Preventing Medication Errors With Technology Part 2.pdf

Running head: PREVENTING MEDICATION ERRORS 2 1

Preventing Medication Errors With Technology: Part 2

Rita Summerlin

Liberty University

NURS 521-B03: Nursing Issue, Informatics and Technology

Dr. Rose Linsky

February 27, 2020

PREVENTING MEDICATION ERRORS 2 2

Preventing Medication Errors With Technology: Part 2

Medication errors, also called adverse drug events (ADEs),can be devastating to the nurse

who administers the wrong medication or the wrong dose of medication. Harmful effects or even

death can be caused by medication errors. One-third of ADEs occur when being prescribed and

another one-third occur when being administered according to a study done by Truitt, Thompson,

Blazey-Martin, NiSai, and Salem (2016). Although the majority of healthcare providers already

use electronic health records (EHRs) or electronic medical records (EMRs), some may or may

not include an electronic medication administration records (eMAR). When the right measures

are used, medication errors are preventable (Bogner, 2018). This paper discusses the

Medication administration errors are usually be caused by human error and is where the

intervention is most likely to have an effect and the PSQRD supports this (Dykes & Schnock,

Since the decision has been made to launch a new EHR with BCMA, a go-live plan will

be made. Each planned activity for go-live will be assigned to a specific team or individual

(Meyer, 2018). Critical task such as cross-checking patient census between the old and new

EHRs, loading diagnostic test results and medications from the past few days to the new EHR,

and confirming that all patient orders are in the new EHR (Meyer, 2018). Education and training

PREVENTING MEDICATION ERRORS 2 3

of the new EHR will be conducted by the vendor consultants with the assistance of the hospital

Training and Development department. Different training guides will be developed for all the

disciplines. Some disciplines will required only 2-3 hours of classroom education and nurses will

need 6-8 hours, if not more (Meyer, 2018).

The big bang approach will be used for go-live. This approach is where everything with

the new EHR is implemented all at once (Meyer, 2018). The big bang approach is all less

expensive and time for implementation is shorter (Meyer, 2018). The shorter implementation

time allows for staff to return to normal quicker (Meyer, 2018). On-site support personnel and

vendor consultants will also be available for the initial days of go-live with this approach

and informatics.

Patient-centered care is a relationship between healthcare providers and the patient where

the patient is considered a member of the healthcare team as well as being the center of care

(Okun & Caligtan, 2018). Evidence-based practice is the incorporation of the highest standard of

care (SOC) through research, clinical expertise, and patient/family preference (Sherwood &

Zomorodi, 2014). Electronic health records with eMARs and bar coding medication

administration (BCMA) are the highest SOC for medication administration according to EBP.

PREVENTING MEDICATION ERRORS 2 4

Quality improvement and safety are ongoing in all healthcare settings according to Risor,

Lisby, & Sorensen (2018). Better health information management and improved data integrity is

how quality improvement is related to EHR technology (Seckman, 2018). Mekonnen et al (2018)

states that BCMA implementation may reduce medication administration errors. The facility

where I work has an EHR with an eMAR system built in. However, the nurse has to pull the

medication from an Omnicell (automatic dispensing cabinet) and take the medication to the

patient’s room and administer the medication. Then the nurse goes back to the nurses’ station and

opens the eMAR and clicks on the medication given to document the administration. Medication

administration safety has been shown to improve by use of an eMAR and BCMA combined

engaged with digital tools and information systems in clinical practice as a foundation for

evidence-based care, decision support, and EHR. McGonigle & Mastrian (2018) says that nurses

must not only be able to perform their duties as a nurse physically, cognitively, and emotionally;

they must also have the technological skills to manage technological equipment.

Communication is key to collaboration and teamwork in the healthcare field. The

patient/family should also be included in the collaboration of their care as an active participant of

the healthcare team (Sherwood & Zomorodi, 2014). Communication is an essential component

of the EHR and is a medium between healthcare providers and patients (Seckman, 2018). Email,

PREVENTING MEDICATION ERRORS 2 5

mobile devices, texting, telemedicine, and integrated health records are all examples of ways to

communicate in the healthcare field (Seckman, 2018).

Health Information Technology Policies

In 2004, Executive Order 13335 was signed into law by President Bush which gave

healthcare providers incentives to implement and use health information technology (HIT) in the

form of EHRs/EMRs (Madison, 2018). This initiative has eight key components, two of which

involve medication errors: 1) improve healthcare quality, decrease medication errors, and

advanced delivery of appropriate evidence-based medical care; and 2) decrease healthcare costs

resulting from inefficiency, medication errors, inappropriate care, and incomplete information

In 1982, Mark Siegler stated that confidentiality was already a “decrepit concept”.

