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Course Description: The course deals with the prevention of medication errors as part of medical errors. Describe how you can Improve patient safety through the various procedures, protocols and policies that impact patients. Course Time: About thirty hours for online study, test taking with course evaluation feedback and certificate printing.
Preventing Medical Errors: An epidemic of errors, where do they occur, their costs, associated fears, the system problem. Improving Patient Safety: Match needs with capacity, have clear communication, specific setting for care, assigned work-spaces. Types of Medication Errors: categories of errors, patients at risk, and how do errors happen. Preventing Medication Errors: prevention via prescriptions, regulations, classification, labeling, and tracking.
Reporting Medication Errors: computerized systems, using report data, evaluation of safety, charting, administrative databases,claims, and audits. If you are taking the 30 Hour Prevention of Disease Course, you have already read the first three articles below in the previous module. The November 1999 report of the Institute of Medicine (IOM), entitled To Err Is Human: Building A Safer Health System, focused a great deal of attention on the issue of medical errors and patient safety.
Even using the lower estimate, this would make medical errors the eighth leading cause of death in this country—higher than motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516).
The President ordered the Quality Interagency Coordination Task Force to make recommendations on improving health care quality and protecting patient safety in response to the IOM report. Errors occur not only in hospitals but in other health care settings, such as physicians’ offices, nursing homes, pharmacies, urgent care centers, and care delivered in the home. The serious problem of medical errors is not new, but in the past, the problem has not gotten the attention it deserved. The final report of the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry, released in 1998, identified medical errors as one of the four major challenges facing the Nation in improving health care quality.
While there has been no unified effort to address the problem of medical errors and patient safety, awareness of the issue has been growing. Forty-two percent of respondents had been affected by a medical error, either personally or through a friend or relative.
Thirty-two percent of the respondents indicated that the error had a permanent negative effect on the patient’s health. Overall, the respondents to this survey thought the health care system was “moderately safe” (rated a 4.9 on a 1 to 7 scale, where 1 is not safe at all and 7 is very safe). Most people believe that medical errors are the result of the failures of individual providers. This fear of medical errors was borne out by the interest and attention that the IOM report generated. The IOM emphasized that most of the medical errors are systems related and not attributable to individual negligence or misconduct. The specialty of anesthesia has reduced its error rate by nearly sevenfold, from 25 to 50 per million to 5.4 per million, by using standardized guidelines and protocols, standardizing equipment, etc. One hospital in the Department of Veterans Affairs uses hand-held, wireless computer technology and bar-coding, which has cut overall hospital medication error rates by 70 percent. Most people believe that medical errors usually involve drugs, such as a patient getting the wrong prescription or dosage, or mishandled surgeries, such as amputation of the wrong limb. Diagnostic error, such as misdiagnosis leading to an incorrect choice of therapy, failure to use an indicated diagnostic test, misinterpretation of test results, and failure to act on abnormal results. Equipment failure, such as defibrillators with dead batteries or intravenous pumps whose valves are easily dislodged or bumped, causing increased doses of medication over too short a period. Blood transfusion-related injuries, such as giving a patient the blood of the incorrect type. Misinterpretation of other medical orders, such as failing to give a patient a salt-free meal, as ordered by a physician.
A study released last year, based on a chart review of 15,000 medical records in Colorado and Utah, found that 54 percent of surgical errors were preventable. Use of information technology, such as hand-held bedside computers, to eliminate reliance on handwriting for ordering medications and other treatment needs. Standardization of treatment policies and protocols to avoid confusion and reliance on memory, which is known to be fallible and responsible for many errors.
Medical errors are responsible for injury in as many as 1 out of every 25 hospital patients; an estimated 48,000-98,000 patients die from medical errors each year. Agency for Healthcare Research and Quality (AHRQ) research has shown that medical errors may result most frequently from systems errors—organization of health care delivery and how resources are provided in the delivery system.
An elderly woman with ambiguous symptoms (shortness of breath, abdominal pain, and dizziness) whose heart attack is not diagnosed by emergency room staff.
Errors like these are responsible for preventable injury in as many as 1 out of every 25 hospital patients. Errors in health care have been estimated to cost more than $5 million per year in a large teaching hospital. These and other findings of the IOM report are based on research sponsored by a variety of organizations, including the Agency for Healthcare Research and Quality (AHRQ). For example, a study by AHRQ found that just one type of error—preventable adverse drug events—caused one out of five injuries or deaths per year to patients in the hospitals that were studied.
Errors can occur at any point in the health care delivery system, AHRQ-supported research has revealed. These are preventable mistakes in prescribing and delivering medication to patients, such as prescribing two or more drugs whose interaction is known to produce side effects or prescribing a drug to which the patient is known to be allergic. Research by AHRQ-supported investigators is helping to characterize these errors (called preventable adverse drug events, or ADEs) and suggest how to prevent them.
In a study of inpatient care in two tertiary care hospitals, errors in ordering and administering medicines accounted for 56 and 34 percent, respectively, of preventable adverse drug events. Findings from a second study showed that dosage errors, in particular, were primarily due to the physician’s lack of knowledge about the drug or about the patient for whom it was prescribed. An attempt to identify risk factors for preventable adverse drug reactions among patients admitted to medical and surgical units at two large hospitals7 found few such factors, which suggested to the researchers that a focus on improving medication systems would prove more effective.
In contrast to ADEs, surgical adverse events (1 in 50 admissions in Colorado and Utah hospitals during 1992), accounted for two-thirds of all adverse events and 1 of 8 hospital deaths in a recent retrospective study of these institutions by an AHRQ fellow. Incorrect diagnoses may lead to incorrect and ineffective treatment or unnecessary testing, which is costly and sometimes invasive. One study showed that physicians who performed 100 or more colposcopies (a test used to follow up abnormal Pap smears) a year had more accurate findings than physicians who performed the procedure less often.
Another study demonstrated that measuring blood pressure with the most commonly used type of equipment often gives incorrect readings that may lead to mismanagement of hypertension. Although errors in medication, surgery, and diagnosis are the easiest to detect, medical errors may result more frequently from the organization of health care delivery and the way that resources are provided to the delivery system. Investigators in a major stud discovered that failures at the system level were the real culprits in over three-fourths of adverse drug events. Failures in disseminating pharmaceutical information, in checking drug doses and patient identities, and in making patient information available are system errors that accounted for adverse drug events in over half of the hospitals studied. One system-level factor, staffing levels of nurses (adjusted for hospital characteristics), was found in a study to influence the incidence of adverse events following major surgery, such as urinary tract infections, pneumonia, thrombosis, and pulmonary compromise. This research on systemic problems leads investigators to conclude that any effort to reduce medical errors in an organization requires changes to the system design, including possible reorganization of resources by top-level management.
