Use of information systems in healthcare
In 1970’s computers were first used in the departments to support functions such as accounting, and general administration works just like any other department. In the 1980’s the cost of computers started going down allowing many people to be in a position to afford a computer, with that the use of computers was stretched to prospective payments of bills via the credit cards. The invention of internet in 1990s brought about =a great demand for health systems. The need for sharing of information was exaggerated and most of the functions was shifted to the use of information systems. In the current systems the information systems have been made to adopt a centre stage in terms of supporting the core function of the hospital which is geared towards the patient. The systems, are meant to improve the chances of improvement, chances of of better handling and provide affordable customised care to the clients.
Chronology of Developments in Nursing Informatics
- Francis Gremy, a Frenchman was the first person to come up with the name ‘Informatique medical’ which translates to medical informatics in English(ehow,2010).
- In 1988,Univesity of Maryland initiated a first degree education program in nursing informatics
- In 1992, a composite health care system that was used in Walter Reed criticized for mixing up information regarding to doctors, nurses, and patients (ehow, 2010).
- A workshop on First users policy was held where they developed a version of nursing informatics curriculum.
- October 2001, document called Scope and Standards of Nursing Informatics was released. It provided for the description of the Nursing Informatics as ‘the use of computer and IT that assists nurses in their functions(Monteiro et al, 2005).
- In December 2006, the ONIG(Ontario Nursing Informatics group) held their Annual general meeting. In attendance were over 50 nurses in the profession. This is an affiliate member of an association of registered nurses of Ontario
Barcode Medication Administration System
The pharmacist dispenses the bar-code-labeled unit dose of the drug to the floor. When attempting to administer a dose, the clinician administering the medication (i.e., registered nurse, licensed vocational nurse, or respiratory therapist) uses a hand-held device to scan the bar codes on his or her identification badge, the patient’s wristband, and the drug. If the BPOC system cannot match the drug to be given with the order in the system, it alerts the user with a visual warning. At that point, the clinician can change what he or she will administer or override the warning and continue with drug administration. If the clinician overrides a warning and continues with the administration, the BPOC system evaluates the situation to determine whether an error may have occurred. If the clinician cancels or alters administration of the drug, the BPOC system determines whether an error was prevented. The details of the transaction, including the name of the clinician administering the medication, are automatically captured in an electronic medication administration record. The hospitals in the network using BPOC apply bar codes to all inpatient medications. Bar codes can be damaged or lost, but more than 90% of the doses delivered to the floor bear a readable bar code. If a clinician encounters an unreadable bar code, he or she can use the computer mouse and keyboard to select the dose to be administered from a list in the patient’s electronic profile. Selecting a dose in this manner limits the system’s error-checking abilities, but it ensures that the drug’s administration will appear in the patient’s electronic medication record.
Medication Administration Process
- Right Patient, Right Medication, Right Time, Right Dose, Right Route
- The Information system
- Matches Bar-Code to medication order
- Checks 5 rights of medication administration & notifies nurse of any discrepancies
- Documents medication administration
- Charges patient for medication
- Reminds the nurse of missed and late medications
Software in a Barcode Medication Administration System
The medication administration software helps nurses at the bed side and prevents medication errors. The application is easy to use and is self explanatory allowing for user friendliness.
Some of the software listed can be used in combination with MAC.
The goal of the future is to combine programs, improve safety, eliminate time consuming charting (paper charting) and allow for more time with the patient.
The wave of the future is to allow for computerized charting and health information charting capabilities not only within hospitals, but with physicians offices as well.
Module MAC
The goal of MAC software is to eliminate medication errors at the bedside.
During Report, she is able to check patient demographics, allergies, lab values, and other information right on the screen.
Patient is selected by personal census, location census, patient inquiry, or by scanning patient id bracelet.
Patients database
This is what is seen when accessing the database. Nurses can simply select the patient and follow on screen guidelines and instructions.
The nurse is allowed to chart on this patient as well.
Information is then shared with pharmacy and doctors.
