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Medications can be life-saving, but they can also be life-threatening when not prescribed or given appropriately. If you think you have been harmed by a medication error, contact Rosen & Spears to have your claim evaluated. ABSTRACTAn estimated 300 million radiologic procedures are conducted per year in the United States. Most automated medication dispensing cabinets store approximately 80% of the medications your patients need. SinglePointe automatically assigns each patient’s medications to the automated dispensing cabinet, where they are stored in a patient-specific drawer. Medications are removed against a patient’s profiled order, reducing the potential for medication errors. Nurses obtain medications from one location instead of tracking down medications from multiple areas in the unit. Tracks inventory through the automated dispensing cabinet, providing a complete audit trail. Automatically assigns each patient’s medications to the automated dispensing cabinet, eliminating the manual assignment of medications to a given location.
Tracks all patient-specific medications and provides a complete audit trail to help identify and quickly resolve issues. Restock levels are calculated automatically based on patient medication order frequency and actual usage. System identifies which patients are moving to new patient areas and establishes an efficient process to remove those patients’ medications and assign them to the new cabinet during the restock process.
Creates a streamlined workflow for removing and tracking medications remaining in the dispensing cabinet for patients who have been discharged, which helps to resolve potential billing discrepancies.
The Savvy™ mobile medication workstation from Omnicell should not be confused with ordinary hospital medication carts. This fully integrated solution features Omnicell's Anywhere RN™ software application and a wireless, medical-grade mobile workstation. The Anywhere RN software allows nurses to order medications in quieter areas away from interruptions, assisting in preventing medication errors.
Savvy provides secure transport of medications from the ADC to the point-of-care, creating a critical layer of accountability and addressing ISMP recommendations for safe transport of medications. Nurses can place all needed patient medications for a medication pass into patient-assigned locking drawers and then move from room to room, instead of returning to the ADC between each patient. Reduces trips back to the cabinet to record medication waste, which can now be done remotely. Savvy seamlessly integrates the Omnicell ADC, mobile workstation, and bedside point-of-care (BPOC) systems during the medication administration process, to enable a closed-loop process for tracking medication accountability.
Savvy is part of the Unity platform of solutions that share a single database, helping to eliminate redundant data entry that can lead to errors. Eliminates the manual process of labeling drawers: patient-specific drawers (up to 12) are automatically assigned via the software. Features independently locking drawers, which minimizes the risk of administering the wrong medication to a patient.
Omnicell’s unique guiding lights technology helps nurses quickly identify the drawer that has been unlocked, adding speed and convenience to the medication administration process. Lithium-ion hot-swap battery system (2 batteries) provides up to 18 hours of continuous run time.
Battery charging station conveniently charges depleted battery without having to plug the Savvy unit into a power outlet. Nurses can focus on patients without worrying about running out of power at a critical time. In cardiac catheterization laboratories, radiology, and other diagnostic departments, medications such as contrast media are administered, rates are adjusted for intravenous (IV) fluids, and IV access lines are flushed. It also increases the risk of loss, diversion, missing doses, and even potentially fatal medication errors. Savvy streamlines the medication administration process and provides safe and secure transportation of medications from the automated dispensing cabinet (ADC) to the patient's bedside.
Because clinicians can remotely select patient medications quickly and securely, from any location at any time, their transaction time at the ADC is reduced, providing more time for direct patient care.

Nurses can use the Savvy mobile medication workstation, which integrates Omnicell's Anywhere RN software, to request, retrieve, and deliver all of their patients' medications for a medication pass with a single trip to the cabinet, without compromising on security.
In addition to specific medications that are used in radiology, high-alert medications such as IV sedatives, vasopressors, and blood coagulation modifiers are given in this setting.