Research funded by AHRQ and others has been important in identifying the extent and causes of errors. Although chart review was found in an AHRQ-funded study to be more accurate than computer tracking and voluntary reporting in identifying adverse drug events, it required five times more personnel time. Some diagnostic tests must be repeated to follow up certain conditions, but a small number of such repeat tests are done too early to yield useful results.
One study funded by AHRQ found that a computerized reminder system to alert physicians to the proper timing of repeat tests reduced the number of patients who were subjected to unnecessary repeat testing.
The same research group subsequently reported that an automatic alerting system for communicating critical laboratory results reduced the time until appropriate treatment when compared with the existing hospital paging system. An AHRQ-sponsored study of patients in intensive care units who had severe respiratory disease found a four-fold increase in survival rate with the use of computerized treatment protocols. Still other investigators are testing computerized decision support systems in various patient populations. AHRQ-funded research continues to create and test methods to help clinicians avoid errors in health care delivery. The Agency has recently funded four Centers for Education and Research in Therapeutics (CERTs) as part of a 3-year demonstration program. In addition, the Agency has recently announced that it will enter into cooperative agreements with nonprofit and for-profit health care organizations to test the effectiveness of the transfer and application of systems-based best practices to reduce medical errors and improve patient safety. One reason adverse events and medical errors occur is that evidence-based information on what works to prevent them, or reduce the harm they cause, is not available. The National Quality Forum, with support from the Agency for Healthcare Research and Quality (AHRQ), has identified 30 safe practices that evidence shows can work to reduce or prevent adverse events and medical errors. The goal in the United States is to deliver safe, high-quality health care to patients in all clinical settings.
The 30 safe practices that follow have been endorsed by the membership of the National Quality Forum, which includes representatives of 260 of the Nation’s leading health care provider, purchaser, and consumer organizations. The best way to understand how medication errors happen and how to prevent them is to consider their classification, which can be contextual, modal, or psychological. Psychologists consider an error to be a disorder of an intentional act, and they distinguish between errors in planning an act and errors in its execution.
Knowledge-based errors can be related to any type of knowledge, general, specific, or expert.
Rule-based errors can further be categorized as (a) the misapplication of a good rule or the failure to apply a good rule; and (b) the application of a bad rule. An action-based error is defined as ‘the performance of an action that was not what was intended.
Memory-based errors occur when something is forgotten; for example, giving penicillin, knowing the patient to be allergic, but forgetting.
Errors have been classified as errors, mistakes, slips, violated rules, unperformed actions, and  lapses. When Jacquelyn Ley shattered her elbow on the soccer field, her parents set out to find her the best care in Minneapolis. Since 1992, the Food and Drug Administration has received nearly 30,000 reports of medication errors. A physician ordered a 260-milligram preparation of Taxol for a patient, but the pharmacist prepared 260 milligrams of Taxotere instead. An older patient with rheumatoid arthritis died after receiving an overdose of methotrexate–a 10-milligram daily dose of the drug rather than the intended 10-milligram weekly dose.
One patient died because 20 units of insulin was abbreviated as “20 U,” but the “U” was mistaken for a “zero.” As a result, a dose of 200 units of insulin was accidentally injected. A man died after his wife mistakenly applied six transdermal patches to his skin at one time. A patient developed a fatal hemorrhage when given another patient’s prescription for the blood thinner warfarin. A medication error is “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer,” according to the National Coordinating Council for Medication Error Reporting and Prevention. The FDA enhanced its efforts to reduce medication errors by dedicating more resources to drug safety, which included forming a new division on medication errors at the agency in 2002. Bar code label rule: After a public meeting in July 2002, the FDA decided to propose a new rule requiring bar codes on certain drug and biological product labels.
Drug name confusion: To minimize confusion between drug names that look or sound alike, the FDA reviews about 300 drug names a year before they are marketed. After drugs are approved, the FDA tracks reports of errors due to drug name confusion and spreads the word to health professionals, along with recommendations for avoiding future problems. The last time the FDA changed a drug name after it was approved was in 2004 when the cholesterol-lowering medicine Altocor was being confused with the cholesterol-lowering medicine Advicor. Drug labeling: Consumers tend to overlook important label information on OTC drugs, according to a Harris Interactive Market Research Poll conducted for the National Council on Patient Information and Education and released in January 2002. The regulation requires a standardized “Drug Facts” label on more than 100,000 OTC drug products. As for health professionals, the FDA proposed a new format in 2000 to improve prescription drug labeling for physicians, also known as the package insert.
Error tracking and public education: The FDA reviews medication error reports that come from drug manufacturers and through MedWatch, the agency’s safety information and adverse event reporting program. A recent ISMP survey on medication error reporting practices showed that health professionals submit reports more often to internal reporting programs such as hospitals than to external programs such as the FDA. The FDA receives and reviews about 300 medication error reports each month and classifies them to determine the cause and type of error.
In 2001, the agency released a public health advisory to hospitals, nursing homes, and other health care facilities about the hazards of mix-ups between medical gases, which are prescription drugs. In December 2003, the USP released an analysis of medication errors captured in 2002 by its anonymous national reporting database, MedMARX. An action-based error is defined as ‘the performance of an action that was not what was intended’.
Mistakes that result from applying bad rules, or misapplying or failing to apply good rules (rule-based errors), can be prevented by improving rules.
Of the 1010 medication errors reviewed, 298 (30%) were prescribing errors, 245 (24%) were dispensing errors, 410 (41%) were administration errors, and 57 (6%) involved medication administration records (MAR).
Despite clear imperfections in the data captured, medication error reporting tools are effective as a means of collecting reliable information on errors rapidly and in real time. AMCP has voiced support for a medication error reporting system that encourages participation and provides confidentiality and protection of the information reported and the person(s) reporting.
