Medication changes with technology: A description and detailed review of five clinical electronic systems that correlate with the process of medication administration technology. Computerized physician / prescribed order entry (CPOE)

In 2000, following the huge spate of accidental death (approximately 2 million) that occurred nationwide, the Department of Health Services (DHS) surveyed hospitals in California regarding the nexus of patient safety and technology and which technological system they had it in mind to procure by 2005.

46% of the hospitals surveyed rated the computerized physician / prescribed order entry (CPOE) as their preferred technological system since it helps the prescribing clinician enter the medication order directly into the system (Spurlock, et al., 2003). The CPOE, moreover, can instantly detect any error in the prescription as well as employing various levels of decisions support to detect errors to situations that could have led to an error in the prescription (such as duplicate or incorrect doses or tests). Also important is the fact that the CPOE can constrain certain types of errors (such s allergies, dosing perimeters, weight / age / renal function change, and so forth) from being entered in the prescription in the first place. The medical orders are transferred to the medical staff or departments (such s pharmacy or laboratory) that are responsible for filling out the order.

Because the CPOE facilitates order completion in an error-reducing manner as well as allowing order entry at either point-of-care or off-site site, and simplifies inventory and posting of change besides scrupulous error-checking, the CPOE was rated as the most popular technological tool that hospitals planned to have installed in 2005 in response to the technology requirements of California Senate Bill (CSB) 1875. 157 hospitals planned to purchase it and rated it as the technology that was most efficient and important in reducing and preventing medical-related fatality.

Nonetheless, the CPOE, despite all its benefits, can present new types or errors and, particularly, when first used may show slower entry of orders than when person-to-person communication is effected in an emergency situation. There may be also an over reliance on the technology's capabilities that errors are screened leading to unnecessarily heightened mortality (as occurred in the Children's Hospital of Pittsburgh's Pediatric ICU where CPOEs were introduced. Similarly, shortcut or default selections can result in toxic outcome for obese or elderly patients, whilst frequent alerts and warning can interrupt the workflow. CPOE needs close supervision to be effective and users need constant training for optimum efficiency of system.

Electronic medication administration record (eMAR)

Medication administration records are generated whenever a patient receives a medication. The records document the specific route, drug, dose, and time that the medication is administered. It also serves to prompt the clinician when to apply the medication as well as to schedule the dose.

Written MARs can cause minor to major errors due to illegibility of writing, incorrect transcription, failing to record a certain medication, or numerous other such errors.

An eMAR can be connected to a pharmacy information system or can be generated in a stand-alone computer or Web-based operation. Barcode point-of-care systems can also generate eMARs.

The eMAR was rated third on the hospitals' list for planned purchase. 108 hospitals planned to acquire this tool (Spurlock, et al., 2003).. A study in 2009 (Health Information Technology, 2009) also showed the eMAR to be capable of significantly reducing high risk in nursing homes. More than 300 hours of observed implementation and integration of eMARs in five Midwestern nursing homes which contained 3,700 residents found that the tool significantly improved communication among a variety of user, as well as integrating complex tasks and signaling alerts on medication safety issues. However, the deficiencies in the eMAR lay in the fact that staff found it harder to transfer to this new technologically complex system, and that the eMAR highlighted what was deficient in the traditional medication systems instead of updating and fixing them. The eMAR, however, brought these problems (such as omitted medication or...

The bar code point-of-care can also produce the patient's electronic medication administration records, as well as prevent counterfeit or expired drugs from being administered. It may also be implemented on surgical instruments to denote sterilization.
Medication bar codes indicate the National Drug Code (NDC) 10-digit string of the drug as well as the name of the medication dosage, and drug company that produces the medication. Lot number and expiration date of drug are also included.

This bar-coding technology is distinct from other bar-coding systems that are used in the pharmacy alone for tracking and dispensing of inventory. In fact, bar codes are used in more ways than one and combining with bar codes with smart pumps can further reduce medication errors.

Only 52 hospitals of the 157 surveyed placed bar codes Point-of-care technology on their list for purchase (Spurlock, et al., 2003)..

Automated dispensing cabinets (ADC)

These are mobile 'cabinet's that contain multiple medications for dispensing on the nursing unit. The 'cabinets' have software to track medication dispensing as well as varying levels of safeguards. The most technologically advanced of these cabinets have a mechanism that enables all other cabinets to be "locked out" except for those containing the specific medications for specific patients at the times determined by the physician's orders. Like this, risk of safety or misuse of drug is locked out and the drug is prescribed as per physician's requirements in the safest way.

Incidentally, ADCs also reduce the billing paperwork by enabling providers to record charges upon dispensing. Nurses can also note returned medications as well have speedier access to the patient's medications. Decreased wait time, additionally, also enhances nurse and patient satisfaction with care.

ADCs can also be connected to the hospital pharmacy so that new orders can be entered by the nurse on duty and checked by the pharmacist against the patient's profile.

The ADCs succeeded rating of the CPOE and the eMAR as the third desired technology for hospitals in California (Spurlock, et al., 2003)..

Since there is no single method of medication distribution that works equally well in all hospitals across the board, ADCs are customized to fit the needs of particular hospital and pharmacies. ADCs, in short, can improve accountability of the inventory and patient safety as well as streamlining the billing and drug process leading to enhanced patient and nurse satisfaction.

Smart IV Pump

These are intravenous pumps that can be programmed with drug libraries that can not only perform calculations but also apply medication-specific dosing limits. Smart IV Pump are coherent with both bag and syringe devices and are sometimes combined with bar-coded medications in order to further reduce possibility of error. In fact, smart pumps preceded the rated preference of bar code point-of-care by just 53 hospitals in ratio to the 52 who intended to purchase bar code point-of-care.

The effect of IV drugs is one of the most difficult to reverse once administered. According to Kaufman (2009), IV medications have been responsible for causing 79% of fatal errors. In this sense, smart pumps are invaluable in restraining and preventing these errors from occurring.

Kaufman's (2009) conclusion on smart IV pumps is that they can provide safer patient care in complex health-system environments. They do have safety considerations that need to be taken in mind and evaluated consistently, but they certainly can reduce medication errors from IV medications.

In conclusion, the perfect, most complete and integrated medical system would require all of these technologies to be looped end-to-end in one seamless process. This would entail CPOE to be linked to a comprehensive electronic medical record whilst nurses would administer the medications with…