Nearly 1,000 event reports submitted to the Pennsylvania Patient Safety Authority specifically mentioned medication errors that occurred in care areas providing radiologic services. The administration of wrong drugs and unauthorized drugs was the most commonly reported medication error, followed by wrong-dose errors. These include cost of implementation of the system, resistance to the system by ICU physicians and nurses, and integration of data systems and clinical information into the remote electronic ICU model.
While contrast agents and radiopharmaceutical products were cited in almost a quarter of all medication error reports, a majority of the drugs listed are used across the spectrum of patient care settings, not just in radiology. In this chapter, we will provide background information on error reduction theory and the role of the remote ICU model, review current data supporting use of the remote ICU system, address the current obstacles to effective implementation, and look to the future of the field for solutions to these challenges.
Further qualitative analysis of events classified as wrong-rate medication errors in these areas shows no radiologic medications. Strategies to address these problems include conducting organizational examinations of the medication-use processes in radiology areas to uncover risks that could lead to harmful errors, proactively addressing the plan for the management of the patient’s infusion therapy while they are undergoing a radiologic procedure, and including radiology staff when evaluating and validating the level of training and competency to perform medication administration or related tasks.
Radiologic services are provided in a variety of inpatient and outpatient settings but most commonly involve cardiac catheterization, radiology, and nuclear medicine services. These services use medical imaging, such as radiography, computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, positron emission tomography, and ultrasound. Pharmacopeia (USP) report on medication errors in radiology1—that pooled error reports to MEDMARX® from 2000 to 2004—revealed that, while medication errors in radiologic services are not more prevalent when compared to other settings, they do have more potential to cause harm. Twelve percent of the medication errors reported by USP in radiologic services resulted in patient harm (“harm” defined as National Coordinating Council for Medication Error Reporting and Prevention [NCC MERP] harm category E or higher) compared to 1.7% of all medication errors.
As a patient is being transferred to and from a radiologic care setting, the opportunity for miscommunication and lack of access to patient information sets the stage for errors to occur.
Because the care provided to the patient is very much focused on a particular procedure, drugs that were administered pre-examination, or those to be continued postexamination, may not be given sufficient attention. Certification and training requirements for radiologic staff can vary by setting, state regulations, and institutional policies. Frequently, staff directly dispense and administer medications; however, there is no true standard on how much or what kind of medication-use training they receive.
In cardiac catheterization laboratories, radiology, and other diagnostic departments, staff administer medications such as contrast media, adjust rates of IV fluids, and flush IV access lines. In reality, these medications are sometimes administered without a radiologist ever actually seeing the patient or the patient’s medical record. Additionally, there is sometimes no written prescription and no written documentation on a patient’s medication administration record when these drugs are administered. Because of this, there is very little opportunity for a pharmacist’s involvement in reviewing the orders and screening the patient for allergies, drug-drug interactions, or drug-disease state warnings before the medication is administered. A Look at the NumbersLittle information in the literature specifically mentions medication errors that occur in the radiologic setting. Table 2 identifies the top 15 most common drugs mentioned in reports associated with the radiologic unit.
When combining the medications listed into their respective class of medications, 28.3% of all medications mentioned are considered high-alert medications, excluding IV contrast agents (which are also high-alert medications). Top 15 Medications Involved in Medication Errors in the  Radiologic Care Area (n=15)       Table 3. Forty (28.4%) of the wrong-drug errors involved mix-ups of the various formulations of technetium, a radiopharmaceutical widely used as a diagnostic aid. Its applications include imaging procedures of the brain, myocardium, lungs, thyroid, and bone.
Technetium has numerous uses in nuclear medicine, and it is available in more than 60 different products. This means that 44.7% (n = 63) of wrong-drug reports involved medications specific to that setting. In most cases, the result of this mix-up does not lead to patient harm; however, it may lead to the rescheduling of the intended test and result in increased cost and loss of productivity. In fact, the most common medications listed included insulin and heparin infusions, such as in the following example: The patient has been in radiology since early this morning.

