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Missed medication doses can affect patient safety in hospitals. The use of automated dispensing cabinets (ADC) in clinical areas may reduce the occurrence of medications being unavailable at the time of need by alerting pharmacy to replenish stock. However, workarounds in ADC use can affect this capability. We studied nurses' use of an ADC in a paediatric intensive care unit with ~54 hours of observation, semi-structure interviews (19 nurses; 4 pharmacy/management staff) and review of reported incidents. We found running out of medication a recurrent problem despite the ADC. Contributing factors affecting data entry in the ADC, and therefore replenishment alerts to pharmacy, included: the organisation of medication activities in the ward, nurses' information needs, patients' medication needs, and ADC design. Running out of medications was a 'tragedy of the commons'. Effective solutions may require going beyond user training and directives for accurate data entry, to work process redesign. [ABSTRACT FROM AUTHOR]

Evidence is limited of automated dispensing cabinets (ADCs) impact on effectiveness and efficiency of controlled drugs' (CDs) governance processes. We carried out a mixed-methods study of an ADC in an intensive care unit. We found ADC improved effectiveness and efficiency of governance of CDs through secure storage, alerts and automated recording of transactions. Limitations were associated with ADC design and 'fit' between ADC and some types of CDs. [ABSTRACT FROM AUTHOR]

Medication errors are a leading cause of preventable harm in hospitals. Electronic medication systems (EMS) have shown success in reducing the risk of prescribing errors, but considerable less evidence is available about whether these systems support a reduction in medication administration errors in paediatrics. Using a stepped wedge cluster randomized controlled trial we investigated changes in medication administration error rates following the introduction of an EMS in a paediatric referral hospital in Sydney, Australia. Direct observations of 284 nurses as they prepared and administered 4555 medication doses was undertaken and observational data compared against patient records to identify administration errors. We found no significant change in administration errors post EMS (adjusted Odds Ratio [aOR] 1.09; 95% CI 0.89-1.32) and no change in rates of potentially serious administration errors (aOR 1.18; 95%CI 0.9-1.56), or those resulting in actual harm (aOR 0.92; 95%CI 0.34-2.46). Errors in administration of medications by some routes increased post EMS. In the first 70 days of EMS use medication administration error rates were largely unchanged.

Medication prescribing in paediatrics is complex and compounded by the need to provide age and weight related doses, and errors continue to be problematic. Electronic medication systems (EMS) can reduce errors through dosing calculators and computerised decision support. However, evidence on costs and benefits of these systems is limited, particularly in paediatric hospitals. This paper presents the development of a cost-benefit analysis (CBA) framework to assess the impact of an EMS implementation in a paediatric tertiary hospital. An innovative component of the framework is the incorporation of the impact of the effects of the EMS for both the health system as well as for patients and their wider family networks, allowing a net social benefit assessment. We describe the impact of non-clinical out-of-pocket costs of admission and use discrete choice experiments to measure both medication related harm and the importance of medication safety to families and members of the community.

Electronic medication systems (EMS) improve medication safety in hospitals; however require modifications to optimize their performance. Drawing on a five-year program of research, we developed the Health Innovation Series to disseminate recommendations arising from our research to a wide audience. Each issue contains EMS optimization tips that can be actioned by EMS managers and system vendors, as well as user tips for health professionals including nurses, doctors and pharmacists. Five issues were released by 30 Nov 2022, via two email campaigns, with further issues planned. The five issues had 2,035 downloads by March 2023. The most recent email campaign open and click rates indicate very good audience engagement.

The inclusion of new technologies in health, such as the 2D Codes scanning Drug Administration System (BCMA), has an impact on the perception of nurses, mainly changes in their workflow, and incorporation of mobile devices for patient care. The objective of this study is to know the perceptions and expectations of nurses regarding the implementation of BCMA. Qualitative research was conducted based on interviews with groups of nurses from different inpatient wards of the Hospital Italiano de Buenos Aires, with and without system implementation. The analysis of the interviews produced the categorization of information for future interventions and the need to create standard strategies for the effective continuity during the implementation of the project. Some determinants for the acceptance of the system by the nursing staff: the ease of use of the mobile station, the device, the nursing application and its usefulness, and high expectations about the new process. [ABSTRACT FROM AUTHOR]