Medication errors have important implications for patient safety, and their identification is a main target in improving clinical practice errors, in order to prevent adverse events. The major methods for detecting medication errors and associated adverse drug-related events are chart review, computerized monitoring, administrative databases, and claims data, using direct observation, incident reporting, and patient monitoring. Reporting discloses medication errors, can trigger warnings, and encourages the diffusion of a culture of safe practice. Error prevention can be planned by means of retroactive and proactive tools, such as audit and Failure Mode, Effect, and Criticality Analysis (FMECA).
Patient safety must be the first aim in every setting, in order to build safer systems, learning from errors and reducing the human and fiscal costs. Medication errors and drug-related adverse events have important implications – from increased length of hospitalization and costs to undue discomfort and disability or increased mortality. In order to build safer systems we must be able to learn from previous errors, and detection is the first crucial step. The approaches used to detect errors are likely to be different in research and routine care, given the available resources [9].
Chart review is retrospective and based on practice sources (medical charts and laboratory data, prescription data, and administrative data). Computerized monitoring is the modern version of voluntary pharmacist reporting (pharmacy logs) [13]. Administrative databases screen International Classification of Diseases, 9th revision codes, for statistical purposes. The value of screening of claims data is limited by the underlying reasons for litigation, which are sometimes frivolous, and by the involvement of small numbers of local claims. Direct observation is the only method available for detecting errors of administration of medications. The Royal College of Anaesthetists was the first to use an incident reporting system in the UK in 1978. In today’s rapidly changing healthcare environment, technological advancements and computer assisted devices can challenge nurses in many ways. Medication safety has been identified by the Institute for Safe Medication Practices Canada (ISMPC) as a priority among hospitals and long term care facilities since medication errors in hospitals are a serious threat to patient safety. The purpose of this paper is to discuss how Lewin’s Change Management theory can guide the process of implementing bar-coding medication administration (BCMA) at this large psychiatric facility. The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) defines a medication error as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. The ISMPC has worked closely with hospitals, pharmacies and drug companies to address many preventable occurrences ranging from medication reconciliation programs to the standardization of drug names and labeling. With added distractions, complexities of care, and faced paced environments, nurses may inadvertently overlook inconspicuous errors or fail to catch packaging errors, leading to medication mishaps that could have serious consequences. In today’s busy healthcare environment, nurses are expected to keep up with modern integrated technology, often with little say as to how it affects them. Workarounds are common and are a unprofessional attempts to circumvent computer failures or save time.
Many health care organizations have used Kurt Lewin’s theory to understand human behaviour as it relates to change and patterns of resistance to change. In Lewin’s first ‘unfreezing’ stage, an understanding of the difficulties related to the identified problem are sought and “strategies are developed to strengthen the driving forces and weaken or reduce the restraining forces” (Bozak, 2003, p. The first step of Lewin’s Analysis involves identifying the change focus; specifically, implementing a bar-code scanning system of medication delivery at a large psychiatric facility.
During the unfreezing stage, round table discussions with the purpose of teasing out the driving and restraining forces will help identify barriers that may need to be overcome. The moving stage represents the period of actual change including the planning and implementation stages of the project.
In this final stage of Lewin’s theory, the process of freezing or refreezing the changed practice occurs and leads to a time of “stability and evaluation” (Bozak, 2003, p.
With any project of this magnitude, it is imperative to have a complete plan in place for ultimate success. Karen Sutherland RN BScN CPMHN(C) is a first year Masters of Nursing Student at Memorial University. Anywhere RN™ creates a flexible medication administration process that positively impacts nursing and patient safety. The latest release of Anywhere RN software features enhanced privacy for patient data and more configurable options to improve patient safety and assist in meeting regulatory requirements. Crowding at the ADCs takes valuable time away from nurses and also limits access for pharmacy. By reducing the number of trips to and from the ADC, Anywhere RN helps reduce the potential for interruptions that can lead to medication errors in nursing, and it frees up more time for patient care.
Fewer lines at the cabinet during the medication pass process increases nurse satisfaction. When used with Omnicell's Savvy™ mobile medication workstation, nurses can securely retrieve medications for multiple patients in one trip to the cabinet.


Introduction medication calculations - slideshare, Introduction to medication calculations 1.
Pediatric sedation: practice essentials, overview, Procedural sedation may be defined as the administration of sedative or dissociative agents, with or without analgesics, to induce a state that allows the. Dosage calculations practice exam answers - course hero, Dosage calculations practice exam answers top of form 1. Simple medication calculations for every nurse, Easy medication calculations are sometimes allusive for us nurses, luckily i have found an amazingly simple formula for calculating all types of iv drip rates.. Although medication errors in hospitals are common, medication errors that result in death or serious injury occur rarely. Copyright © 2012 Autos Weblog, All trademarks are the property of the respective trademark owners. Klimes, PhD, MPH (John Hopkins U), author of articles on overall health and wellness prevention. The strength looks different for one of these medications, even though all mean the same thing—5 mg. But medical errors can occur anywhere in the health care system: In hospitals, clinics, surgery centers, doctors’ offices, nursing homes, pharmacies, and patients’ homes.
The report indicated that as many as 44,000 to 98,000 people die in hospitals each year as the result of medical errors. About 7,000 people per year are estimated to die from medication errors alone—about 16 percent more deaths than the number attributable to work-related injuries.
Based on the recommendations of that report, President Clinton directed the establishment of the Quality Interagency Coordination Task Force (QuIC) to coordinate quality improvement activities in Federal health care programs.
According to a survey by the Kaiser Family Foundation, 51 percent of Americans followed closely the release of the IOM report on medical errors. The key to reducing medical errors is to focus on improving the systems of delivering care and not to blame individuals.
However, the patient who receives an antibiotic to which he or she is known to be allergic, goes into anaphylactic shock, and dies, represents a preventable adverse event. Errors in health care have been estimated to cost more than $5 million per year in a large teaching hospital, and preventable health care-related cost the economy from $17 to $29 billion each year.
According to a recent report by the Institute of Medicine (IOM)3, preventable health care-related injuries cost the economy from $17 to $29 billion annually, of which half are health care costs. Even the lower estimate is higher than the annual mortality from motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516), thus making medical errors the eighth leading cause of death in the United States.
Also, inexperience with a technically difficult diagnostic procedure can affect the accuracy of the results.
Research by AHRQ-supported scientists is helping to identify the systemic factors contributing to preventable adverse events. Now, additional research is needed to develop and test better ways to prevent errors, often by reducing the reliance on human memory. Researchers concluded that the computerized method was the most efficient means of tracking drug errors.
