Gary L. Cochran

Errors prevented by and associated with bar-code medication administration systems.

As expected, bar-code medication administration systems can prevent medication errors. However, health care organizations must be aware of identified failure points in bar coding that may contribute to errors.

Comparison of medication safety effectiveness among nine critical access hospitals

PURPOSE The rates of medication errors across three different medication dispensing and administration systems frequently used in critical access hospitals (CAHs) were analyzed. METHODS Nine CAHs agreed to participate in this prospective study and were assigned to one of three groups based on similarities in their medication-use processes: (1) less than 10 hours per week of onsite pharmacy support and no bedside barcode system, (2) onsite pharmacy support for 40 hours per week and no bedside barcode system, and (3) onsite pharmacy support for 40 or more hours per week with a bedside barcode system. Errors were characterized by severity, phase of origination, type, and cause. Characteristics of the medication being administered and a number of best practices were collected for each medication pass. Logistic regression was used to identify significant predictors of errors. RESULTS A total of 3103 medication passes were observed. More medication errors originated in hospitals that had onsite pharmacy support for less than 10 hours per week and no bedside barcode system than in other types of hospitals. A bedside barcode system had the greatest impact on lowering the odds of an error reaching the patient. Wrong dose and omission were common error types. Human factors and communication were the two most frequently identified causes of error for all three systems. CONCLUSION Medication error rates were lower in CAHs with 40 or more hours per week of onsite pharmacy support with or without a bedside barcode system compared with hospitals with less than 10 hours per week of pharmacy support and no bedside barcode system.

From physician intent to the pharmacy label: prevalence and description of discrepancies from a cross-sectional evaluation of electronic prescriptions

Objective The objectives of this cross-sectional study were to estimate the prevalence of unintended discrepancies between three sources of prescription information and to describe the types of electronic prescribing system vulnerabilities identified. Methods Staff from community pharmacies identified approximately 200 new prescriptions written at three participating ambulatory care clinics (2 adult, 1 paediatric). Unintended discrepancies were identified by comparing three sources of prescription information: (1) the prescribers note as documented in the patients chart; (2) the electronic prescription (e-prescription) entered into the clinics electronic prescribing software; (3) the medication that was ultimately dispensed by the pharmacy as indicated on the prescription label. The discrepancy rate was calculated by dividing the number of discrepancies identified by the number of prescriptions evaluated. Results A total of 602 prescriptions written by 33 prescribers were evaluated from the 3 ambulatory care clinics. The discrepancy rate between the prescribers note and the e-prescription was 1.7%, 0.6% and 3.9% for the three clinics. The discrepancy rate between the e-prescription (clinic) and the prescription label (pharmacy) was 4.2%, 0.9% and 1.5%. Differences between directions for administration was the most common type of discrepancy identified. Conclusions Discrepancy rates between the prescribers note and the e-prescription were similar to the discrepancy rates between the e-prescription and pharmacy label. To reduce outpatient medication errors, a better understanding is needed of the sources of discrepancies that occur within the prescribers clinic, and those that occur between the clinic and pharmacy.

Health care provider perceptions of a query-based health information exchange: barriers and benefits

Background Health information exchange (HIE) systems are implemented nationwide to integrate health information and facilitate communication among providers. The Nebraska Health Information Initiative is a state-wide HIE launched in 2009. Objective The purpose of this study was to conduct a comprehensive assessment of health care providers’ perspectives on a query-based HIE, including barriers to adoption and important functionality for continued utilization. Methods We surveyed 5618 Nebraska health care providers in 2013. Reminder letters were sent 30 days after the initial mailing. Results A total of 615 questionnaires (11%) were completed. Of the 100 current users, 63 (63%) indicated satisfaction with HIE. The most common reasons for adoption among current or previous users of an HIE (N = 198) were improvement in patient care (N = 111, 56%) as well as receiving (N = 95, 48%) and sending information (N = 80, 40%) in the referral network. Cost (N = 233, 38%) and loss of productivity (N = 220, 36%) were indicated as the ‘major barriers’ to adoption by all respondents. Accessing a comprehensive patient medication list was identified as the most important feature of the HIE (N = 422, 69%). Conclusions The cost of HIE access and workflow integration are significant concerns of health care providers. Additional resources to assist practices plan the integration of the HIE into a sustainable workflow may be required before widespread adoption occurs. The clinical information sought by providers must also be readily available for continued utilization. Query-based HIEs must ensure that medication history, laboratory results and other desired clinical information be present, or long-term utilization of the HIE is unlikely.