Apparently, the insulin pump was disconnected before the patient’s arrival in the radiology department. After several hours passed, the radiology technicians made the nurse from the unit aware that the patient would be in the radiology department a while longer. The patient’s companion alerted me in the early afternoon to the fact the patient had an insulin pump and it has been disconnected since this morning, so a blood sugar was obtained. The floor nurse was notified of the patient’s status and that the radiology department does not carry insulin.This example reported to the Authority demonstrates a bigger problem, which is the effect any procedure may have on a patient’s current drug therapy. Errors may occur when the infusion pump is restarted by radiology staff or if the pump is off for a prolonged period of time. It would be expected that medication errors that occur in this area would primarily involve problems with medications specifically given for radiologic procedures. However, as indicated in Tables 2 and 3, a majority of the medications involved in errors in radiologic settings were not radiologic medications, such as contrast or radiopharmaceuticals.
The following are two examples submitted to the Authority:Patient was consented for MRI with conscious sedation.
A registered nurse (RN) administered Versed® (midazolam) and fentanyl IV push prior to MRI.
Patient developed respiratory distress and cyanosis for which an airway emergency was called. The patient stabilized and was taken to recovery room and subsequently was transferred to pediatric intermediate care for observation.In addition, analysis of events classified as wrong-rate medication errors in these areas shows not one radiologic medication, and over half of these events involved high-alert medications.
These problems include misprogrammed infusion pumps, infusions that were stopped for the radiologic test but not restarted, tubing misconnections, and wrong-patient errors. The following reports illustrate these problems:The patient arrived to the intensive care unit (ICU) from the cardiac catheterization lab. When the patient returned from ultrasound, the infusion was found to be no longer running and clamped.
A subclavian catheter and tracheostomy were present and all of the ports had similar injection valves. Patient was then pulled out of the MRI and discovered that contrast had been injected into tracheostomy cuff with a rupture of the balloon. Following a preliminary investigation, it was determined that an inpatient was in x-ray around the same time the ED patient was in the ED, and for unknown reasons the inpatient’s IV was connected to the ED patient. A review of the data submitted to the Authority reveals 126 reports (13%) where breakdowns in obtaining and using patient information occurred, including the following case examples:Patient presented to the ED with abdominal pain and vomiting. The patient's creatine came back at a critical level and contrast should not have been given.A nurse gave a verbal order for a heparin dose to be given IV push and the physician assisting with the heart catheterization did not know that the heparin was already administered. The patient developed a hematoma at the catheter site and required blood products.A patient received a dosage of IV contrast for a CT scan administered by CT technicians without checking the lab values of the patient’s BUN and Cr before administering the contrast.
The physician was notified and stated [the intent to] hydrate the patient.A four-year-old patient underwent a Cardiolite® (technetium Tc99m sestamibi) cardiac imaging scan. A routine audit of the records discovered that the dose was based on 50 kg and not the patient’s weight of 50 lbs.
Upon internal review, it was discovered that the weight was obtained verbally by the technician and then forwarded to the pharmacy for nuclear medicine.
Risk Reduction StrategiesHealthcare facilities should identify the error risks currently present in cardiac catheterization laboratories, radiology, and other diagnostic departments and take steps to implement risk reduction strategies. Ultimately, the responsibility for patient safety falls to the licensed medical professional supervising the technician.Include radiology staff when evaluating and validating the level of training and competency to perform medication administration or related tasks.
Keep technicians in the information loop regarding safe medication administration practices by providing in-service education.11Organizations need to carefully consider current and recent patient information before ordering, dispensing, and administering any medication in this setting that may affect the procedure.
MEDMARX® data report: a chartbook of 2000-2004 findings from intensive care units and radiologic services.
Contrast material-induced renal failure in patients with diabetes mellitus, renal insufficiency, or both. Incidence, risk factors, and clinical course of acute renal insufficiency after cardiac catheterization in patients 70 years of age or older.

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