In contrast, laboratory results showing that a patient needs critical care may not be communicated in a timely manner. All of these research efforts reflect AHRQ’s commitment to improving patient safety by providing new tools to augment provider judgment.
An investigation funded by AHRQ and the National Institute on Aging will address the incidence and preventability of adverse drug events in elderly patients receiving ambulatory care. The CERTs will conduct research to increase understanding of ways to improve the appropriate and effective use of drugs, biologicals, and devices in treatments and to avoid adverse events.
This research will help identify high-risk patients or patient groups, providers, health care processes and settings, as well as developing generalizable methods for error reduction. Despite the best intentions, however, a high rate of largely preventable adverse events and medical errors occur that cause harm to patients. These organizations strongly urge that these 30 safe practices be universally adopted by all applicable health care settings to reduce the risk of harm to patients. For designated high-risk, elective surgical procedures or other specified care, patients should be clearly informed of the likely reduced risk of an adverse outcome at treatment facilities that have demonstrated superior outcomes and should be referred to such facilities in accordance with the patient’s stated preference. Specify an explicit protocol to be used to ensure an adequate level of nursing based on the institution’s usual patient mix and the experience and training of its nursing staff.
All patients in general intensive care units (both adult and pediatric) should be managed by physicians having specific training and certification in critical care medicine (“critical care certified”). Pharmacists should actively participate in the medication-use process, including, at a minimum, being available for consultation with prescribers on medication ordering, interpretation and review of medication orders, preparation of medications, dispensing of medications, and administration and monitoring of medications. Verbal orders should be recorded whenever possible and immediately read back to the prescriber; that is, a health care provider receiving a verbal order should read or repeat back the information that the prescriber conveys in order to verify the accuracy of what was heard. Ensure that care information, especially changes in orders and new diagnostic information, is transmitted in a timely and clearly understandable form to all of the patient’s current health care providers who need that information to provide care. Ask each patient or legal surrogate to recount what he or she has been told during the informed consent discussion. Ensure that written documentation of the patient’s preference for life-sustaining treatments is prominently displayed in his or her chart. Implement standardized protocols to prevent the occurrence of wrong-site or wrong-patient procedures. Evaluate each patient undergoing elective surgery for risk of an acute ischemic cardiac event during surgery, and provide prophylactic treatment for high-risk patients with beta blockers. Evaluate each patient upon admission, and regularly thereafter, for the risk of developing pressure ulcers. Utilize dedicated anti-thrombotic (anti-coagulation) services that facilitate coordinated care management. Upon admission, and regularly thereafter, evaluate each patient for the risk of aspiration. Adhere to effective methods of preventing central venous catheter-associated bloodstream infections.
Evaluate each pre-operative patient in light of his or her planned surgical procedure for the risk of surgical site infection, and implement appropriate antibiotic prophylaxis and other preventive measures based on that evaluation. Utilize validated protocols to evaluate patients who are at risk for contrast media-induced renal failure, and utilize a clinically appropriate method for reducing risk of renal injury based on the patient’s kidney function evaluation. Decontaminate hands with either a hygienic hand rub or by washing with a disinfectant soap prior to, and after, direct contact with the patient or objects immediately around the patient. Keep workspaces where medications are prepared clean, orderly, well lit, and free of clutter, distraction, and noise. Identify all “high alert” drugs (for example, intravenous adrenergic agonists and antagonists, chemotherapy agents, anti-coagulants and anti-thrombotics, concentrated parenteral electrolytes, general anesthetics, neuromuscular blockers, insulin and oral hypoglycemics, narcotics, and opiates). Dispense medications in unit-dose or, when appropriate, unit-of-use form, whenever possible. Contextual classification deals with the specific time, place, medicines, and people involved. If a prior intention to reach a specified goal leads to action, and the action leads to the goal, all is well.
A slip of the pen, when a doctor intends to write diltiazem but writes diazepam, is an example. When she woke up in the middle of the night and checked on her, Jacquelyn was barely breathing. These are voluntary reports, so the number of medication errors that actually occur is thought to be much higher. Both are chemotherapy drugs used for different types of cancer and with different recommended doses. Some dosing mix-ups have occurred because daily dosing of methotrexate is typically used to treat people with cancer, while low weekly doses of the drug have been prescribed for other conditions, such as arthritis, asthma, and inflammatory bowel disease. The multiple patches delivered an overdose of the narcotic pain medicine fentanyl through his skin. The council, a group of more than 25 national and international organizations, including the FDA, examines and evaluates medication errors and recommends strategies for error prevention.
Department of Health and Human Services (HHS) and other federal agencies formed the Quality Interagency Coordination Task Force in 2000 and issued an action plan for reducing medical errors.
Health care professionals would use bar code scanning equipment, similar to that used in supermarkets, to make sure that the right drug in the right dose and route of administration is given to the right patient at the right time.
Nurses have laptop computers and scanners on top of medication carts that they bring to patients’ rooms. Now Altocor is called Altoprev, and the agency hasn’t received reports of errors since the name change. In May 2002, an FDA regulation went into effect that aims to help consumers use OTC drugs more wisely. Modeled after the Nutrition Facts label on foods, the label helps consumers compare and select OTC medicines and follow instructions.
One FDA study showed that practitioners found the labeling to be lengthy, complex, and hard to use. The agency also receives reports from the Institute for Safe Medication Practices (ISMP) and the U.S.
According to the ISMP, one reason may be health professionals’ limited knowledge about external reporting programs.
Depending on the findings, the FDA can change the way it labels, names, or packages a drug product. In one case, a nursing home in Ohio reported four deaths after an employee mistakenly connected nitrogen to the oxygen system. Of the errors reported to MedMARX, slightly more than one-third reached the patient and involved a geriatric patient. They are best tackled by putting in place systems that detect such errors and allow remedial actions. Following expert review, 208 errors (21%) were deleted because they had been inappropriately coded as errors and 97 (10%) were added as they were not initially coded despite having occurred.
Our data suggest that administration errors are at least as common as prescribing errors in children.
Case reports are published to educate health care professionals regarding errors and near errors.