Medication errors are common in healthcare settings. To prevent these errors, use of modern technology is suggested. Improvement of medication administration system particularly at the time of drug administration is mandated in Iran. Barcode medication administration (BCMA) systems are useful in this regard. This study was conducted to assess nurses' attitude for the use of BCMA systems. To this end, 283 randomly selected nurses working in teaching hospitals were surveyed using a five point Likert scale questionnaire. The most positive attitudes were related to the role of BCMA in reducing medication errors (4.02±0.8), improving performance (3.8±0.99), productivity (3.8±0.97) and making patient care easier (3.83±0.9). Only 9.9 percent of nurses did not like to use the technology. There was no significant difference between nurses in terms of their age, experience, education, and hospitals. In conclusion, nurses' attitude about BCMA was in a relatively good level. However, there is a need to train nurses for the use of this technology. [ABSTRACT FROM AUTHOR]

Decision-support based medication adjustment in heart failure management. Prospective analysis of clinical decision support in fifteen patients that collected vital parameters and medication intake up to one year within a clinical trial. Correlation of event episodes and medication adjustments with respect to applied rule-sets and medication classes. 713 events were grouped to 195 event episodes. Physicians performed 86 medication adjustments. 30 of them were triggered by event episodes. 35% of all performed medication adjustments occurred between event episodes. 20% of all episodes triggered a medication adjustment. 15% of all episodes triggered the expected medication adjustment. Correlation between episodes and medication adjustment was low. Further analysis needs to be done, to evaluate reasons for low correlation and how the rule-set should be adapted to increase reliability. [ABSTRACT FROM AUTHOR]

Despite CPOE (Computerized Physician Order Entry) systems' potential to enhance patient safety by reducing medication errors, recent studies have cast some doubts on their role in error reduction. CPOE systems with poorly designed interfaces have proven to cause users dissatisfaction and to introduce new kind of errors in the ordering process, suggesting a threat instead of an enhancement of patient safety. The main objective of this study is to identify usability problems related to a CPOE medication system's design and determining their severities. Two experts completed a cognitive walkthrough (CW) of an ordering task based on a clinical scenario for ordering the consolidation phase of chemotherapy for a leukemic patient. Fifty five usability problems were found and classified into eleven categories. CW identified cosmetic to catastrophic problems leading to inefficient use of the CPOE system and potentially resulting in users' confusion, longer ordering duration, and medication errors. The complexity of the CPOE design, its rigidness and lack of user guidance suggests the necessity to redesign the current user interface in order to match clinicians' ordering behaviors and to fully support them in the medication ordering process. [ABSTRACT FROM AUTHOR]

Although many studies have discussed the benefits of Computerized Provider Order Entry (CPOE) systems, their configuration can have a great impact on clinicians' adoption of these systems. Poorly designed CPOE systems can lead to usability problems, users' dissatisfaction and may disrupt normal flow of clinical activities. This paper reports on a literature review focused on the identification of CPOE medication systems' design aspects that impact CPOE systems' usability and create opportunities for medication errors. Our review is based on a systematic literature search in PubMed, EMBASE and Ovid MEDLINE for relevant publications from 1986-2006. We categorized the design aspects extracted from relevant publications into six different groups: 1) timing of alerts, 2) log in/out procedures, 3) pick lists and drop down menus, 4) clues and guidelines, 5) documentation and data entry options, and 6) screen display and layout. Our review shows that the manner in which a CPOE system is configured can have a high impact on ease of system use, task behavior of clinicians in ordering drugs, and medication errors. Characterization of consequences associated with certain CPOE design aspects provides insight into how CPOE system designs can be improved to enhance physicians' adoption of these systems and their success. Recommendations are provided to enable CPOE system designers to create CPOE systems that are not only more user friendly and efficient but safer. [ABSTRACT FROM AUTHOR]

Medication reconciliation (MR) is a process that seeks to assure that the medications a patient is supposed to take are the same as what they are actually taking. We have developed a method in which medication information (consisting of both coded data and narrative text) is extracted from twelve sources from two clinical information systems and assembled into a chronological sequence of medication history, plans, and orders that correspond to periods before, during and after a hospital admission. We use natural language processing, a controlled terminology, and a medication classification system to create matrices that can be used to determine the initiation, changes and discontinuation of medications over time. We applied the process to a set of 17 patient records and successfully abstracted and summarized the medication data. This approach has implications for efforts to improve medication history-taking, order entry, and automated auditing of patient records for quality assurance. [ABSTRACT FROM AUTHOR]

