NR360 Informatic Systems in Healthcare
rebcca 1
Group4.pptxComputerized Medication Dispensing System
Description of Technology
-Computerized Medication Dispensing Systems are medication dispensing systems that allows computer-controlled tracking, dispensing,and storage of pharmaceuticals at the point-of-care in patient care units (i.e. hospitals).
-This system is a recommendation to help improve the efficacy and safety of medication administration for patients in the hospital environment.
Brianna McKay: Computerized Medication dispensing systems are located in patient care hospitals, surgical suites, long-term care facilities, emergency rooms, physicians offices, etc. This type of medication dispensing system is very beneficial when workers are caring for more than one patient. This dispensing system helps to separate patients and limit the amount of errors that can occur when caring for several patients at once. There are several manufacturers that make their own form of computerized medication dispensing systems with the overall purpose and function being the same.
Purpose for Use in Healthcare
-Computerized medication dispensing systems are used to safely administer patients medications at the right time to the right patient.
-Computerized medication dispensing systems purpose is to decrease the risks of medication errors by all of the checkpoints and steps embedded into the dispensing systems to help ensure medications is being given safely and correctly.
Brianna McKay: This system has helped healthcare workers limit the amount of medication errors as a whole. This system comes in several forms and brands such as the pyxis, omnicell, capsa, etc. The medication dispensing system also serves a purpose as to tracking who is removing which medication at what time and date. This ensures that healthcare workers are doing their job diligently and honestly. Medication dispensing systems have definitely changed the healthcare environment as a whole due to the checkpoints created and the time/date stamps to ensure patients are receiving the best quality of care that can be provided by their caregivers.
Significant Findings That Promote Development
Conserves time
Provides secure medication storage for only authorized personnel use
Better medication tracking and monitor system
Reduces the amount of misunderstandings between the physician and nurse when completing a medication order
Reduces medication errors
Stephanie Montesino (Monty):Medical dispensing systems are efficient for not only for the use for nurses but for the patient as well to provide better care.The technology use for medical dispensing cuts down on written prescriptions and misunderstandings between the provider and staff. The computerized technology has advanced to online orders for easy access, clear typed orders, and multiple verification notices. According to Shoenfeld,”while automated medication dispensing systems are not the cure-all for what ails the hospitals, they do address many of the issues better driving medication management” (Shoenfeld, 2019).
History and current use of technology in healthcare
History
”The first pharmacy was established by King James 1 in the 17th Century” (proficientrx, 2018).
19th century- Physician prescribes and pharmacist’s compounds (medisca, n.d)
20th century- Compounding pharmacies diminish due to mass drug manufacturing (medisca, n.d)
Current use
1950’s -”the passing of the Durham-Humphrey Amendment to the Federal Food, Drug and Cosmetic Act, pharmacists were required to have a prescription from a physician” (proficientrx, 2018).
1980’s-Repacking of medications and creation of automated drug and supply cabinets/units
Stephanie Montesino (Monty):“While some accounts date back to the mid-1200s, physician dispensing as we know it now was introduced in the early 1980s” (proficientrx,2018).This is where the Medicare Prescription Drug Improvement and Modernization Act was placed for educating and consulting the patient about the medication. Today, “To be completely sure patients receive the best treatment and education, many physicians are choosing to dispense medications at the point of care. This is what is considered modern medical dispensing, says the author from proficientrx” (proficientrx, 2018).
Three goals of the technology implementation
Easy access of patient/medication information with the use of Pyxis an automatic medication dispensing system
Efficient work environment
Time saving tool -avoids redundant tasks
Stephanie Montesino (Monty):The use of technology helps gain better and easier access to information, instant messaging or changing orders, and time saving solution for medication dispensing. “The technology developments are also helping to improve work environments and lifestyles of people in the workplace, says Staff” (Staff,2020). It has been said in the advanced world health ,that the use of automated medication dispensing system such as Pyxis , the rates of medication errors reduced by 82%(2020). I can’t imagine if we didn’t have the technology we have today, it has tremendously helped improved human daily lives especially in the medical field.
Impact on professional nursing practice related to:
PATIENT SAFETY-
■It helps us to look for medication under each patient names. Also, we have access to the patient’s most current medication orders. It improves patient safety (Kornusky, 2019). In the hospital, it is organized by patient’s name, dosage, and time.
■Some of the high-risk medications or controlled substances/narcotics are locked in special cabinet that requires special lock to open. It reduce unauthorized access to the medication, and it reduce errors.