To be successful a medication error reporting system must have protections for those reporting. Although designed primarily for reporting adverse events from medication use, FDA’s MedWatch is an appropriate venue to discover medication errors, such as prescribing misadventures and look-alike, sound-alike errors leading to adverse reactions. Approaches to this are likely to be different in research and routine care, and the most suitable must be chosen according to the setting. Combining and comparing data from various and encourages the diffusion of a culture of safe practice sources increases the reliability of the system. Audit is also an educational activity, which promotes high-quality care; it should be carried out regularly. Scientific societies and surveillance agencies, reviews, original studies, and case reports may warn us to be on the alert and promote knowledge of risks and improved performance. In order to prevent medication errors and reduce the risks of harm, organizations need tools to detect them [10].
It can be improved by using computerized data, such as electronic medical records, computerized physician order entry (CPOE), and computer-integrated triggers.
Patient safety indexes and adverse event-adjusted rates are elaborated from a combination of discharge data. Events often still need to be confirmed, and about one-third of claims lack evidence of errors.
A trained nurse observes drug administration, registers each action, and then compares what was done with the original physician orders. Implementing a change in practice within these environments can produce anxiety or fear of failure in nurses, leading to a resistance to change practice.
Bar coded medication administration is one such tool that has the potential to reduce medication errors significantly, when used correctly (Carroll, 2003; Dennison, 2007). The introduction of automated pharmacy dispensing machines, bar-coding and scanning of medications is a national project throughout Canada, aimed at reducing medication errors and ultimately improving patient safety. As with any new change, ‘buy in’ by front line nurses is essential to a smooth transition of any informatics project, as many nurses can be unsure and resistive to new computer aided devices in practice (Bozak, 2003).
They come about through frustration on the part of the nurses when they are unable to find a solution to an immediate problem.
Also referred to as Lewin’s Force Field Analysis, the model encompasses three distinct phases known as unfreezing, moving and freezing or refreezing (Bozak, 2003).
Key components of this step are communicating with all stakeholders including frontline nurses, managers and administration.
In this facility some restraining forces might be; staff resistance to using computerized devices, the possibility of workarounds, lack of computer experience, lack of trust in the organization, and aversion to using a new system. Implementing bar coding across the facility will require sustained effort from various teams, some of which include; information technology (IT), pharmacy, clinical information services (CIS), nursing, program managers, clinical nurse educators and administrators.
Using Lewin’s Change Management theory to guide the implementation of  BCMA at this large psychiatric facility can help to promote acceptance by frontline nurses by involving them in all aspects of the planning and implementation.
Workarounds to barcode medication administration systems: Their occurrences, Causes, and threats to patient safety.
It is a web-based application that lets nurses remotely perform medication management tasks away from the automated dispensing cabinet (ADC). Nurses often feel rushed if others are waiting in line, which causes stress and can increase the potential for medication errors. Nurse interrupted: South Jersey Hospital uses technology to reduce disruptions, avoid errors. A report released by the Institute of Medicine in 1999 stated that medication errors in hospitals cause an estimated 7,000 deaths and cost hospitals $2 billion annually. The IOM report indicated, however, that many errors are likely to occur outside the hospital.
About half of the expenditures for preventable medical errors are for direct health care costs.
Some areas of past research that have shown promise in helping to reduce errors include computerized ADE monitoring, computer-generated reminders for followup testing, and standardized protocols. These centers will also add to our knowledge of the possible risks of new uses of drugs, and combinations of drugs, as they are prescribed in everyday practice. Adverse events and medical errors can occur in any health care setting in any community in this country.
There is a need to promote a culture that overtly encourages and supports the reporting of any situation or circumstance that threatens, or potentially threatens, the safety of patients or caregivers and that views the occurrence of errors and adverse events as opportunities to make the health care system better. Failures of skill can be divided into (iii) action-based errors (‘slips’, including technical errors) and (iv) memory-based errors (‘lapses’). And that’s very important to me.” The hospital began using pumps that are easier to use and revamped nurses’ training. There is no “typical” medication error, and health professionals, patients, and their families are all involved. The patient died several days later, though the death couldn’t be linked to the error because the patient was already severely ill. For example, the VA medical center in Topeka, Kan., has reported that bar coding reduced its medication error rate by 86 percent over a nine-year period.
The rule, which took effect on April 26, 2004, applies to prescription drugs, biological products (other than blood, blood components, and devices regulated by the Center for Biologics Evaluation and Research), and over-the-counter (OTC) drugs that are commonly used in hospitals.
The agency tests drug names with the help of about 120 FDA health professionals who volunteer to simulate real-life drug order situations.
One report involved the death of an 8-year-old boy after a possible medication error at the dispensing pharmacy.
The label clearly lists active ingredients, uses, warnings, dosage, directions, other information, such as how to store the medicine, and inactive ingredients.
The proposed redesign would feature a user-friendly format and would highlight critical information more clearly. In addition, once a problem is discovered, the FDA educates the public on an ongoing basis to prevent repeat errors. In addition, 352 medication error reports needed to have the subtype of error reclassified; 207 (59%) of these involved the reporter choosing the non?descript “other” category on the reporting tool (such as “Prescribing other”) which was able to be reclassified by expert review.
Further research is needed, not only in the area of computerized physician order entry (CPOE) for children, but also on ways to make the dispensing and administration of medications safer. In some cases, the FDA may work with drug manufacturers and others to inform them about concerns with pharmaceutical labeling, packaging and nomenclature to make appropriate changes to reduce the risk of medication errors. Often, pharmacists view mandatory reporting laws and regulations as punitive, especially if public disclosure is included. Many state boards of pharmacy have begun medication error reporting initiatives to detect trends in ambulatory dispensing errors. In an audit cycle we can compare what is actually done against reference standards and put in place corrective actions to improve the performances of individuals and systems.
First, identify individual problems and deficiencies that can lead to error; second, analyse faulty systems design.
For this purpose, reports, alerts and recommendations are available on the web, issued by national and federal healthcare systems, regulatory agencies, and non-profit-making organizations [the Food and Drug Administration (FDA), European Medicines Agency (EMEA), United States Pharmacopeia (USP-MEDMARX), UK – National Health Service (NHS), Veterans Health Administration (VHA), Australian Patient Safety Foundation (APSF), Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)][7, 8]. Any system must then be able to analyse errors and identify opportunities for quality improvement and system changes. Chart review is the most precise approach for detecting adverse events, but is less good at detecting medication errors. Claims data have a positive predictive value for adverse events of about 50%, of which only about 18% point to a medication source [15]. Reports submitted to management or legal services can cause misunderstanding and carry a connotation of blame.
