A nursing evaluation of unit dose and computerized medication administration records

A nursing evaluation of the unit dose system and a computerized medication administration record (MAR) was conducted to determine satisfaction with and perceptions of the effectiveness of these programs. A Nursing Evaluation Questionnaire was used to document nurses' attitudes towards the new programs. Of 228 questionnaires distributed on eleven nursing units, 152 were returned (response rate 66.7%). Full-time registered nurses represented 73.7% of the respondents, part-time 21% and casual 5.3%. Of the 152 respondents, 86.6% reported at least "some" time savings preparing and administering medications with the unit dose system, with 57% of this group reporting "significant" time savings. Unit dose was considered a safer distribution system by 82% of the respondents. Almost all of the respondents (99.3%) would choose to work with the unit dose system. Of the 152 respondents, 86% reported the computerized MAR decreased time spent charting medications administered, with half of this group reporting "significant" time savings. The computerized MAR was considered a safer charting method by 74% of the respondents. All of the respondents (100%) would choose to work with the computerized MAR. The evaluation indicated the unit dose system and computerized MAR were well accepted by nursing staff and were perceived to be working effectively.     

Reasons for community pharmacists establishing patient medication records

A survey was conducted among a sample of those pharmacists in Britain who installed a patient medication record (PMR) system during 1990 to gauge the importance of various factors that might have influenced the pharmacist's decision to acquire the system. The responses indicate that government funding influenced the developing utilisation of PMRs, but to a lesser extent than anticipated. PMRs have been installed primarily for clinical and professional reasons. Of the reasons for installing a PMR system, competition from other pharmacies was more likely to be considered important by female pharmacists, and by pharmacists working for large multiple companies, than by their male counterparts or independent contractors. The need to upgrade equipment at the end of its life span was cited as a reason for purchasing a PMR system. Future progress is likely to be very dependent on such upgrades at periodic intervals to introduce new technology into pharmacy practice.     

Using bar-code technology and medication observation methodology for safer medication administration.

PURPOSE: The implementation of a multidisciplinary approach to systematically decrease medication errors through the use of observation methodology and the deployment of electronic medication administration records (EMARs) and bar-coded-medication administration (BCMA) is described. SUMMARY: For a consistent and reliable approach to data collection, a direct-observation technique was used. The measurement of medication errors using the observation process occurred in two phases-preimplementation and postimplementation. Three inpatient nursing units participated. The control group was a 20-bed cardiac telemetry unit. Intervention group 1 was also a 20-bed cardiac telemetry unit. Intervention group 2 was a 36-bed medical-surgical unit. During the first phase of the study, all three study groups participated in evaluating the medication administration process associated with a manual five-day medication administration record (MAR). A total of 188 errors were reported. The pharmacy, nursing, and information services departments collaborated on the design and deployment of the EMAR and BCMA systems. The systems were implemented in one nursing unit in August 2003, with full implementation on all inpatient units by July 2004. During the second phase of the study, the control group continued to use the manual five-day MAR without a change in the process. Intervention groups 1 and 2 were measured to evaluate the medication administration process using EMAR and BCMA technology. The direct-observation accuracy rate before BCMA was 86.5%; after BCMA, the rate rose to 97%. CONCLUSION: The direct-observation methodology was used to monitor medication administration before and after the deployment of the EMAR and BCMA systems. A 54% reduction of medication administration errors was observed following implementation of a multidisciplinary, collaborative approach to medication safety.     

Implementation of a computerized medication administration record

Implementation of a computerized medication record reduces both medication errors and the time pharmacy and nursing services have to spend keeping records. A collaborative team approach to the development of the computerized medication record is integral to its success. The team at Day Kimball Hospital included representatives from departments who participated in goal-setting and problem-solving. The collaborative team also addressed the basic problem areas common to the implementation of the project as well as follow up for the purpose of continuous quality improvement. This article provides insight to professionals who wish to implement a computerized medication record through the collaboration of a team. The outcome of the project is a safe medication administration document, which decreases the potential for medication errors and improves patient outcomes.     

