.

435 Maali Alabdulhafi th and Srinivas Sampalli / Procedia Computer Science 37 ( 2014 ) 434 – 438

process to check the five “rights” of medication administration, which are: right patient, right medication, right time, right dose and right route. Although barcode systems are intended to enhance medication safety, there are some difficulties associated with using them. A study on how barcode systems are used in hospitals [9] showed that the main sources of difficulty with using the barcode system are malfunctioning scanners and failing batteries, and that medication barcodes can be unreadable when they are damaged (e.g. wrinkled, smudged, ripped, or covered). Furthermore, because barcode systems are integrated with computers on carts, it is challenging for a nurse to move from one room to another, especially when the structure of the room impedes bedside access. However, separating the barcode scanner from the computer could hinder the nurse from hearing or seeing alerts [9]. From this information, it is clear that the issues associated with the use of the barcode systems need to be resolved.

We propose a solution that uses Near Field Communication (NFC) to overcome barcode systems difficulties and help nurses check the five “rights”. NFC is a short-range radio communication technology that uses NFC-enabled smartphones as readers and silicon tags. Simply put: the NFC system is a 3-in-1 innovation that replaces the barcode scanner, computer, and cart with a smartphone. The phone works as a reader and interface to the system, can easily be carried from room to room, and delivers real-time alerts. Moreover, the silicon tags are much more reliable than printed barcodes, as they do not get easily damaged and can be read when covered.

2. Proposed System Design

We propose a system design for an NFC-enabled smartphone application for checking the five rights of medication administration. The end users of the application are nurses, physicians, and pharmacists, but the system is intended for use in hospitals, especially in patients’ rooms.

2.1. Main components of the system

The system involves the following:

• Hospital Database (HDB): The hospital database works as a trusted source for providing the required data we need to check the five rights. It has: 1) the patient’s personal and clinical information, including his/her prescribed medication; 2) the medication information that is provided from the manufacturer; 3) drug-drug interaction information; and 4) information about who is treating the patient (i.e., who gave the patient his/her last medication).

• Tagged Medication: Each prescribed medication will be tagged with an NFC tag that has a unique ID. This ID has corresponding information in the hospital database. The NFC tag will be used to accurately identify the medication that the patient needs (i.e., prescribed medication).

• Tagged Patient: Every admitted patient will be wearing an NFC tag bracelet that has a unique ID. This ID has corresponding information in the hospital database. The NFC tag will be used to accurately identify the patient.

• Treatment Team: The treatment team includes physicians, nurses, and pharmacists who are the end users for the smartphone application.

• Smartphone: The nurses will carry an NFC-enabled smartphone such as an Android. This type of smartphone will act as an NFC reader to read the patient’s and medication’s tags to check the five rights. The physicians and the pharmacists will carry smartphones, but not necessarily NFC-enabled ones.

• Smartphone Application: The smartphone application will be installed on the treatment team’s smartphones. Each member of the treatment team will have to log in to the application. The nurses will have an interface that allows them to check the five rights and alert physicians/pharmacists if there is a potential medication error. The physicians and the pharmacists will have a different interface that allows them to receive an alert from the nurses and take an action if there is any potential medication error.

436 Maali Alabdulhafi th and Srinivas Sampalli / Procedia Computer Science 37 ( 2014 ) 434 – 438

2.2. The Operation Phases

The system works in two main phases: the log-in phase, and the checking-the-five-rights phase.

2.2.1. Log-in phase

In the first step, the treatment team has to log into the application using their username and password. See Fig. 1(a). Depending on their log-in information, they will have different interfaces. For example, if a nurse logs into the application, her/his log-in information (username and password) will be sent to the database; then, the database will communicate with the smartphone application to let the nurse access the appropriate interface.

2.2.2. Checking the five rights phase:

This phase has two steps, which are: 1) reading tags and 2) checking the five rights. In the first step, the nurse will use her NFC-enabled smartphone to read the prescribed medication tag and the patient’s tag. It is a one-time reading that will allow the nurse to check the five rights. The application will store the tags’ IDs, send them to the HDB, and retrieve the necessary data. See Fig. 1 (b).

In the second step, the smartphone application will communicate with the database to check the five rights. It will check for the following: • Right Patient: To ensure that the nurse is giving the medication to the right patient, the application will check if

the name and Medical Record Number (MRN) on the patient’s tag matches the name and MRN on the prescribed medication tag. If the names match, then the application will proceed to check the second right; if they do not match, the application will alert the nurse.

• Right Medication: To ensure that the nurse is giving the patient the right medication, the application will compare the medication that the nurse carries with the prescribed medication for the patient in the HDB. If they match, then the application will check whether the patient is allergic to this medication. It also checks if this medication may cause drug interactions. In case the patient is allergic to the medication or the medication may cause drugs interactions, the application will alert the nurse and provide him/her with an option to alert the physician who prescribed the drug and the pharmacist who dispensed it. See Fig 2. If there was no problem with the medication, the application will proceed to check the third right.

Fig 1. (a) Log-in phase; (b) reading tag phase and retrieving data from the HDB.

(a) (b)

437 Maali Alabdulhafi th and Srinivas Sampalli / Procedia Computer Science 37 ( 2014 ) 434 – 438

• Right Time: To ensure that the nurse is giving the patient the medication at the right time, the application will check to see if this medication was taken before, and if so, when. It will also check when the physician says the medication should be given and compare it with the recommended time from the manufacturer. If they do not match, the application will alert the nurse and provide him/her with an option to alert the physician and the pharmacist. If there was no problem with the time, the application will proceed to check the fourth right.

• Right Dose: To ensure that the nurse is giving the patient the right dose of medication, the application will check the ordered dose, the recommended dose, and the present medication dose. If there is any mismatch, the application will alert the nurse and provide him/her with an option to alert the physician and the pharmacist. If there was no problem with the dose, the application will proceed to check the fifth right.

• Right Route: To ensure that the nurse is giving the patient the medication via the right route, the application will check the route in the medication order and the route recommended by the manufacturer. If they do not match, the application will alert the nurse and also provide an option to send an alert to the physician and the pharmacist. If they match, the application will notify the nurse that the five checks are successfully completed and she can proceed with medicating the patient.

Conclusion

In this paper, we proposed a solution that uses NFC technology to prevent five types of medication errors (wrong patient, wrong medication, wrong time, wrong dose, and wrong route) from occurring. If there is any possibility that these errors might happen, the smartphone application alerts the nurse prior to administering the medication to the patient. The application also provides the nurse with an option that allows him or her to alert the physician who prescribed the medication and the pharmacist who dispensed it. In the next stage of our work, we will implement and test the proposed system in a real-world scenario.

Acknowledgements

This work has been funded by Princess Nora bint Abdulrahman University in Saudi Arabia, with the support of the Saudi Cultural Bureau in Canada. The authors appreciate and acknowledge the support given by these organizations.

Fig 2. Sending alert message to the nurse, physician, and pharmacist.

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