Transcript Work Arounds and Medication Safety

Innovation Poster Session
HRT1215 – Innovation Awards
Sydney
11th and 12th Oct 2012
Do Electronic Medication Systems Impact
Patient Safety: What do the Frontline
Clinicians Think?
Debono, D.1, Greenfield, D.1, Black, D.2, Braithwaite, J.1
1 Centre
for Clinical Governance Research, Australian Institute of Health Innovation, University of
New South Wales
2 Faculty of Health Sciences, University of Sydney
4-4d_HRT1215-Session_DEBONO_UNSW_NSW
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KEY PROBLEM
Medication Error
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Key cause of iatrogenic harm
Exact measurement of the incidence of medication errors is difficult
17 percent of adverse events recorded in Australian hospitals1
Estimated to occur at a rate of one per day per patient in US hospitals2
Causes include:
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illegibility of prescription and improper use of abbreviations
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poor mathematical skills
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insufficient knowledge of or access to information about medications
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distractions and interruptions
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nurse fatigue and stress3
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violations4
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PROPOSED SOLUTION
Electronic Medication Management Systems (EMMS)
Different types of EMMS
 Electronic Medication Administration Record (EMAR)
 Computerized Physician Order Entry (CPOE)
 Bar Code Medication Administration Systems (BCMA)
 Electronic Medication Management Assistant (EMMA)
Aims
 To standardise practice
 Structure medication related tasks
 Provide information support
 Improve legibility of orders
Research
 Studies identify unintended consequences of the implementation of
technology in practice5 and resistance to technology implementation6
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AIMS
To examine
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What nurses perceive are barriers to using EMMS
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Nurses’ perceptions of the effects of the EMMS on
quality and safety
This presentation reports on one component of a larger
study that examines how nurses use EMMS in everyday
practice
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METHOD
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The broader study utilised a qualitative multi-method
approach employing document analysis, observation, process
mapping, individual and focus group interviews
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This presentation reports the preliminary results emerging
from interviews and focus groups undertaken 2011-2012
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Participants were nurses from six wards across two Sydney
hospitals using two different types of EMMS
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Data analysis is an ongoing iterative process using content
and thematic analysis
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EMERGING THEMES
Nurses identified barriers when using the EMMS
 The mobile computers (COWs) are cumbersome
 Black spots in which there is limited or no connectivity
 Crowding in medication rooms due to number of nurses
and size of COWs
 Battery life issues decreasing mobility of the COWs
 Contradiction between policies (e.g. infectious rooms)
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Workarounds were employed to circumvent some of the
perceived barriers
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EMERGING THEMES
Nurses believed that EMMS had improved quality and safety
Common to both types of EMMS
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Improvement in legibility of orders
Point of care access to information resources e.g. MIMs,
test results, instructions from pharmacists
Transparency and auditability
Visual notification when medications are late
Forcing functions
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CONCLUSIONS
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Nurses identified perceived barriers related to using
EMMS and employed workarounds to circumvent
some of these barriers
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Nurses perceived that EMMS had improved quality and
safety through improving information accessibility,
legibility of orders and enhancing transparency and
accountability
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Other research provides quantitative support for
nurses’ perceptions that EMMS improves quality and
safety7
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ACKNOWLEDGEMENTS
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The exceptional nurses who so generously participated in
this study
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The Information Systems teams who also generously
gave their time and expertise
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The Funding Body: The NH&MRC Patient Safety
Program Grant
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REFERENCES
1.
WILSON, R. M., RUNCIMAN, W. B., GIBBERD, R. W., HARRISON, B. T., NEWBY, L. & HAMILTON, J. D.
(1995) The quality of Australian health care study. The Medical Journal of Australia, 163, 458-471.
2.
THE INSTITUTE OF MEDICINE COMMITTEE ON IDENTIFYING AND PREVENTING MEDICATION ERRORS
(2007) Preventing Medication Errors, Washington DC, The National Acadamies Press.
3.
AMPT, A. & WESTBROOK, J. I. (2007) Measuring nurses' time in medication related tasks prior to the
implementation of an electronic medication management system. Studies in Health Technology &
Informatics, 130, 157-67.
4.
FOGARTY, G. J. & MCKEON, C. M. (2006) Patient safety during medication administration: the
influence of organizational and individual variables on unsafe work practices and medication errors.
Ergonomics, 49, 444-56.
5.
ASH, J. S., BERG, M. & COIERA, E. (2004) Some unintended consequences of information technology
in health care: the nature of patient care information system-related errors. Journal of the American
Medical Informatics Association, 11, 104-12.
6.
TIMMONS, S. (2003) Nurses resisting information technology. Nursing Inquiry, 10: 257–269.
7.
WESTBROOK JI, RECKMANN M, et al. (2012) Effects of Two Commercial Electronic Prescribing
Systems on Prescribing Error Rates in Hospital In-Patients: A Before and After Study. PLoS Med 9(1):
e1001164. doi:10.1371/journal.pmed.1001164
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Deborah Debono
[email protected]
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