■It increases the speed of getting out medications. We could take out the right medications on the right time. It all improves patient outcome and safety.
Jaime Saji- Computerized medication dispensing system is very organized, which prevent making errors. Medication are organized into pouches by day and time of administration, and labels with patient’s name, it also includes medication name and dosage (Kornusky, 2019). Employs should get training before using Computerized medication dispensing system including the bad side of overriding medications. It all improve patient safety and reduce errors.
Impact on professional nursing practice related to:
QUALITY OF CARE MEASURES/MONITORING
-We could administer medication in a rapid speed especially urgent cases. We will also be able to manage time especially in a critical situation and for the sensitive treatment.
-The quality of care improved after using medication dispensing system, it improved patient’s medication adherence.
-The readily available medications can help with improving patient condition (Kornusky, 2019).
-It increased the speed, accuracy, and efficiency of care. It reduced the workload of the healthcare workers. It allows easy access to data and information at low cost (McGonigle & Mastrian, 2018).
Jaime Saji- It reduce problems with some patient’s such as with people taking multiple medications at the same time (Kornusky, 2019). Computerized medication dispensing system has reduced many errors that could have been taken place if used some other methods. People find it as easy to use, support in patient care, and improve patient outcomes.
Impact on professional nursing practice related to:
RISK MANAGEMENT
-CMDS helps with risk management by, it keeps a track of what medications are taken out of the machines and what medications are return to the machine. If some medications are taken out and do not administered to the patient/return to the machine, the individual who taken out the medication from the machine is responsible for the medicine.
-It helps to prevent loss of medication from floor stock, this system discourage sharing of the same prescription medication between patients. Also, it helps with secure storing of the medications (Kornusky, 2019).
-We need to count some of the medications each time we take out from the machine, because it will detect any loss of medication from the system.
Jaime Saji- It helps with administration of medication on correct time by provider flexibility to users to early dispensing of medications. It eliminates missed doses and incorrect dosage. It keeps a memory of all the activities (Kornusky, 2019).
Impact on professional nursing practice related to:
PRIVACY, CONFIDENTIALITY, AND SECURITY OF PATIENT DATA
-To get into the medication dispensing system, login and password/ fingerprints are required, which protect patient privacy and confidentiality. Only licensed nurses have access to the medication dispensing system (Kornusky, 2019).
-Electronic tracking of storage and dispensing of medications helps with security of patient data. Privacy and policies keeps the patient’s medical information secure.
Jaime Saji- The security of patient care protects from unauthorized usage of medication dispensing system (McGonigle & Mastrian, 2018). Always confirm medication including dosage, name, route and expiration date. Always follow six rights of medication administration.
Impact on professional nursing practice related to:
EFFECT ON POPULATION WITHIN THE REGION
Marisol Martinez:
Automated dispensing machines have increased within the market throughout the years. This chart shows the estimation of this device within the market over the next few years. As one can see, it is gradually increasing year after year in North America. This device is planned to replace other devices that have been outdated. The impact that these devices have on professional nursing practice is outstanding.
Impact on professional nursing practice related to:
Ethical Practice
-Nurses are involved in all stages in medication process. They are expected to improve and maintain the ethical and conducive environment that is safe and promote quality healthcare to patients (ANA, 2018).
-Medication process consists of five dynamic stages (Vito et al., 2017); 1. Prescribing
2. Transcribing
3. Dispensing
4. Compounding
5. Administering
Love Nzeadu:Collaboration and communication among healthcare providers, and lastly, the nurse and the patient. Computerized dispensing system surveillance the effects of the medication and alters the nurse when there is medication error. So computerized medication dispensing system helps the nurse maintain ethical safety of patients and workplace.
It has automated functionality that alerts nurses when there is medication error
It is the health information technology that promotes patient safety and quality outcome in nursing process.
It maintains four patient centered systems namely:
1. Clinical documentation system.
2. Pharmacy information system
3. Laboratory information system.
4. Radiology information system.
It helps the nurse to practice patient-centered care.
Impact on professional nursing practice related to:
COMPLIANCE WITH LEGAL AND REGULATORY MANDATES
-The Nurse is primarily committed to the patient weather individual, family, group, community or population. Healthcare does not justify unwarranted intrusion into a person’s life. The rights of privacy and confidentiality of patient health information must be protected. For example, Health Information Portability and Accountability Act must be observed to avoid lawsuits, lost of nursing license or termination of job.
