Running head: NURSING INFORMATICS 1
Nursing Informatics and Medication Error Prevention
Jonnie Glover
Liberty University
Nursing Informatics and Medication Error Prevention
NURSNING INFORMATICS 2
Nursing informatics allows science, technology, information, and medicine to come
together for the purpose of supporting nursing practice. Informatics is widely used in many areas
to improve healthcare delivery, patient outcomes, and most importantly, patient safety. To reduce
the risk of further harm and/or injury to patient(s), this organization will be adopting a new
electronic health record (EHR) to utilize while providing patient care. This paper will outline the
framework used as the foundation for the new project as well as explain the important role
informatic nurse(s) play in its development.
Patient Safety
According to The Joint Commission (2018), medication errors are among the top ten
sentinel events in the nation with 32 having been reported in 2017. These sentinel events ranged
from: need for additional care/monitoring, psychological impact, permanent/severe/temporary
harm, and/or patient death. Patient safety can be best defined as “freedom from accidental injury
due to medical care, or medical errors” (Nelson & Staggers, 2018, p. 409). By adopting health
information technology (e.g. electronic health record [EHR]), organizations can achieve high-
quality, effective, and safe patient care in addition by improving communication and reducing
errors (Nelson & Staggers, 2018).
Intervention
Conceptual Framework
The foundation for this intervention is based on the work of Avedis Donabedian.
Donabedian established a framework for determining quality based on structure, processes, and
their association to patient outcomes (Nelson & Staggers, 2018). The Donabedian Model is
offered as a way of delivering structures and processes for teamwork in the healthcare setting
(McKay & Wieck, 2014). Donabedian’s model offers a foundation for the framework that is used
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to evaluate patient safety and quality research design (PSQRD). Health information technology
(IT) tools not widely adopted and used will have a limited effect on patient outcomes. For health
IT intervention, the framework provides a way to classify interventions according to areas
targeted (e.g., the structure, the management/clinical process, and the patient outcome) (Nelson
& Staggers, 2018). The PSQRD framework is appropriate for assessing the outcomes of health
IT interventions on patient safety and quality, and whether or not it was successful. Within the
framework, quality and safety issues are not mutually exclusive entities but exist on a “vector of
egregiousness” (Nelson & Staggers, 2018, p. 413). Quality is at one end, which represents events
with lower levels of proximity, and causality and patient safety are at the other end, involving
more immediate events with high levels of causation. Using this model as a framework, serious
medication errors would be higher on the vector, as they may transpire due to poor adherence to
the “five rights” of medication safety (patient, time, drug, dose, and route) (Nelson & Staggers,
2018, p. 413). Medication errors are high on the vector (toward safety) because these errors are
preventable and have the potential to cause immediate and/or significant patient harm.
Medication Safety Practices
Bar Code Medication Administration (BCMA) and Electronic Medication Administration
Record (eMAR) systems have been implemented in many hospitals to enhance patient safety and
modernize clinical workflow, particularly with improving processes at the point of care. These
systems can guarantee compliance with documentation of drug administration in real time, and
barcode labels placed on medications and patient wristbands. BCMA and eMAR systems can be
effective when executed and used properly. One study found that “bar coding technology led to a
74% reduction in the administration of wrong medications, a 57% reduction in errors caused by
the administration of incorrect doses, a 91% reduction in wrong patient errors, and a 92%
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reduction in wrong time errors” (Keane, 2014, p. 10). One potential problem with this system is
that nurses may bypass the scanning to reduce workload and/or prevent the delay of medication
administration (Nelson & Staggers, 2018; Staggers, Iribarren, Guo, & Weir, 2015). A study was
conducted at a children’s hospital to reduce immunization errors by using age-specific alerts
within the electronic medical record (EMR). This quality improvement project decreased the
number of vaccine-related errors by implementing age-appropriate immunization warnings in the
EMR as well as mandatory education for prescribers (Rogers, Sebastian, Cotton, Pippin, &
Merandi, 2016).
