Integrative Review

Patient centered care and patient safety are the most important roles in nursing. “Serious medication errors are common in hospitals and often occur during order transcription or administration of medication” (Poon et al., 2010. p. 1). One important aspect of nursing is drug administration. It is a multidisciplinary task including doctors, pharmacist and nurses. This paper will show evidence that using electronic medication systems instead of paper based systems to administer medication will reduce medication errors.

CPOE systems have been proven to decrease medication errors and promote patient safety effectively. A study (Patent Safety Primer, 2014) suggested that 90% of medication errors occurred during the ordering or transcribing stages, and a systematic literature review shows that CPOE was able to reduce those errors by 48% compared to paper-based orders ( Radley, Wasserman & Bradshaw, et al. 2013). CPOE systems are effective in reducing medication errors by eliminating problems related to hand writing,

The stage 1 of the meaningful use includes thirteen core criteria and ten menu set objectives. The first core criteria is the computerized provider order entry (CPOE). CPOE entails the provider’s use of computer assistance to directly enter medication orders from a computer or mobile device. The use of CPOE and the electronic prescription process is a technology that has been found to be helpful in preventing medication prescribing errors in several ways (Mominah & Househ, 2013). Having an accurate electronic patient medication profile will help prescribers and pharmacists review the medication history easily and consequently alert the pharmacist to communicate with the prescriber in case any unexplained change in the prescribed medication to the patient and then conforming the change with the prescriber. Applying CPOE technology reduces medication errors.

The pharmacy, nursing, and informatics department were required to be involved in implementing the bar-code-assisted medication administration (BCMA) patient safety initiative. The involvement of the informatics department was required for planning and coordination of the electronic medication administration record and the scanning devices. The nurses were administering the medications so they were required to undergo training on BCMA methods and the importance of BCMA implementation. Pharmacists were needed to assist nurses in case if a scanning error occurred. Pharmacy, nursing, and informatics staff members were responsible for evaluation of the BCMA system upon implementation.

The incorporation of evidenced-based practice (EBP) into nursing practice is supported by research to positively improve the quality of care and improve patient outcomes. EBP is important to the nursing profession because it also leads to increased job satisfaction, teamwork, and levels of engagement in clinicians (Melnyk, et al., 2017). Miniature research projects such as quality improvement projects, surveys, and clinical research studies are frameworks used to get feedback and data from patients during their time spent in health care systems. EBP is not the standard of care in many health care systems (Melnyk, et al., 2017). This due to many factors, including lack of EBP mentors, nursing programs that do not incorporate EBP into the curriculum,

Medication errors are among the most significant cause of patient injury in all types of medical errors (Johnson, Carlson, Tucker, & Willette, n.d). In the nursing profession, medication administration errors occur 34% of the time, second only to physician ordering errors (Gooder, 2011). The introduction of information technology, such as the Bar Code Medication Administration (BCMA), offers new opportunities for reducing medication administration errors. BCMA was developed by the Veteran’s Affairs Medical Center in 1998 to help improve the documentation of medication administration, decrease medication errors and provide

This integrative review explores the difference of the onset-to-hospital arrival time between females and males with acute strokes. The results demonstrate that the means and medians of the hospital arrival times among female patients trend toward more delay than male patients, particularly in the Asian-Pacific and Middle Eastern region. However, the various evidences show that gender difference is not statistically significant.

“Medication errors are a frequent and costly problem for hospitalized patients, and medication administration errors account for one-third of all medication errors” (Bonkowski, Carnes, Mirtallo, Reichert, & Weber, 2013, p. 802). Therefore, in return to the all the mistakes that were being made barcode-assisted medication administration was developed. It has been shown that when barcode-assisted medication administration is used properly and in compliance it improves errors by 40-70% in hospitalized patients (Bonkowski et al., 2013, p. 802). Therefore regarding non-compliance with barcode-assisted medication scanning, the nurses who pose a threat to the non-compliance need to be pointed out and dealt with on a first-hand basis. Nurses who start

Bar code medication administration (BCMA) is a mechanism to decrease medication mistakes through scanning a code printed on the patient’s armband and then scanning the medication (Leapfrog Hospital Survey, 2016). The scanned information is processed through the electronic medical record and displays on the medication administration record (MAR) to ensure that bedside nurses are using the “Five Rights of Medication Administration” (Leapfrog Hospital Survey, 2016). The process of passing medication to patients has moved from a printed medication administration records and medication carts to an electronic version with automated medication dispensing systems. This electronic version effects nursing care by

