Nurse interruptions and medication errors yii,type 2 diabetes indian diet plan indian,sup quatro 2015,m550d release - New On 2016

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. The daunting daily task, performed by hundreds of correctional nurses every day, is complicated by distracting noise and frequent interruption.
A recent study published in the Archives of Internal Medicine tracked the toll of interruptions on medication errors by viewing nurses administering medications in 2 hospital settings. Have the medication nurse where an item of clothing, such as a brightly colored vest or apron, when administering medications. Educate all staff members to the patient safety basis of uninterrupted medication delivery. Educate custody staff and patients of the need to decrease nurse interruptions during medication administration processes. Omnicell® G4 Unity automated dispensing cabinets (ADCs) create better workflow to improve how medications are managed. Omnicell ADCs are linked via a shared database with our Controlled Substance Manager and other solutions on the Unity platform. Omnicell is the only company to offer a Medication Label Printer integrated within the ADC. OmniDispenser™ dispenses each dose individually, virtually eliminating the need for countbacks.
High capacity storage accommodates oral solids, ampules, vials, oral liquids, IVs, bulk stock, etc. Wide array of drawer styles meets needs of each patient care area as well as long-term care sites. Medications and supplies can be combined in a single cabinet, adding convenience and saving space. Universal eBox (electronics) used across the Omnicell product line ensures quick and efficient service. Enables users to access the cabinet via fingerprint scan only, which helps prevent unauthorized users from gaining access. Stores medications in a separate, secured location in the cabinet and dispenses each dose individually.
Virtually eliminates time-consuming countbacks and discrepancies related to controlled substances. Enables you to store, manage and track up to 100% of medications needed for every patient within the automated dispensing cabinet. Allows nurses to print patient-specific labels during medication issue for medications that won't be administered immediately. Gives nurses the freedom to remotely interact with the Omnicell cabinet from anywhere in the patient care area. Enables 2D bar code scanning to confirm the identity of a medication or supply at all points of access: restock, selected issues, and returns. Interfaces with hospital pharmacy information system to access patient-specific orders, administration schedules, and allergy information. Provides a filtered list of "due" medication orders to the nurse for greater dispensing efficiency and enhanced patient safety.
Omnicell automated dispensing cabinets come in a wide range of formats and can be configured with a variety of drawer types. Minimizing IV Risk Factors for ICU PatientsJudith Jacobi, PharmD, FCCM, FCCP, BCPSMay 2011 - Vol. Critically ill ICU patients typically receive a greater number of medications than patients in other care areas, and a high number of these drugs are given intravenously. Managing the Complexities of the ICUThe IV drug administration process is complex, and is estimated to require dozens of steps from preparation to completed drug administration and documentation. Other factors of the ICU environment specifically contribute to the risk for medication error, including interruptions due to emergencies, sometimes difficult working conditions due to stress or complexity, and the larger number of interventions needed to care for these critically ill patients. Techniques to Ensure StandardizationWhen medications are prepared outside of the pharmacy there may be inconsistency in the final concentration.
Other methods, such as use of pre-mixed IV products, can diminish the likelihood of product variability. Our facility, Indiana University Health Methodist Hospital, decided to use the actual weight taken at admission as the standard weight throughout the hospital stay. Preparing for Smart Pump ImplementationLinking the standard IV solution concentrations with a smart pump library provides safeguards beyond those realized from standardization alone. Amiodarone is an example of a drug with complex dosing phases that can contribute to medication errors. The Institute for Safe Medication Practices’ (ISMP) Summit on Intravenous Medication Errors in 2008 produced a list of the features that make an ideal smart pump.
New Technology TrainingDeployment of new technology should be accompanied by policy statements that describe its proper use and documentation standards.

A simple safety feature can be incorporated into the infusion pump process by requiring an independent double-check be completed, wherein a second nurse verifies the order, pump setup, and connections to the patient, prior to initiation of therapy.
Developing a Collaborative Safety TeamSignificant preparation is needed to ensure optimal use of smart pumps. Creating an ICU Culture of SafetyClinicians in the ICU must adapt to challenges and confront limitations to continually provide quality patient care.
We created a culture of safety where practitioners report actual errors and near-miss errors either verbally or electronically.