Identifying discrepancies in electronic medical records through pharmacist medication reconciliation

ObjectivesTo describe the types and causes of medication discrepancies in the electronic medical record identified by pharmacist medication reconciliation during outpatient medical visits and to identify patient characteristics associated with the presence of discrepancies.DesignObservational case series study.SettingIndigent primary care clinic in Pittsburgh, PA, from April 2009 to May 2010.Patients219 adults presenting for follow-up medical visits and self-reporting medication use.InterventionMedication reconciliation as part of patient interview and concurrent chart review.Main outcome measuresFrequency, types, and reasons for medication discrepancies and demographic variables, patient knowledge, and adherence.ResultsOf 219 patients interviewed, 162 (74%) had at least one discrepancy. The most common type of discrepancy was an incorrect medication documented on the chart. The most common reasons included over-the-counter (OTC) use of medications and patients not reporting use of medications. The presence of one or more medication discrepancies was associated with the use of three or more medications. Patient factors such as gender, age, and race were not associated with discrepancies. Patients able to recall the strength for more than 75% of their medications had fewer discrepancies, while knowledge of the medication name, indication, or regimen had no association with discrepancies.ConclusionPharmacists play a critical role in identifying discrepancies between charted medication lists and self-reported medication use, independent of adherence. Inaccuracies in charted medications are frequent and often are related to use of OTC therapies and lack of communication and documentation during physician office visits. Knowledge of patient-related variables and other reasons for discrepancies may be useful in identifying patients at greatest risk for discrepancies and interventions to prevent and resolve them.     

The evolution of patient medication records in British community pharmacy

The concept of patient medication record systems has been recognised since the 1970s. This article traces the development of PMRs from a pharmacy held, manual card index system to computer read “smart cards” retained by the patient.     

Closing the loop of the medication use process using electronic medication administration registration

Recent reports and studies of errors in the medication process have raised the awareness of the threat to public health. An essential step in this multi-stage process is the actual administration of a medicine to the patient. The closed loop system is thought to be a way of preventing medication errors. Current information technology can facilitate this process. This article describes the way barcode technology is being used to facilitate medication administration registration on several wards in our hospital and nursing home.     

社区卫生服务之药历建设初探

目的探索我国社区卫生服务机构中的药历建设,并付诸实施,加强社区卫生服务中的药学服务,使社区卫生服务更加完善。方法以湖南省长沙市的社区卫生服务机构为对象,初步调查了社区卫生服务中服务满意度情况和药学服务展开情况。结果通过所得数据,分析、总结了现阶段在社区卫生服务中开展药历建设的必要性和可行性。结论提出和讨论了目前在我国国情下开展药历建设值得注意的若干问题。     

我院呼吸内科80份药历的用药分析

目的 通过对近年来我院呼吸科药历的汇总分析,了解呼吸科病种与性别、年龄的相关性,并总结用药中存在的问题,促进临床合理用药.方法 采用回顾性分析方法,分析我院近年来临床药师参与临床药物治疗记录的80份药历,统计各年龄段分布的患者数、患病各病种的男女比例及年龄分布、药历中常用的药品种类、常见的不合理用药,并进行分析讨论.结果 我院呼吸科慢性阻塞性肺疾病患者居多,且男性比例偏高;抗菌药物、祛痰平喘药物、中药注射剂以及糖皮质激素在呼吸科使用频率较高;临床用药存在一定的不合理使用情况.结论 应进一步加强临床药学工作,建立良好的监管机制,促使我院合理用药水平全面提高.     

General medical practitioners' attitudes towards the use of patient medication records

A survey was conducted to ascertain general medical practitioners' (GPs') attitudes to community pharmacists' use of patient medication records (PMRs) and to assess whether GPs envisage a role for family health service authorities (FHSAs) in maintaining records of patients' data. The survey questionnaire was sent by post to all 1,257 GPs in contract with Avon and Devon FHSAs. A total of 811 questionnaires was returned, an overall response rate of 64.5 per cent. A majority (59 per cent) of GPs considered that community pharmacists should keep patient medication records and there was strong support for pharmacists holding PMRs for the elderly and confused, and also for patients with diabetes, asthma, epilepsy, and those patients who had experienced major adverse drug reactions or allergies. Some GPs, however, remained unconvinced of the usefulness of a pharmacy PMR. Seventy four per cent of respondents considered that patients should keep their own medication records. In contrast, only 4 per cent were in agreement with patient medication data being stored by FHSAs. The community pharmacist's role in maintaining PMRs received less support from doctors in dispensing practices than from their non-dispensing counterparts. Some 80 per cent of respondents were in favour of pharmacists providing PMR system-generated patient information leaflets with dispensed medicines. Most GPs considered that such leaflets had a positive effect on patient compliance. Recently registered GPs were found to be more supportive than their older colleagues of community pharmacists recording patients' clinical conditions and providing information leaflets.