Nursing Strategies to Increase Medication Safety in Inpatient Settings.

Using data obtained through 2 multidisciplinary studies focused on medication safety effectiveness, this article provides nursing recommendations to decrease medication delivery errors. Strategies to minimize and address interruptions/distractions are proposed for the 3 most problematic time frames in which medication errors typically arise: medication acquisition, transportation, and bedside delivery. With planned interventions such as programmed scripts and hospital-based protocols to manage interruptions and distractions, patient safety can be maintained in the inpatient setting.

Comparison of medication safety systems in critical access hospitals: Combined analysis of two studies

PURPOSE The role of pharmacist transcription, onsite pharmacist dispensing, use of automated dispensing cabinets (ADCs), nurse-nurse double checks, or barcode-assisted medication administration (BCMA) in reducing medication error rates in critical access hospitals (CAHs) was evaluated. METHODS Investigators used the practice-based evidence methodology to identify predictors of medication errors in 12 Nebraska CAHs. Detailed information about each medication administered was recorded through direct observation. Errors were identified by comparing the observed medication administered with the physicians order. Chi-square analysis and Fishers exact test were used to measure differences between groups of medication-dispensing procedures. RESULTS Nurses observed 6497 medications being administered to 1374 patients. The overall error rate was 1.2%. The transcription error rates for orders transcribed by an onsite pharmacist were slightly lower than for orders transcribed by a telepharmacy service (0.10% and 0.33%, respectively). Fewer dispensing errors occurred when medications were dispensed by an onsite pharmacist versus any other method of medication acquisition (0.10% versus 0.44%, p = 0.0085). The rates of dispensing errors for medications that were retrieved from a single-cell ADC (0.19%), a multicell ADC (0.45%), or a drug closet or general supply (0.77%) did not differ significantly. BCMA was associated with a higher proportion of dispensing and administration errors intercepted before reaching the patient (66.7%) compared with either manual double checks (10%) or no BCMA or double check (30.4%) of the medication before administration (p = 0.0167). CONCLUSION Onsite pharmacist dispensing and BCMA were associated with fewer medication errors and are important components of a medication safety strategy in CAHs.

Electronic prescriptions: opportunities and challenges for the patient and pharmacist

Electronic-prescribing (e-prescribing) is one part of the larger move to increased utilization of health information technologies (HITs). Along with other HITs such as electronic health records and health information exchanges, e-prescribing is seen as a tool for improving patient-centered care. The potential benefits of e-prescribing are meant to extend to prescribers, payers, pharmacies, and patients. In general, the benefits of e-prescribing fall into the following categories: patient safety, improved prescribing, efficiency/workflow, and cost savings. Most literature to date has focused on the benefits to prescribers. This review summarizes the exist - ing literature around the impact of e-prescribing on pharmacists and patients. While there are studies supporting many of the proposed benefits to pharmacies, such as increased legibility of prescriptions and improved workflow, there have also been studies that demonstrate unin - tended challenges brought about by e-prescribing. Likewise, studies examining the patients experience with e-prescribing make it clear that patients do not always see all of the benefits of e-prescribing, which happen away from their view. There are opportunities for additional research and development of new technologies to improve the e-prescribing experience for both

Potential Effect of Coding Differences on Comparisons of Rural and Urban Outcomes

under tension at low speed, which stimulates the ankle and may be why tai chi exercise increases ankle strength. A previous study found that the load on the first metatarsal head and the great toe were significantly greater than on other regions during tai chi and concluded that the plantar pressure characteristics of tai chi may be one factor in the increase in muscle strength. Hence, wearing a weighted vest could give the ankle muscle more load stimulation and increase ankle muscle strength even more. The results of this study indicate that weighted tai chi can increase leg muscle strength significantly. Weighted tai chi is suitable for physical training of older adults to improve the strength of the lower extremities because of its low cost, high adherence, and the gentle characteristic of the movements, especially for older adults who cannot conduct resistance training because of lack of opportunity.