An alternative medication system that functions at the point of care is a “smart infusion
pump.” Smart infusion pumps, or smart pumps, are designed to reduce medication errors by
decreasing the rate of intravenous (IV) medication errors (Nelson & Staggers, 2018). Smart
pumps possess a pre-encoded medication library with “dose limit alerts and audio/ visual
feedback to users regarding entries programmed beyond predetermined dose, concentration, and
duration thresholds” (Nelson & Staggers, 2018, p. 414). A hospital in Canada implemented a
drug error reduction software (DERS) to reduce drug errors. The DERS prevents extreme bolus
doses, and inappropriate IV medication administration. After receiving feedback along with close
monitoring, it was noted that within the first five hours there was 100% compliance (Boshart,
Rottar, Grin, & Bunston, 2016).
Nursing Informatics
Nationwide, BCMA systems continue to grow and expand. If the current movement
continues, there will be a requirement to have a BCMA coordinator in every hospital in the
nation. The best candidate for the role is a nurse—with a focus on patient safety, team-based
attitude, critical thinking, advanced informatics skills, and a work ethic devoted to quality and
NURSNING INFORMATICS 5
positive patient outcomes (Gann, 2015). Smaller hospitals, possibly due to budgetary reasons,
could choose to merge the BCMA coordinator responsibilities with another position (such as:
informatics support, patient safety manager, or performance improvement coordinator).
Christian Worldview
Healthcare facilities are encouraged to operate more proficiently and effectively to reduce
cost and maintain high standards of safe patient care and quality. Nurses, at the forefront of the
healthcare field, are in charge of delivering safe and patient-centered care. Christian nurses can
look to Christ to understand total and whole person care. Jesus was a true total person healer who
focused on the needs of those needing to be healed—physically and spiritually (Murphy &
Walker, 2013). In Luke 5:17–26, Christ healed the lame man not only physically, but spiritually
(New International Version). Nurses with a foundation in Christianity strive to live a Christ-like
life, treating others as Christ would (John 13:34-35). These nurses strive to think and act like
Christ because the Holy Spirit of God lives within them (John 14:16-17; 1 Corinthians 3:16, New
International Version).
Conclusion
Medication errors continue to occur and will continue to do so if action is not taken. By
moving forward, healthcare organizations and facilities must try to meet and surpass patient
expectations of safety and quality through the adoption and use of health IT. Adoption of this
framework will allow for implementation and use of health IT intervention(s), and ultimately
patient outcomes, particularly as it pertains to the reduction of medication administration errors.
References
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Boshart, T., Rottar, C., Grin, S., & Bunston, G. (2016). DERS - What is it good for? Vascular
Access, 10(2), 8.
Gann, M. (2015). How informatics nurses use bar code technology to reduce medication
errors. Nursing, 45(3), 60-66. doi:10.1097/01.NURSE.0000458923.18468.37
Keane, K. (2014). Reducing medication errors by educating nurses on bar code technology.
MEDSURG Nursing, 23(5), 1-11.
McKay, C., & Wieck, K. L. (2014). Evaluation of a collaborative care model for hospitalized
patients. Nursing Economic$, 32(5), 248-267.
Murphy, L. S., & Walker, M. S. (2013). Spirit-guided care: Christian nursing for the whole
person. Journal of Christian Nursing: A Quarterly Publication Of Nurses Christian
Fellowship, 30(3), 144-152.
Nelson, R., & Staggers, N. (2018). Health informatics: An interprofessional approach (2nd ed.).
St. Louis, MO: Mosby.
Rogers, J., Sebastian, S., Cotton, W., Pippin, C., & Merandi, J. (2016). Reduction of
immunization errors through practitioner education and addition of age-specific alerts in
the electronic prescribing system. American Journal of Health-System Pharmacy, 73(3),
S74-S79. doi:10.2146/ajhp150311
Staggers, N., Iribarren, S., Guo, J., & Weir, C. (2015). Evaluation of a BCMA’s electronic
medication administration record. Western Journal of Nursing Research, 37(7), 899-921.
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