Others include delays in data accessibility, albeit shorter delays and the continued need for source data verification (Donovan, 2007).
Other obstacles have occurred in the developing of mobile healthcare applications. These have included mobile device limitations, wireless networking problems, infrastructure constraints, security concerns, and user distrust (Keng and Shen, 2006).
A third problem that has been encountered is that of a lack of education on not only the importance of the information technology but also training on how to use the specific pieces of equipment. The tools that are provided to people are only as good as the training that is provided on how to use them. The tools may be able to do wonderful things, but if those that are using them do not know how to get the best use out of them they will in the end be less efficient.
According to an Institute of Medicine (IOM) medical errors are the fifth to eighth leading cause of death in the United States. The number is thought to exceed that of deaths related to motor vehicle accidents each year. It is estimated that each year, an estimated 7,000 people die from medication errors, and most medical errors are system-related. Patient-related errors can occur in any health-care setting, including physician offices, nursing homes, and inpatient or outpatient environments. "An evidence-based assessment report by the evidence-based practice centers of Agency of Healthcare Research and Quality (AHRQ) has reported that medical errors are not confined to medication errors -- they can also occur from misdiagnosis, misinterpretation of laboratory results with incorrect therapy, equipment failure, infections, blood transfusion errors, or misinterpretation of medical orders" (Koshy, 2005). But the biggest area where errors are seen is in the area of medication errors.
Types of Errors
Drug administration is a major part of the clinical nurse's daily role. Medication management by the nurse is only one part of a process that also involves doctors and pharmacists (Betz & Levy, 1985). Medicines are prescribed by the doctor and dispensed by the pharmacist, but responsibility for correct administration usually rests with the nurse. Each Nurse is ultimately accountable for their practice. This includes preparing, checking and administering medications, updating knowledge of medications, monitoring the effectiveness of treatment, reporting adverse reactions and teaching patients about their drugs. The patient expects to receive the correct medication at each drug round, but several studies suggest that this does not always occur. Unfortunately medication errors do occur and are a persistent problem associated with healthcare practice (O'Shea, 1999).
Medication errors due to illegible handwritten prescriptions, overlooked allergies and drug interactions, and incorrect dosages are often a problem. Because of this technology-based interventions are being used in order to help reduce the likelihood of these medication errors. Computerized physician order entry (CPOE) has been authorized as one of three initial methods that are being widely adopted by hospitals in order to help reduce prescribing and transcription errors. Several factors are thought to influence the appropriate use of particular technologies for managing medications. These factors include the complexity of a hospital environment, limitations in the number of care components that can be automated, and how the technologies interact with humans. If a technology is not used as it is intended, increased inefficiency and medical errors can still result. As a result, in addition to demonstrating the value of a new technology with outcomes evidence, it is important to investigate whether the technology is being used appropriately and to identify barriers to its appropriate use (Oren, Shaffer, and Guglielmo, 2003).
Medication errors that occur when using Health Information Systems can be either from errors in the systems themselves or from the individuals that are using the systems. The medication use process in health care systems involves clinical and technical activities, including both written and verbal communications; delegated process execution; and documentation of the activity. These activities are carried out by some combination of manual, semi-automated, and computerized processes to provide medications to patients. Errors that result from using a computer can occur at any phase of the medication-use process (i.e., prescribing, transcribing or documenting, dispensing, administering, and monitoring). Computer-entry errors occur when incorrect data, such as patient names, drugs, drug doses, and laboratory test results, are entered into a computer system. Incomplete data entry also presents a risk for medication errors (Santell, Kowiatek, Weber, Hicks, Sirio, 2009).
Factors that Contribute to Errors
Many hospitals still use a combination of paper-based systems and computerized systems in order to process medication orders. These situations contribute to the risk of errors in order entry and dose scheduling. There is also room for error in the notation of medication allergies; access to pertinent patient information (e.g., laboratory data, current conditions, allergies, medications); identity of the medication or the dose administered compared to original orders and standard dosing schedules; and medication distribution, administration, and documentation (Santell, Kowiatek, Weber, Hicks, Sirio, 2009). When dealing with human beings there is always going to be present a factor for mistakes to be made.
Medical errors cause up to 98,000 people to die every year in the United States. It is thought that they are the fifth leading cause of death. The cost to the United States is $29 billion annually (Al-Assaf, Bumpus, Carter and Dixon, 2003). Because of this there has been a big push for innovative health information technologies (health it) that would provide system-wide support to help reduce medical errors and improve patient quality of care. "A number of studies suggest that effective implementation of health it, such as electronic health records (EHRs), computerized physician order entry (CPOE), and data exchange networks have the potential to generate cost savings and improve patient safety" (Damberg, Ridgely, Shaw, Meili, Sorbero, Bradley and Farley, 2009). It has been estimated that a widespread, nationwide adoption of EHR systems could produce efficiency and safety savings of $142 billion in the ambulatory care setting and $371 billion in the inpatient setting over the next 15 years. Health it has the potential to assist in dramatically transforming the delivery of health care, making it safer, more effective, and more efficient (Damberg, Ridgely, Shaw, Meili, Sorbero, Bradley and Farley, 2009).
Areas for Improvement
Medication errors occur everyday and even with the implementation of information technology in the healthcare arena there is still room for improvement. It is thought that a lot of patient errors can be averted if the launch of the it systems are better planned and implemented. Often times there are difficulties that are encountered when implementing it systems. It implementation must have support from the top level of management, strong clinical leadership, a proactive internal marketing campaign, a timeline and an implementation approach that allows for learning and change. Careful planning and thoughtful perseverance are required to ensure a successful it implementation that benefits patients along with everyone involved (Spetz and Keane, 2009).
Another area that would need to be looked at for improvement would be that of training. It is very important that those who are using the information technology not only understand how it works but also know how to use it. It has been seen that when people have not been trained properly that errors can still occur. This is not the outcome that is desired since the one of the goals in using information technology in health care is to reduce the number of errors that are made and improve patient quality of care.
It is also thought that working closely with information technology personnel dedicated to assisting pharmacy departments and vendors, along with providing adequate trainingfor pharmacy staff and development of national standards for drug information displays in computer order-entry systems may help minimize errors as well (Santell, Kowiatek, Weber, Hicks, Sirio, 2009). Training must be a never stopping process because of the every changing world that healthcare information technology exists in. As things change people must be made aware of these changes and then trained so that they can provide patients with efficient and effective healthcare.
Information technology (it) has the potential to improve the quality, safety, and efficiency of health care everywhere. Dispersal of it in health care is generally low, but surveys indicate that providers are looking to increase their investments. Drivers of investment in it include the promise of quality and efficiency gains. Barriers include the cost and complexity of it implementation, which often necessitates significant work process and cultural changes within an organization (Information technology in health care, n.d.). The implications of the changes that must be made in our healthcare sector are clear: we must be prepared to harness and integrate new technologies in order to deliver high quality, reliable and timely services to patients everywhere (Brommeyer, 2005).
With all of the new technology that has come onto the scene over the last few years it is interesting to give some thought to what potential lies in the future. It would be interesting to know how information technology will change in the medication dispensing…