The success of this culture of safety can be assessed with the use of surveys that evaluate practitioner attitudes and willingness to report concerns. When the safety team prioritizes error recognition and reporting, there is improved planning for methods to prevent medication errors. ConclusionFrom medication prescribing, to drug administration, to documentation, IV drug therapy is a complex process. Judith Jacobi, PharmD, FCCM, FCCP, BCPS, is part of the multiprofessional ICU team as a critical care pharmacy specialist for the adult critical care and neurocritical care units at Indiana University Health Methodist Hospital and is a board certified pharmacotherapy specialist. Our facility has focused on safe heparin use for many years, with an understanding that the delivery device is only one aspect for process improvement. 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. Lined up at the window, much like a bank teller’s queue, are inmates waiting for their morning pills.
I remember setting up meds in the day before unit dose and when the med room was both the dirty and the clean utility room. With these factors being tied to reimbursement, it’s more important than ever to improve nursing workflow across the healthcare enterprise, including long-term care settings. This integrated platform allows a more automated chain of custody that provides greater visibility and helps reduce time spent resolving discrepancies. The greater the number of steps in drug administration, the higher the possibility for error.
However, for products that are prepared in the pharmacy or by nursing, standards are needed to diminish variability in the final product. Critically ill patients often have an estimated weight on admission to the emergency department, an actual weight on admission, and then daily weights throughout their stay.
However, if the weight declines by more than 20%, a new standard weight is established and changes in drug doses and infusion rates are ordered.
Pharmacists should initiate and lead these standardization initiatives in conjunction with nurses and other patient-care colleagues.
The synchronization of processes from preparation to administration makes detection of error more likely, as deviations from usual practices may be more evident.
A bolus dose may be programmed to infuse over a period of time that is appropriate for the agent.
This pattern has been exacerbated as of late, as numerous shortages of common ICU drugs have required clinicians to find alternatives to preferred agents. Failure of staff members to use technology properly should initially trigger re-education efforts, but persistent failure to use safety technology or disregard for proper policies may necessitate corrective action.
However, in a busy ICU, this can mean interrupting the workflow of another nurse, potentially creating error elsewhere.
A multiprofessional committee of nurses, pharmacists, and physicians should be assembled to define the standard concentration(s) that will be allowed, the dosing units, and the upper and lower dosing limits for the infusion and bolus doses.
Unfortunately, employing these spontaneous alternative methods may bypass safety systems, although we have learned through experience that this behavior may signal that the systems have been improperly designed to achieve the stated goal. Inability to program a pump for a drug infusion led to a change in labeling procedures by pharmacy. Groups with a safety focus learn from prior events, and apply information from a near miss to prevent future errors. There are many potential sources of error involved, and the risk is compounded in busy ICUs during treatment of patients with complex, serious illness.
Intravenous medication administration in intensive care: opportunities for technological solutions.
While weight-based dosing improves heparin delivery, it also increases the delivery complexity and risk of errors. An MAR (Medication Administration Record) is in front of the nurse on her side of the window, with pages organized in alphabetical order by patient last name.
The medication nurse is working where other nurses are sharing report and physicians are stopping by to change orders and ask about patient status.
When three interruptions occurred in the administration of a single medication there was a 38.9% rate of error. One bump of my large aluminum med tray would send all my little souffle cups of meds flying from their perch on multi-colored med tickets. While the volume of use opens the door to the possibility of error, so does the ICU working environment—which is oftentimes rife with interruptions, making proper oversight challenging.
The narrow therapeutic range of many agents in these categories and the volume of routine use are the most likely contributors to the high-risk potential. Simple methods to minimize this source of error include the use of standardized concentrations, availability of detailed mixing instructions, and standardized labeling methods to ensure clarity of information.

Techniques to reconstitute drugs and transfer the contents to the infusion bag influence the final concentration. Septic shock patients typically receive several liters of fluid for initial therapy, and ultimately 5 to 10 liters of additional fluid for resuscitation, which affects their daily weight.
The benefit of weight standardization is that all doses are calculated and pumps are programmed consistently, weight settings do not need to change, and variation in practice is minimized. It is especially valuable to describe the intended therapeutic use of the drug during ordering, which will improve the likelihood of error detection and prevention.