Medication errors in hospital settings lead to devastating consequences for both nurse and patient that can be reduced significantly through the use of technology that improves patient care and saves time for busy nurses.
The ramifications of medication errors affect all healthcare organizations, resulting in consumer mistrust, increased healthcare costs, and patient injury or death (Carroll, 2003). Patient safety is one of health care’s top priorities and safe medication delivery is an important aspect of total patient care. The use of Lewin’s Change Management theory can support nurses through the transitions and identify areas of strengths and resistances prior to implementing change.
The technology involved in bar-code scanning also integrates electronic medication records (EMR) and computerized physician order entry (CPOE) into practice, thereby reducing paper documents and the possibility of transcription errors, ineligible handwriting or missed signatures.
Managing change has always been challenging in health care facilities, and new technologies often incite resistance from nurses who already cannot find enough time in their shift to complete patient related tasks. Some common workarounds in BCMA include administering medications without scanning the patient’s wristband, placing the wristband on a stationary object such as the end of the bed, scanning medication packages after delivery and administering medications without scanning the medication bar code. The intention of the model is to identify factors that can impede change from occurring; forces that oppose change often called restraining or  ‘static forces’ and forces that promote or drive change, referred to as ‘driving forces’.


Unfreezing involves identifying key players that will be affected by the change and gathering them together to communicate ideas and create lists of all driving and static forces that will affect the project. Bozak (2003) asserted that it was important that lines of communication remain open and honest, which creates a “sense of security and trust in all those involved with the proposed change” (p.
Driving forces would be the forces that will help move the project to completion such as; adequate financial investment, support from upper level management, potential for ease of use and better time management.
A project of this magnitude will affect all of these departments in different ways, so planning an effective roll out with the assistance and inclusion of all stakeholders is imperative.
Ongoing support of the nurses on the frontline and technology support to all stakeholders should continue until the change is deemed complete and all users are comfortable with the technology. Creating this ‘buy in’ from frontline nurses builds autonomy and ownership of the project, ultimately leading to success. A medication safety education program to reduce the risk of harm caused by medication errors. Effect of bar-code-assisted medication administration on medication error rates in an adult medical intensive care unit. She completed her post RN BScN degree at Laurentian University in Ontario in 2009 and her RN diploma from George Brown College, Toronto Ontario in 1983.
It list and discusses the types of medication errors that are common in health-care settings. Sometimes prescriptions are written this way and the decimal point can be missed, leading to a tenfold overdose (50 mg instead of 5 mg). They can happen during even the most routine tasks, such as when a hospital patient on a salt-free diet is given a high-salt meal. For example, in a recent investigation of pharmacists, the Massachusetts State Board of Registration in Pharmacy estimated that 2.4 million prescriptions are filled improperly each year in the State.
Clinically appropriate preventive methods should be implemented consequent to the evaluation.
They have been defined as occurring when ‘an outcome fails to occur or the wrong outcome is produced because the execution of an action was imperfect’. After a successful three-hour surgery to repair the broken bones, Jacquelyn, who was 9 at the time, received the pain medicine morphine through a pump and was hooked up to a heart monitor, breathing monitor, and blood oxygen monitor. Ley believes there were many contributors to the error, including the fact that it was Labor Day weekend and there were staff shortages. Thompson announced a Patient Safety Task Force to coordinate a joint effort to improve data collection on patient safety. The bar codes provide unique, identifying information about drugs given at the patient’s bedside. Manufacturers, repackers, relabelers, and private label distributors of prescription and OTC drugs would be subject to the bar code requirements.
The overall distribution of error type categories did not change significantly with expert review, although only MAR errors were underreported by the reporters.
Compliance with such programs is likely to be less than optimal since the results of reporting could include lawsuits, regulatory enforcement actions, forfeiture of pharmacy license, and loss of professional reputation with accompanying loss of business.
At this point in time, most are limited to mandatory internal reporting systems within a setting, as is the case in California, where errors must be logged and open for board inspection during routine visits and complaint investigation.
The major methods for detecting adverse events are chart review, computerized monitoring, incident reporting, and searching claims data. Furthermore, reports may concern different organizations, according to the field of application, causing multiplication and incorrect analysis. Bar-coded medication administration is one type of technology that uses a scanning device to compare bar codes on patient identification bands with bar codes on prescribed medications, electronically verifying the medications against the medication records, thereby reducing medication errors significantly. Medication errors can occur at any stage of the dispensing and administration process but only an estimated five percent are noted in nursing documentation, suggesting that many errors that have not led to serious results are unreported (Wilkins & Shields, 2008).
The current system of medication delivery and administration at our facility involves old medication carts in poor repair and relies on manual checks to ensure the right drug is given to the right patient at the right time, route, site and dosage by the nurse.
Without a framework for guidance, new technologies can result in workarounds that threaten patient safety. The economical impact of medication errors is estimated to be around five thousand dollars per error unless there is legal litigation, when the costs can skyrocket into the millions (Dennison, 2007). BCMA technology consists of bar coded medication packets and bar codes on patient identification bands as well as a scanner attached to a medication cart. Currently nurses use old medication carts that have worn wheels, broken drawers and some are health and safety hazards.
Several common barriers have been identified when implementing a change in procedure of this magnitude including lack of cooperation amongst staff, fear of using new techniques, and resistance to change in hopes that the new technology would just disappear (Spetz, Burgess & Phibbs, 2012). For successful implementation of a project as large as bar-coding, careful planning and identification of all barriers are imperative. When health care organizations fully understand what behaviours drive or oppose change, then work to strengthen the positive driving forces, change can occur successfully (Bozak, 2003). The second ‘moving’ stage is where the actual change in practice takes place as a result of equalization of the opposing forces, thereby allowing the driving forces to support the change. The important point here is that this exercise actively engages all parties to work towards accentuating the positive driving forces and diminishing the restraining forces so that BCMA is successfully adopted without the use of dangerous workarounds with full nursing investment in the outcome. Bozak (2003) recommended actively involving nursing staff, to create a feeling of ownership of the success of the project. Once completed and fully operational, an evaluation and summary of problems encountered, successes realized, and challenges encountered throughout the project should be done, for future reference. The use of brainstorming round table discussions to identify driving and resisting forces is a first step in this process.