Evidence regarding how health information technologies influence clinical work patterns and support efficient practices is limited. Traditional paper-based data collection methods are unable to capture clinical work complexity and communication patterns. Our objective was to design and test an electronic data collection tool for work measurement studies which would allow efficient, accurate and reliable data collection, and capture work complexity. We developed software on a personal digital assistant (PDA) which captures details of nurses' work; what task, with whom, and with what; multi-tasking; interruptions and event duration. During field-testing over seven months across four hospital wards, fifty-two nurses were observed for 250 hours. Inter-rater reliability scores were maintained at over 85%. Only 1% of tasks did not match the classification developed. Over 40% of nurses' time was spent in direct care or professional communication, with 11.8% in multi-tasking. Nurses were interrupted approximately every 49 minutes. One quarter of interruptions occurred while nurses were preparing or administering medications. This approach produces data which provides greater insights into patterns of clinician's work than has previously been possible. [ABSTRACT FROM AUTHOR]

Electronic medication management (eMM) systems can have a significant impact on efficiency and safety. There is limited evidence on the effects of eMM implementation on the physical location of work. The objective of this study was to evaluate the impact of eMM and associated hardware implementation on the location of tasks performed by doctors and nurses. 41.5 hours of observation were conducted in the oncology ward of a paediatric hospital. Tasks, locations and resources used were recorded pre and post eMM implementation. Results showed that a wider variety of locations were used to conduct tasks following eMM implementation. Post-eMM, more tasks were performed in the hallway, where medication trolleys with attached laptops were situated, and in patient rooms where additional computers were installed, providing more opportunities for patient/carer and clinician interaction. The findings from this study reveal the impact that computer placement has on the location of work for doctors and nurses, and the importance of planning hardware placement for eMM implementation.

Electronic Health Records (EHR) are constantly gathering an exponential amount healthcare data. Historical data is often studied to identify trends and determine the effectiveness of interventions, but rarely is Real-time data utilized to positively influence the nurse at the Point of Care. A dashboard allowing nurses to visualize their individual Near-Miss (MN) medication error risk as the needs and subsequent workload of the patients they served changed was created and piloted for 30-days. Implementation of the dashboard resulted in a 15.6% reduction of NMs. [ABSTRACT FROM AUTHOR]

The purpose of this study is to describe nurses' views of what supports safe medication administration in the current electronic medication administration system. Data was collected at the turn of 2014-2015 and open-ended answers were inductively analyzed using content analysis. The system's usefulness, good usability, and the feature that there is extra information available on medications and the patient-specific information needed in medication administration are elements that support safe medication administration. The study identifies wide support for the electronic medication administration system in safe medication administration.

This paper explores the impact of an electronic medication management system (EMMS) on users in an intensive care unit using the Unified Theory and Use of Technology constructs. It also explores the impact of having a consistent EMMS hospital wide, as it is the first Australian hospital to implement the same EMMS hospital wide. The research model was evaluated using survey data from 100 nurses, doctors and pharmacists both within the ICU and externally, to assess the usability and acceptability of the system. Results showed that performance expectancy, effort expectancy, social influence and facilitating condition all correlate with overall user satisfaction. Overall, teams external to the ICU are in strong favor of its implementation whist user acceptance from within the ICU itself is poor.

Background: electronic prescription is shown to have many benefits in terms of reducing medication errors, improving patient safety, productivity, and resource management, but it may cause new errors and physician frustration if not designed and implemented properly. Improving usability and user-centered design is essential for physicians' adoption., Objectives: To enhance the efficiency of the e-prescribing system by reducing the risk of inappropriate selection of the medication and also to reduce the prescribing time and effort to reach the desired drug., Methods: Important data fields for predicting medications were determined through interviews with pharmacists. Among those, fields which were available in a claims dataset of 16 million prescriptions were extracted and were used to develop a neural network model to be used by a recommender system that displays the most probable medications on top of the drop-down list in the e-prescription application., Results: Offline and field evaluations both showed that this model could improve performance., Conclusion: smart recommenders systems can improve e-prescription usability, safety, and enhanced physicians' adoption.

Electronic Health Records (EHR) are constantly gathering an exponential amount healthcare data. Historical data is often studied to identify trends and determine the effectiveness of interventions, but rarely is Real-time data utilized to positively influence the nurse at the Point of Care. A dashboard allowing nurses to visualize their individual Near-Miss (MN) medication error risk as the needs and subsequent workload of the patients they served changed was created and piloted for 30- days. Implementation of the dashboard resulted in a 15.6% reduction of NMs.

Medication management is a complex process and is taken into account of daily activities. Moreover, participation in daily activities could define the wellbeing. On the other hand, the medication management process for visually impaired individuals is more difficult. Nowadays, the technologies like mHealth and RFID, have caused a significant progress in both areas of medication management systems and visually impaired Independent Living. Therefore the aim of this work was to develop an assistive medication management system for visually impaired people in order to improve the medication adherence among them. The development process started by requirements extraction according to goal directed design methodology introduced by Cooper. Then the system, called MedVision was developed, consisting of an android mobile application, RFID device and a medication box with vibration motors and it is developed for Iranian visually impaired individuals in Persian language. At the final step of this study, a functional assessment was performed in order to improve the system even more in next prototypes.