Love Nzeadu: 1. Nurses must be knowledgeable about the privacy and security rules of patients.
2. They must comply to confidentiality and integrity of protected health information of patients.
3. It is mandatory to adhere to HIPPA which is a federal law and must not be breached.
4. Obtain patient consent is very important before disclosing health information.
5. As nurses use electronic communication or social media network, they must maintain data security of their patients 6. Nurses who protect the privacy and security of their patient’s health information protect themselves from ethical lapses (McGonigle & Mastrian, 2018).
Impact on professional nursing practice related to:
-Allows safe medication administration
-Reduces medication errors
-Higher medication availability
-Improves quality of care
-Enhanced monitoring of medications
Marisol Martinez:
The impact that these computerized medication administration systems have within the nursing profession is outstanding. These devices have helped nurses in a variety of ways to efficiently help with medication administration. This device allows for safe medication administration by giving nurses the exact medication needed for the patient and nothing more. It also allows for a higher mediation availability because pharmacists can come restock the device when viewing that it is low. This decreases the wait time for nurses because now they have the medication ready for administration. This improves the quality of care for the patient, example being, that if patient is in pain the nurse will just go to the pyxis and take out pain medication to administer it. Instead of waiting or pharmacy to drop it off. This device also enhances monitoring of medication being taken out. The nurse uses their fingerprint and password to receive medication for the patient in which means that they are constantly being monitored on what specific medication is being given as well as how much. This reduces the risk of an abundant amount of medication errors.
PATIENTS PERSPECTIVE
Advantages
-Medication errors decreased by 48% after dispensing machines implemented.
-Safety- Elderly and children dosing dispensing.
-Satisfaction= accurate, timely care
Disadvantages
-Unable to find medications. Missed or delayed doses
-Safety. Overrides may miss safety checks
Lura Lumsden
Advantages
According to Ahtiainen et al. (2020), when using a medication dispensing machine, errors in patient medication administration decreased by 48%. In healthcare, safety is the priority. Computerized dispensers can be programmed to verify dosage based on weight. This is especially important in the elderly and pediatric population. A component of patient satisfaction includes timely, safe, accurate care. Computerized medication dispensing machines help with these aspects and impact patient and family satisfaction.
Disadvantages
If there is a technical difficulty or an emergency, the nurse can override a medication allowing them to pull the medication from the machine without an order. Guardrails are programmed into the dispensing machine and can act as the five rights of medication. If any of these steps are overridden, the nurse risks patient safety. Sometimes medications are lost in transit between central pharmacy and the machines (Ahtiainen et al., 2020).
NURSES PERSPECTIVE
Improvements
-Most commonly prescribed medications stocked on the unit which saves time.
-Medication doses already drawn to correct doses.
Hindrance in Job Efficacy
- Streamlines documentation when integrated with electronic medical record.
-Learning curve to implement new processes.
Safety
-Patients and families do not have direct access to medications within the machines.
-The machine helps prevent overdose.
Lura Lumsden
Medication dispensing machines provide quick access to commonly prescribed medications. Medication administration data is analyzed to determine the most common prescriptions for each unit and these medications are stored directly on the unit. Dosages calculated by the pharmacist, are placed into the syringes already with the correct dose. This alleviates the nurses of having to find the supplies and draw up medications. All the nurse has to do is verify the dosage is correct and administer the medications. When the nurse scans a medication to administer, the machine may provide a warning for cumulative dose. The door will not open and liites the access to the medication until the nurse verifies the correct dosing order (Martinez, 2021).
Nurses feel that medication administration has streamlined with the documentation being linked to the emergency medical record. Change within a hopsital setting takes time and many people are resistant to change (Martinez, 2021).
From a safety aspect, the machines keep patients and families from having access to harmful medications. The computerized machines calculate cumulative dosages and alert the nurse when a cumulative dose has been reached. Sometimes the alert is a documentation error but it is the nurses responsibility to explore the alert (Martinez, 2021).
HEALTHCARE ORGANIZATIONS PERSPECTIVE
Regulatory
-DEA guidelines for controlled substances
=Unique login identifiers.
=Drug diversion monitoring within the hospital setting.
Compliance
-Taking medications as prescribed, checking interactions.
Financial
-more staffing needed to program, stock, and maintain medications.
-Stocking less medications in more locations throughout medical facilities.