Somewhere between 25-100 healthcare workers and administrative personnel accessed patient

records in the hospital according to Siegler (1982). With EHR use far more information can be

stored and accessed by substantially more personnel. The effect on quality of care through EHR

use still remains unclear although this technology has been used for many years (Campanella et

al., 2016). Although patient satisfaction has not been negatively affected by EHR use, the

patient-doctor relationship and EHR use needs more research (Moerenbout et al., 2020). The

EHR is a “medicine with side effects” according to primary care physicians (PCPs) in a study

PREVENTING MEDICATION ERRORS 2 6

done by Moerenbout et al (2020). Although everything is in real-time in EHRs, one side effect is

that time with the patient is taken away (Moerenbout et al, 2020). This study also implicated

ethical questions related to autonomy and trust. For example, the EHR allows patients to see

laboratory results before the PCP has a chance to review them at times. Then the patient calls the

PCP freaking out because they have looked up the results on the internet and have found disease

possibilities. Sometimes patients also give different medical and social histories to different

physicians and the current/consulting physician does not know whether to believe the patient or

the patient records they have received from other physicians. Patients may also believe that

anyone can see their medical information if it is in an EHR because it is on a computer.

billion yearly. Medication administration errors have been reduced by 49% to 51% by

implementing BCMA according to some studies (Larson & Lo, 2019). Annual savings of $2.2

million from time-saving have been generated by implementing BCMA per research (Larson &

Lo, 2019).

Medication administration errors are a huge financial burden in healthcare. Studies have

shown that nursing informatics integrates nursing science, computer science, and nursing

knowledge to facilitate BCMA implementation. Patient safety has been improved and medication

PREVENTING MEDICATION ERRORS 2 7

administration errors have been reduced with the implementation of BCMA. Costs savings

through being able to control stock and waste reduction have been decreased with BCMA

implementation because medication administration errors have been reduced.

PREVENTING MEDICATION ERRORS 2 8

Campanella, P., Lovato, E., Marone, C., Fallacara, L., Mancuso, A., Ricciardi, W., & Specchia,

M. L. (2016). The impact of electronic health records on healthcare quality: A systematic

review and meta-analysis. European Journal of Public Health, 26, 60–64.

http://dx.doi.org/10.1093/eurpub/ckv122.

Gann, M. (2015). How informatics nurses use bar code technology to reduce medication errors.

Nursing, 45(3), 60–66. http://dx.doi.org/10.1097/01.NURSE.0000458923.18468.37.

Larson, K. & Lo, C. (2019). Potential cost savings and reduction of medication errors due to

implementation of computerized provider order entry and bar-coded medication

http://dx.doi.org/10.1016/j.jbi.2015.07.012.

Madison, M. P. (2018). The health information technology for education and clinical health act,

meaningful use, and Medicare access and CHIP Reauthorization Act of 2015. In R.

Nelson & N. Staggers (Eds.), Health informatics: An interprofessional approach. (2nd

ed., pp. 455–473). St Louis, MO: Elsevier.

Manias, E., Kinney, S., & Williams, A. (2014). Medication errors in hospitalized children.

Journal of Paediatrics and Child Health, 50(1), 71–77. Retrieved from:

https://doi.org/10.1111/jpc.12412.

PREVENTING MEDICATION ERRORS 2 9

Manos, E. L., Connors, H. B., Warren, J. J., & Stenner, T. (2018). Informatics in the curriculum

for healthcare professionals. In R. Nelson & N. Staggers (Eds.), Health informatics: An

interprofessional approach (2nd ed., pp. 499–515). St Louis, MO: Elsevier.

McGonigle, D.& Mastrian, K. G. (Eds.). (2018). Nursing Informatics and the Foundation of

Knowledge. (4th ed.). Burlington, MA: Jones & Bartlett Learning.

Mekonnen, A. B., McLachlan, A. J., & Brien, J. A. E. (2016). Pharmacy-led medication

reconciliation programs at hospital transitions: A systematic review and meta-analysis.

Journal of Clinical Pharmacy and Therapeutics, 41(2), 128–144.

DOI:10.1111/jcpt.12364.

Rahurkar, S., Vest, J. R., & Menachemi, N. (2015). Despite the spread of health information

exchange, there is little evidence of its impact on cost, use, and quality of care. Health

Affects, 34(3), 477–483.

doi:http://dx.doi.org.ezproxy.liberty.edu/10.1377/hlthaff.2014.0729.

Risor, B. W., Lisby, M., & Sorensen, J. (2018). Complex automated medication systems reduce

medication administration error in a Danish acute medical unit. International Journal for

Quality in Health Care, 30(6), 457–465. http://dx.doi.org/10/1093/omtqjc/mzy042.