A clear example is the shortage of norepinephrine, which led to an increase in phenylephrine use. If another nurse is not immediately available, this second sign-off may be deferred, allowing an error to persist until the second check, or it may be documented without actual performance. Periodic review of the adequacy of these parameters should be performed as a quality-control measure. Our online reporting and systematic review process allows trends to be noted more readily, but any mechanism to ensure communication of concerns is important. Directors and other hospital leaders should be sure to model behaviors they want staff to embody. When the team is focused and demonstrates a readiness for change and improvement, new processes and equipment are integrated more readily and safely.
A systematic evaluation of the risks, open discussion of the error events that are detected and averted, and a culture that supports and promotes safe medication use are needed.
Jacobi is program director of an ASHP-accredited critical care pharmacy residency and has trained 17 residents, along with numerous doctor of pharmacy students, as affiliate assistant faculty for Purdue University and Butler University.
For many years our pharmacists prepared a patient-specific dosing guide that listed the proper rate change in response to intermittent aPTT results. The nurse must positively identify the patient by photo ID card, organize the medication to be delivered for this patient on this date and time, and collect the pills from various single dose bubble-packs into a paper souffle cup.
Because these severely ill patients are at the highest risk for error and adverse drug events, and their underlying illnesses reduce their resiliency and ability to compensate for complications, it is vital that health care providers manage and mitigate these risks by creating an ICU safety culture, using both standardization of processes and new technology, to ensure IV medications are administered safely and correctly. If the drug volume contributes significantly (eg, more than 20%) to the final volume, it may be appropriate to remove a corresponding volume from the bag prior to drug transfer.
As with most explicit policies, a few exceptions must be created; for example, drotrecogin alfa (activated) is dosed based on the weight at the time of initiation.
Pump programming must consider all three phases and further accommodate repeat bolus doses of 150 mg during the infusion if there are recurrent arrhythmia events. When our facility first started using smart pumps, failure to use the safety features led to reminders—by other pharmacists on the team, by peers at shift change, and by the tele-ICU nurses when they made electronic rounds and reviewed pump settings. To solve this staffing issue the nursing personnel in our tele-ICU perform the independent double-check remotely and then document the action, thus improving safety and minimizing interruptions in patient care. We acknowledge and thank the reporter, and when possible communicate the resultant changes so practitioners recognize that their concerns produce results. Also, the use of a critical incident reporting system and a willingness to report potential problems is associated with a lower risk of error in general, and especially when using IV medications in the ICU. A multiprofessional committee should develop and institute safe medication processes, whether a facility is deploying high-technology tools or standardizing workflow.
However, the lab tests were sometimes overlooked (labs not drawn or there was a delay in taking action based on the results), and doses were occasionally calculated incorrectly, so to remedy the situation, this process was computerized using a locally developed, stand-alone program. After a standard has been determined, methods should be clearly presented to staff (using recipe cards or other reference sources) so that they are practiced consistently from one technician or nurse to the next. The pump then must allow an exception that is specific for one agent, but still allow other drugs to be dosed with the standard weight. Smart pumps may include settings for both therapeutic scenarios, but may use very different dosing limits. Our soft-maximum dose (established as a safety checkpoint to avert a potentially incorrect entry) was triggered more frequently than seemed optimal, and so the number was raised slightly.
The reporting system should be accessible and easy to understand, so all staff know how to report unsafe practices and potential sources of error. Nurses are now reminded to collect blood for heparin monitoring, check for the results in the electronic health record, and then prompted with the new heparin infusion dose based on the results. Fortunately for this correctional nurse, the custody officer in charge of the pill line does the oral cavity check to be sure the patient does not ‘cheek’ the medication for sale on the prison black-market. This is astounding objective data to support efforts to reduce interruptions in the medication administration process.
If this information is available at the time of order entry, solution preparation, and pump programming, optimal and efficient IV drug therapy is more likely to occur. Nurses then feel comfortable pointing out where the pump process may be inadequate to meet their needs, helping improve nursing satisfaction and quality of care for future patients. A high-dose heparin option also was needed in the library to address heparin-resistant patients or obese patients who exceeded the usual maximum dose in the initial heparin profile. Use of color-coded labels for intravenous high-risk medications and lines to improve patient safety. In the future, a useful improvement would be the integration of equipment to allow seamless, direct communication between the computer and the pump.

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