-One machine costs approximately $85,153 USD
Lura Lumsden
Controlled substances are regulated within the hospital setting by following the Drug Enforcement Agency (DEA) guidelines. Access to controlled substances should be limited and computerized dispensing machines provide secure access. Unique identifiers and logins are used to provide access and each access is tracked and monitored within the hospital setting. According to the National Review (2021) drug diversion within the hospital setting has become an issue and many hospitals have departments dedicated directly to drug diversion among employees.
Medication compliance is defined at taking a medication as prescribed. Many drug dispensing machines are able to check for drug interactions and verify compatibility. This is something that should be completed by the pharmacist reviewing the order but the machine provides a second safeguard for medication error prevention (McGonigle & Mastrian, 2018).
When moving from a centralized pharmacy to decentralized medication dispensing machines throughout healthcare facilities, more staffing was needed to troubleshoot, stocks and maintain the computerized dispensing machines. This movement did not erase the centralized pharmacy, which is now used to verify, make, and disseminate medications throughout (McGonigle & Mastrian, 2018).
.
HOW MIGHT ISSUES SURROUNDING THE CHOSEN TECHNOLOGY BE ADDRESSED/SOLVED?
Faulty computer or typing errors can lead to medication error which may affect the safety of patient.
Health facilities must be equipped computer with appropriate software to enhance functioning of computer.
Healthcare managers encourage nurses and train their healthcare professionals to be competent in technology to prevent human. error.
Love Nzeadu: Acquisition of skills and change of attitudes will facilitate manipulation of hardware and software and computerizes medication dispensing system
Nurse must understand that the ethical practice of nursing care is the core value of nursing profession therefore must skillful in scientific and technological understanding to operate them effectively to improve care.
STATISTICAL DATA
This graph is statistical data showing the different between not using computerized medication administration (darker bar) and using these devices (lighter bar.) As one can see, by using these devices it has helped tremendously by reducing:
omission
wrong dose being given
wrong drug being administered
wrong time of administration.
Marisol Martinez:
Computerized medication administration systems have improved the healthcare system in both positive and negative ways. Computerized medication administration records decrease medication occurrences. Studies have shown that medication errors occur at a variety of healthcare facilities, but it has enhanced the communication between pharmacists and nurses (Wilson, 2017.) The more this device is being used, the greater the response is from those who use them. Nurses have stated that by using computerized medication administration systems have allowed them to administer medications faster and safer to the patient.
KEY POINTS
Supports medication management
Helps clinicians safely administer right medications
Efficiently dispense right medications at right time
Decreased medication errors
Frequent updates for better results
Marisol Martinez:
The computerized medication administration system is a device that has tremendously helped the healthcare community. This device has decreased the amount of medication errors throughout the years due to multiple checks between clinicians. Pharmacists bring the medication and dispense it into the device that counts as one check off. Next, nurses are the ones who administers this medication and once dispenses the second check off is done by them. Third check offs are done by getting another nurse to double check the first nurse. These devices have helped clinicians safely and efficiently administer medications by allowing medication to be close and ready to dispense. Frequent updates to these devices are constantly being done to improve the quality of the device. Science is constantly changing for the better and with this comes room for improvement.
DISCOVERIES/SURPRISES
1990 first device was made.
Fingerprint and password required to access the CMDS
Narcotics are kept separate from other medications.
A Medstation is approximately $85,153 USD
CMDS are made by Cardinal Health
Marisol Martinez:
This first ever computerized medication administration system was made in 1990 and it has only increased in efficiency ever since. This device has had modification after modification to allow clinicians to safely use it. Medications that are of higher risk are stocked away in different cabinets to isolate them from other medications. To keep these medications safe and secure, the only way healthcare provers can access these medications is through a fingerprint and password access. This is even before a medication will even be dispensed. This device is owned and made from Cardinal Health. Cardinal Health is a well named brand that makes a lot of the products in hospitals and healthcare facilities. A CMDS is approximately $85, 153 US dollars.
LESSONS LEARNED BY THE TEAM
-Computerized medication dispensing system is a very important part of the healthcare system. It improves the autonomy of the nurses.
-The quality of care has improved after the introduction of medication dispensing system. It improves the work environment.
-It reduces many of the human errors.
-It shows alerts, so it further helps to reduce errors.
Jaime Saji- The introduction of computer medication dispensing system has improved patient outcome. It helps to reduce errors.
HOW DID THE TEAM FUNCTION WELL? (STRENGTHS, BALANCE, ETC)
Thanks to technology, we were able to communicate quickly. Our parts were divided evenly and fairly.