The VA Outpatient clinic has been looking for ways to improve quality of care, operational efficiency, and cut costs by implementing various improvement strategies. The use of information technology in healthcare to improve patient care continues to be an admirable goal. The VA Outpatient clinic currently do not use technology for medication administration. Medication errors are a common cause of injury and death, which is seen in the health care arena. In 2008, it has been reported that nearly 200,000 Americans die from medical errors that could have been preventable (Andel, 2012). Medication errors alone has cost the United States $19.5 billion in 2008 (Andel, 2012). Out of this cost, 87 percent or $17 million were diverted to additional medical care needed, such as hospitalization, outpatient services, ancillary services, and prescription

In today’s current fast-paced and demanding field of heath care, medication administration has become complex and time-consuming task. Approximately one-third of the nurses’ time is used in medication administration. There is much potential for error because of the complexity of the medication administration process. Since nurses are the last ones to actually administer the medication to the patient therefore they become responsible for medication administration errors (MAE). Reasons for MAE may include individual factors, organizational factors or system factors. This paper will discuss the root causes analysis of MAE and strategies to prevent them.

After the interview with my nurse manager, I came up with the PICO question which states: “Does the computerized physician order entry (CPOE) system reduce the number of medication errors compared to the common paper system being used today?” This question is important and I selected it because the population that the Belvoir Community hospital serves includes army officers of all ages both active and retired including their spouses and children. This group includes two sub groups of highly vulnerable persons which include the very young and the very old, who have a high-risk effect for medication errors because the potential adverse drug event is three times greater than an adult hospitalized patient (Levine et al., 2001). CPOE is not a panacea, but it does represent an effective tool for bringing real-time, evidence-based decision support to physicians. Nurses are the last defense level of protection against medication errors, and are solely responsible for the dispensing, administering, and monitoring of medications. In healthcare, computers can be used to help facilitate clear and accurate communication between health care professionals. When using a CPOE system it allows physicians to type in prescriptions right into the device or computer which significantly lessens any mistakes that can occur when

Nursing in today?s society involves more than technical skills, critical thinking, and compassion. It also is changing to add the ability to not only understand but be able to utilize technology to impact a patient?s health. There are many technological changes employed in healthcare practices, however, I have chosen to address bar-code medication administration or BCMA. According to an article in the Journal of Patient Safety, ?bar-code medication administration has been shown to be effective in reducing patient medical errors, yet is still only utilized in 5% of the country?s health care facilities? (Sands, Slebodnik, & Young, 2010). Medication errors are common in hospitals and often lead not only to patient harm, but also lengthy hospital stays and law suits. ?One study identified 6.5 adverse events related to medication use per 100 inpatient admissions, more than one fourth of these events were due to errors and were therefore preventable? (Bane, et. al., 2010).

We do not believe that it is. CPOE eliminates handwritten orders and reduces errors related to medication prescribing (Forni, Chu & Fanikos, 2010), whereas barcoding is another tool to potentially aid in patient safety during the medication administration phase. Barcode scanning at the patient’s bedside identifies the medication being administered to assure it is the correct prescribed medication and dose for the specific patient. By placing a barcode on a patient wrist bracelet and on an identification (ID) badge, we can assure an identical match between patient and medication and capture the practitioner administering the medication (Forni, Chu & Fanikos, 2010). According to Eric Poon, MD, MPH, Director of Clinical Informatics at Brigham and Women’s Hospital in Boston, both of the technologies prevent errors, but in different ways. CPOE is more likely to prevent errors caused by bad judgment, lack of knowledge, or lack of clinical information when choosing which care plan, including lab tests and radiology orders, to pursue in treating a patient. Barcoding assists in preventing medication errors related to memory lapses or mental slips. (Blum, 2010) We believe both are important to implement, but barcoding cannot be substituted for

Electronic-prescribing, often referred to as e-prescribing, is a fairly new, innovative way for physicians and other medical personnel to prescribe medications and keep track of patients’ medical history. Not only has e-prescribing enabled prescribers to electronically send a prescription to the patients’ pharmacy of choice, in the short amount of time it has been available, it has significantly reduced health care costs, not only for the patient, but for the medical facilities as well. In 2003, e-prescribing was included in the Medicare Modernization Act (MMA) which jumpstarted the role of e-prescribing in healthcare. It has proven to significantly reduce the yearly number medication errors and prescription fraud, and its widespread