Interoperability among medication classification systems is known to be limited. We investigated the mapping of the Established Pharmacologic Classes (EPCs) to SNOMED CT. We compared lexical and instance-based methods to an expert-reviewed reference standard to evaluate contributions of these methods. Of the 543 EPCs, 284 had an equivalent SNOMED CT class, 205 were more specific, and 54 could not be mapped. Precision, recall, and F1 score were 0.416, 0.620, and 0.498 for lexical mapping and 0.616, 0.504, and 0.554 for instance-based mapping. Each automatic method has strengths, weaknesses, and unique contributions in mapping between medication classification systems. In our experience, it was beneficial to consider the mapping provided by both automated methods for identifying potential matches, gaps, inconsistencies, and opportunities for quality improvement between classifications. However, manual review by subject matter experts is still needed to select the most relevant mappings.

Errors during drug administration stage represent a significant percentage of adverse events associated with health care. Its prevalence is higher in critical care units, due to vulnerable patient population, characteristics of intensive care as well as complexity of pharmacotherapy. Errors can occur at any stage of the medication cycle although they often occur during administration, so nurses' role in prevention is essential. The bar code medication administration (BCMA) technology increases patient safety by instituting control time, but a poorly designed system or a faulty implementation can lead to low utilization in future. This paper describes implementation, evaluation, detection of problems and search for their possible solutions of a BCMA system in the intensive care unit at Hospital Italiano de Buenos Aires.

In July 2012 Australia launched the Personally Controlled electronic Health Record (PCEHR). This structured record allows health related information to be shared between providers as well as between providers and consumers. The next big challenge in delivering value for consumers is to use the medicines information distributed throughout the record in a way that allows better medications management at all levels. This poster points to the design and usability challenges being dealt with in that process during a national roll out and proposes a maturity model to accelerate the delivery of shared medication records. It is suggested that this model will have relevance in other jurisdictions. [ABSTRACT FROM AUTHOR]

Background: Drug is an important part of disease treatment, but medication errors happen frequently and have significant clinical and financial consequences. The prevalence of prescription medication use among the ambulatory adult population increases with advancing age. Because of the global aging society, outpatients need to improve medication safety more than inpatients., Objective: The elderly with multiple chronic conditions face the complex task of medication management. To reduce the medication errors for the elder outpatients with chronic diseases, a cloud medication safety supporting system is designed, demonstrated and evaluated., Methods: The proposed system is composed of a three-tier architecture: the front-end tier, the mobile tier and the cloud tier. The mobile tier will host the personalized medication safety supporting application on Android platforms that provides some primary functions including reminders for medication, assistance with pill-dispensing, recording of medications, position of medications and notices of forgotten medications for elderly outpatients. Finally, the hybrid technology acceptance model is employed to understand the intention and satisfaction level of the potential users to use this mobile medication safety support application system., Results: The result of the system acceptance testing indicates that this developed system, implementing patient-centered services, is highly accepted by the elderly., Conclusion: This proposed M-health system could assist elderly outpatients' homecare in preventing medication errors and improving their medication safety.

There is a need for evidence-based usability principles to support the design of usable medication-related computerized CDS functions and systems. Such evidence requires establishing scientific relationships between usability principles, their violation in terms of usability flaws, issuing usage problems and their consequences or outcomes in the clinical work and patient care. This kind of evidence is not currently directly available in scientific evaluation studies of medication CDS functions. A possible proxy to seek evidence is systematic review of existing scientific evaluation reports. We rely on a four-stage framework describing the chain of consequences and inferences linking usability principles to clinical outcomes to design the systematic review methodology and interpretation principles. This paper describes the four-stage framework and the resulting consequences for the systematic review design.

Large-scale implementation of electronic prescribing systems (e-PS) is likely to introduce at least some machinerelated errors that will harm patients. We present a dynamic systems modeling approach to developing a comprehensive multilevel accident model of the process, context and task interaction variables which give rise to human error and system failure when e-PS are used in routine care. System dynamics methods are used to represent interactions between medication management processes and the context that is relevant to error generation, interception and transmission, agent-based methods represent task interactions. Capturing the patterns of failure within an accident model will facilitate an evidence-based approach to hazard analysis and design of e-PS features to improve patient safety. The model will have broad potential to guide the design, implementation and regulation of e-PS.