Everyone was really understanding when I did not communicate for a few days leading up to a big exam for another class.
Brianna is a strong group leader and kept everyone on task.
We all chose assignments based on the strengths.
Speaker: Lura Lumsden
Thanks to technology, we were able to communicate quickly. Our parts were divided evenly and fairly.
Everyone was really understanding when I did not communicate for a few days leading up to a big exam for another class.
Brianna is a strong group leader and kept everyone on task.
We all chose assignments based on the strengths.
WHAT PROBLEMS DID THE TEAM HAVE INTERACTING AS A TEAM?
Team interaction during this RUA presentation has been well-regulated. Thanks to the use of technology, we were able to communicate via Canvas to formulate a group chat to assign tasks, discuss, and share ideas for this assignment. There has been no issues in communication, if someone had a concern or had questions regarding to the assignment, everyone has been quickly to respond for a solution.
Stephanie Montesino(Monty) Presenter slide
WHAT SPECIFIC ACTIONS WOULD YOU RECOMMEND TO FUTURE TEAMS?
I would personally recommend that the group of students assign a group leader who becomes a point of contact and then reaches out to everyone with valuable information such as:
-Perspective due date for the group
-Link to the slides so everyone has access
-Providing the topics that are taken and available
-GroupMe link and access
Brianna McKay
REFERENCES
Advancing the world of health - United States | BD. (n.d.). Advancing the World of Health - United States | BD. https://www.bd.com/en-us
Ahtiainen, H. K., Kallio, M. M., Airaksinen, M., & Holmström, A. R. (2020). Safety, time and cost evaluation of automated and semi-automated drug distribution systems in hospitals: a systematic review. European Journal of Hospital Pharmacy, 27(5), 253-262.
American Nurses Association (2018) Code of ethics for nurses with interpretive statements.
Automated dispensing machines market: Industry report, 2024. (2017). Retrieved April 10, 2021, from https://www.grandviewresearch.com/industry-analysis/automated-dispensing-machine-market
The National Review. (2021). DEA provides three exceptions to key regulations addressing the treatment of controlled substances at hospitals and clinics. https://www.natlawreview.com/article/dea-provides-three-exceptions-to-key-regulations-addressing-treatment-controlled.
Follow ISMP guidelines to safeguard the design and use of AUTOMATED DISPENSING CABINETS (ADCS). (2016, February 12). Retrieved April 06, 2021, from https://www.ismp.org/resources/follow-ismp-guidelines-safeguard-design-and-use-automated-dispensing-cabinets-adcs
Intrusion of the data snatchers. (2019, October 2). Healthcare Purchasing News. https://www.hpnonline.com/sourcing-logistics/article/21105912/intrusion-of-the-data-snatchers
Kornusky, J. (2019). Automated medication dispensing systems: Using. CINAHL Nursing Guide, pp. 1-5. https://eds-b-ebscohost-com.chamberlainuniversity.idm.oclc.org/eds/detail/detail?vid=3&sid=f88c5d31-57e5-466a-b19e-fb5ae39d05ba%40pdc-v-sessmgr02&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#db=nup&AN=T922691
Martinez, A. (2021, April 4). Personal interview [Personal interview].
References
McGonigle, D. & Mastrian, K. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Jones & Bartlett.
Pharmacy compounding: History and evolution. (n.d.). MEDISCA. https://www.medisca.com/compounding/history-and-evolution
Shoenfled, B. (2019, November 27). Automated medication dispensing systems: The cure for what ails hospitals? Talon - Medication Delivery Carts and Cabinets. https://www.taloncontrols.com/blog/automated-medication-dispensing-systems-the-cure-for-what-ails-hospitals/
Staff, A. (2020, May 28). 10+ important advantages of technology on personal, work & social life. Advergize. https://www.advergize.com/edu/advantages-technology-modern-life/#1_Ease_of_Access_to_Information
The history of medical dispensing & modern techniques - ProRx. (2020, May 7). ProficientRX. https://proficientrx.com/history-medical-dispensing/
Vito, R., Bobrick, E., Kashmiri, A., Schneider, T. (2017) The impact of computerized provider order entry on nursing practice. Journal of Studies of Health Technology and Informatics. 2017, March 1. p 364- 371
Wilson AL; Hill JJ; Wilson RG; Nipper K; Kwon IW. (2017). Computerized medication administration records decrease medication occurrences. Retrieved April 10, 2021, from https://pubmed.ncbi.nlm.nih.gov/10166241/