Hardware in a Barcode Medication Administration System
Bring med carts closer to patients & Bar-Code scanning equipment, Educate & involve patients in the process, Implement bar-coding in PACU, Cardiac Cath Lab & Outpatient Units,Implement hand-held devices for scanning patient ID bands and Implement CPOE.
Barcode scanning devices
The handheld scanning device is constructed of hard durable plastic resembling those seen in the grocery store. The light weight and comfortable design makes it desirable for nurses to use at the bedside.
The built in decoder helps to determine the right patient, right medication, right route, right time, and right dose.
The high intensity red aiming beam is also similar to that in the store. This beam scans the patient, medication, and the nurses badge to prevent medication errors.
The trigger button makes it easy to scan quickly and accurately.
If we went with all wired scanners then room size became an issue. At cottonwood the patients where two to a room –meaning another computer would have to be placed and a scanner. At IM the rooms are much bigger than any of the other hospital rooms in the region. Not to mention the number of IV lines and tubes.
Some of the issues if we went with all wireless. There is a significant learning curve involved in using the wireless solution. Because it captures the data similar to taking a picture then transfers if to the modem, scanning must be done with a steadier hand.
With the initial thinking to have the nurses carry a scanner there was many complaints of the scanner not working. It wasn’t very ergonomically correct. We then decided to purchase battery handles for each wireless scanner.
Contribution of Barcode Medication Administration System
- Has reduced the number of medical errors associated with administration significantly
- Allows a nurse to receive immediate patient verification
- The system involves fewer physical contact with the patient thereby minimizing possibilities of Nosocomical infections.
- Speeds the administration process
- Helps the organization to save on cost related to many transactions.
Advantages of BMAS
- Reduces medication administration errors
- Requires the use of linear barcodes on prescription drugs
- Confirms the patient’s identity
- Matches the patient with the medication order
- Confirms that administering nurse has the authority to dispense the medications
Disadvantages of BMAS
- Not foolproof
- Bar codes mismatch with drug, dose, and patient at times
- Bar code sometimes function erroneously
- Unable to scan bar codes properly at times
- Nurses override alerts for medication administration at 4.2% of individual patient
Human factors limiting effectiveness of BMAS
Challenges:
- Some nursing resistance from additional time
- New sources of error:
- interface usability
- miss trends in past doses
- integration with IV “smart pumps”
- Self-reported errors higher in hospital:
- IV pump programming
- pharmacy order entry
- prescribing near-misses
- Steep learning curve for some nurses and physicians
- Some meds not bar-coded (unit dose oral, injectables
Cultural and management issues
A medication error policy with punishment potential may have been one of the most significant barriers to the success of the initial BCMA implementation. Clinical nursing staff members were assigned points based on the nature and severity of documented individual errors, and disciplinary action was to have been based on the number of points accumulated for a particular period the medication error policy was rescinded in November 2000.
The BCMA implementation group also was restructured to include key nursing, pharmacy, and computer support staff members. This new group helped to rewrite the hospital’s BCMA and error policy such that punishment for medication errors was an option only when the error was associated with a criminal or purposefully unsafe act, alcohol or substance abuse by an employee, or alleged or suspected patient abuse of any kind. The Institute of Medicine has agreed: “Designing systems for safety requires specific, clear, and consistent efforts to develop a work culture that encourages reporting of errors and hazardous conditions, as well as communication among staff about safety concerns.”25 In an effort to further enhance patient safety, build front-line staff confidence, and illustrate the responsiveness and support of management to the BCMA end-users, the collaborative team and management established Patient Safety Rounds, which is modeled after the Beth Israel Deaconess Medical Center’s Voluntary Reporting System.
Conclusion
- The use of information systems within the health care is expected to become even more in the recent future. The integration of the information systems into the medical has improved a lot of issues including reduction of errors relating to administration transcription and errors of wrong use of medical information available.
- However information systems are continually improving the health care systems to a level that they will form the greatest part of diagnosis, business delivery, therapy and transcription.