However, classification based on psychological theory is to be preferred, as it explains events rather than merely describing them. Her recovery was going so well that doctors decided to turn off the morphine pump and to forgo regular checks of her vital signs.
The lead agencies are the FDA, the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, and the Agency for Healthcare Research and Quality.
The agency continues to study whether it also should develop a rule requiring bar code labeling on medical devices. The agency also has been working on a project called DailyMed, a computer system that will be available without cost from the National Library of Medicine next year. Many physician boards and associations participate in prescribing error investigations, driven primarily by peer review and consumer complaint resolution. Medication errors are mainly detected by means of direct observation, voluntary reporting (by doctors, pharmacists, nurses, patients, and others) and chart review. Advanced software implementation supports integration of laboratory and clinical data with Clinical Decision Support Systems (CDSS), providing detection and prevention of adverse events.
This paper will examine the applicability of using Kurt Lewin’s change management theory as a framework to introduce bar-coded medication technology at a large psychiatric facility.
The psychiatric facility in question is now planning a complete overhaul of the pharmacy system and is incorporating automated dispensing machines, along with electronic medication records and bar coding of medications to modernize their care and improve patient safety. No less important, but certainly less discussed, is the harm to nurse morale after being involved in a medication error, potentially leading to lost time from work (Dennison, 2007). The process begins when the nurse uses the scanning device to scan the patient’s identification band then scans the packet of medication being administered. The nurses use paper medication records and must double check medications against the MAR sheets before administering. One barrier that could impact the implementation at our psychiatric hospital is the possibility of a patient refusing to wear identification bands, which are necessary for BCMA to work.
Not all nurses are comfortable with technology in the work environment, thus they may be resistant to changing practice, or be afraid of failure (Bozak, 2003).
In this stage, implementation of the project produces the change desired, so it is important to continue to keep lines of communication with the nursing staff open.
The inclusion of front line staff in planning groups and key decision – making processes promotes a feeling of empowerment that helps to overcome their resistance to the change and enables them to understand the importance of the project and how it will beneficially affect client care.
Some areas to consider at this facility are implementation timelines, reliability of the equipment, educational training needs, effects on workflow, organizational culture and leadership (Spetz, Burgess & Phibbs, 2012). Addressing restraining forces helps to promote adoption to ensure the smooth implementation of the BCMA resulting in reduced medication errors. Medication administration: The implementation process of bar-coding for medication administration to enhance medication safety. Thompson, on March 13, 2003, proposed a new rule requiring bar codes on certain drug and biological product labels. In order to evaluate and reduce medication errors, a well designed reporting system is required.
Some FDA recommendations regarding drug name confusion have encouraged pharmacists to separate similar drug products on pharmacy shelves and have encouraged physicians to indicate both brand and generic drug names on prescription orders, as well as what the drug is intended to treat.
DailyMed will have new information added daily, and will allow health professionals to pull up drug warnings and label changes electronically. The downsides of this method are the difficulty in training reviewers (nurses, pharmacists, students, research assistants) and the resources needed, both fiscal and human. Lewin’s theory can lead to a better understanding of how change affects the organization, identify barriers for successful implementation and is useful for identifying opposing forces that act on human behviour during change, therefore overcoming resistance and leading to acceptance of new technologies by nurses.
This large project will have the greatest impact on front line nurses, many of whom are skeptical of change or lack confidence in their ability to adapt to new technologies, therefore careful implementation of this project is imperative.
While medication errors can occur at any stage in the process, the nurse is often the last line of defense for catching mistakes due to the nature of the administration of meds at the bedside.
At that time the cart communicates wirelessly with the patient’s electronic medication administration record (MAR) and verifies several elements; that the medication is the correct one ordered for that patient and that the dose, time, route, frequency are correct. The facility has recently introduced new computerized swipe access carts that are bar code scanner friendly with the intent to introduce bar coding once the pharmacy department converts to electronic medication dispensing and electronic medication records.
Other barriers include short cuts that some nurses have adopted to save time, such as pre pouring medications, which contravenes Canadian nursing standards of practice.
It is important to recognize the different educational needs of the various nurses and acknowledge the varying attitudes and stresses the nurses might have. Finally, once the desired change has occurred, the ‘refreezing’ stage can be used to evaluate the stability of the change and the overall effectiveness within practice. It is also important to have a project leader to oversee and monitor a project of this magnitude through all phases. Often, nurses are forced to change practice without having the opportunity to give input, which has eroded their trust of the organization over time. Healthcare professionals would use bar-code scanning equipment to make sure that the right drug in the right dose and route of administration is given to the right patient at the right time. The advantages and limits of the main methods are summarized in Table 1; here are notes on the most interesting ones [10, 11]. Furthermore, the results depend on the quality of documentation and reviewers’ abilities to capture triggers.
Implementation of information technology is costly and necessary for safety, but it can also give rise to new, unknown risks. This can translate into the onus of responsibility being shifted onto the nurse to not only catch drug errors before they occur, but take the blame if they do occur (Wilkins & Shields, 2008). Without bar-coding this process is completed manually by the nurse by checking against the paper MAR, verifying these same elements and has been estimated to take up to thirty minutes per patient (Foote & Coleman, 2008) in extreme cases. While many nurses will welcome this time-saving change, others will feel overwhelmed by the magnitude of the change; therefore careful planning and support on the part of the organization will lessen the stress associated with the implementation.
Several studies identified barriers to successful implementation of BCMA through the use of ‘workarounds”. Using Lewin’s Change Management Theory as a framework can strengthen the probability of successful BCMA implementation. Challenges in this stage may include discovering the use of workarounds that can be resolved through further education. By using Lewin’s theory, we can help reduce stakeholder resistance and fear of change through the development of a well thought plan and active participation in the change process.
The required bar code would contain the National Drug Code (NDC) number, which provides unique identifying information about the drug that is to be dispensed to the patient, in a linear bar code as part of the drug label.In July, 2001, MeritCare Health System, Fargo, ND, installed a unique unit-dose packaging system from Cardinal Health Automation and Information Services that addresses these problems. The system packages both prescription and nonprescription products, including aspirin, Tylenol and the like.
If a patient requires two of the same item, he or she will be given two packages.The Pyxis Homerus® system is a state-of-the-art, integrated medication packaging, bar-coding, storage-and-retrieval system that combines Pyxis iPak™ II, a unit-dose bar-code packaging system and Pyxis iSTOR™, a medication storage-and-retrieval system.
The system includes an AutoLabel One Step bagging and printing machine from Automated Packaging Systems that receives all of the robotically dispensed unit-dose medication packages for each individual patient into a single bag. The machine also prints onto the bag a label with bar-coded information, as well as the name and location of the patient."MeritCare Health System has been moving towards bar-code technology to promote patient safety, and this was an important step in that process. We dispense thousands of medications every day, and as national statistics show, there is always the chance of human error.
We felt that with the use of bar-code technology, the Homerus system would help eliminate dispensing errors," says J. Each rectangular canister contains a nickel-sized chip that stores information about the medication it contains, including NDC number, drug description, lot, manufacturer and expiration information, as well as user information.The operator enters the data at the Canister Programming Station either manually or by scanning the bar code on the container of pills or tablets from the manufacturer. After data is stored, it can be recalled for future packaging of the same medication by entering the NDC number.
Data is transferred to the smart chip by placing the canister on a dedicated platform where the chip is accessed at the push of a button. This also triggers a printer that prints a gummed label containing all of the data that is manually applied to the canister.Using Smart Canister technology, the operator enters data for medication at the Canister Programming stationAfter pills or tablets are transferred to the canister, the operator replaces the cover, which includes a pin that latches the cover in place. A registered certified pharmacist visually checks the canister to make sure it contains the listed medication and also checks the data that is on the chip. This is one of the checks and balances of the system that ensures the accuracy of the procedure.
Once the filled canister is at a checked status by a pharmacist, medications can be repeatedly packaged from that canister without a pharmacist check. If more than one is picked up, they will all be knocked off as they leave the canister.After the canister is filled, the operator places a cover over the top insert. Canisters are generally filled ahead of time, checked and then stored on shelves to await packaging.MeritCare typically packages products during the day shift to be dispensed during the night's cart-fill. After three failed tries, the machine stops, and an alarm sounds to alert the operator that there is a problem. The film is like a flattened, hollow tube, and as the film descends, the bottom of one package is sealed by the cross sealer as it seals the top of the previous bag. The machine then punches a hole in the package above the top seal, after which the bag is cut loose and transferred onto a horizontal shaft into which a spiral groove has been cut. As the spiral on the packaging machine rotates, it moves bags toward the iSTOR™ integrated storage-and-retrieval system.The packaging machine can also package bulkier items, such as syringes, small bottles of oral medication and the like, as long as they are unit-dose items.
In some instances, these items are too big to fit in the normal packages, so the operator will run film that has pleated sides to accommodate the larger sizes.Integrated storage system also dispenses bags The Homerus iSTOR unit consists of 11 horizontal rings, each containing 72 spirals. Each spiral can hold up to 20 packages, so the system has a total potential storage capacity of 15,240 packages. The iSTOR is programmed simultaneously with the canister, so it knows what product is being delivered to it, and it retains this information in memory. It also knows what product is stored on each of its 792 spirals, and which spirals are empty. In addition, if a spiral containing the same product has room on it, the computer can add more packages to that spiral. If the same medicine is on more than one spiral, which is frequently the case, the robot will retrieve the packages having the earliest expiration date first.When a bag reaches the discharge end of the spiral on the packaging machine, it is transferred to a matching spiral shaft on a loader arm that moves vertically. The selected iSTOR ring rotates to the proper receiving position, and the loader arm carrying the medication rises to the level assigned by the computer to meet the selected ring. The loader arm spirals extend to meet the spiral on the iSTOR ring, and the spirals rotate together to transfer the package to the spiral mounted on the ring. The spiral on the packaging machine can hold up to 20 packages, and the transfer from the loader arm to the storage ring continues until all 20 packages have been transferred. While this is taking place, the packaging machine continues to operate and load its spiral, and the transfer process repeats itself.The retrieval process is basically the reverse of the storage operation.
All of the medications required in the hospital for the entire day are interfaced to Homerus from the hospital's order-entry software, and the system operates until they all have been retrieved. The system is programmed so that all of the medications required for one individual are retrieved before retrieval for the next person begins.Suction cups remove packages from storage rings, left. All of the packages for an individual patient discharge into a plastic bag, which is opened, filled and sealed by an automatic bagging and printing machine, right.The retrieval system includes an unloader tower with 11 suction cups mounted vertically to coincide with the 11 storage rings. For each retrieval, the computer rotates the rings until the spirals containing the designated products are in line with the suction cups. A bar-code reader verifies that the correct medicines are in place, after which the unloader arm moves inward, and vacuum is applied to the cups to pull the packages from the spirals. The unloader arm retracts and places the packages onto pegs on a vertical belt that travels downward and drops the packages onto a low-level horizontal belt. This could occur if more than 11 medicines were required, or if two required medicines were on the same ring. Polyethylene bags (also supplied by Automated Packaging Systems) are pulled down into the machine from a roll mounted on top of the machine. The bags, which are clear on one side and white on the other side and have perforations across the top, travel to a thermal-transfer printer that applies the name and bar code of the patient, the nurse's station where the bag is to be delivered as well as other information.The bag then travels to the loading station, where the medication packages are deposited.
The bag will remain in position to receive product if additional retrieval and loading operations are required, until the computer triggers the next cycle.
The bag is then pulled to the sealing station, where the top is heat-sealed, after which the stepper motor reverses and pulls the bag tight to tear it across the perforations, which are above the seal.The system is programmed to retrieve all of the patient-medication bags for one nurse's station before starting on bags for the next station.
Bags for a station drop into a reusable cardboard tote that is labeled with the unit name and date for delivery to the nurse's station.A significant part of the Homerus system is the iReturn unit, which transfers product from off-line storage into the iSTOR system.
These products include packages that were not administered at the nurse's stations and are being returned, and packages that were prepacked at some other time. An operator scans the packages into the computer and then manually places them onto the spindles. The conveyor then delivers the packages to the loading arm described previously, which delivers them to the designated ring in the iSTOR unit."We were a beta site, the second to go live in the country, and this being a complex system, naturally we had a lot of issues when we went live.
But due to bar-code technology, we've virtually eliminated errors in the dispensing of medication, and we're saving maybe ten hours per day of pharmacists' time previously spent dispensing. The next step is to implement bar-code scanners at the bedside to ensure the patient receives the right dose of the correct medication at the right time, while simultaneously checking for allergies," says Brown.



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