MEDICATION SAFETY & TECHNOLOGY Objectives Identify technology that can improve medication safety and decrease medication errors Identify ways that technology can cause medication errors if used inappropriately Does the use of advanced technology improve medication safety? Kathleen Darragh, CPHT Self Regional Healthcare March 15, 2011 1 Identify who is responsible for medication safety Identify ways to make medication distribution and compounding of medication safer 2 Disclosure The information disclosed in this presentation has not been sponsored or supported by any pharmaceutical or software company. TPN Dose of Calcium Gluconate 0.6 meq/kg 22.7 kg 0.6 X 22.7 = 13.62 meq Concentration = 0.465 meq/ml 13.62/0.465 = 29.3 ml of drug 3 4 TPN Dose Compounded As: 6.6 meq/kg 22.7kg 6.6 X 22.7 = 149.82 meq 149.82/0.465 = 322.19 ml 5 How has technology improved the way we dispense and compound medications AdminRx AcuDose Rx Computerized Physician Order Entry DoseEdge Auto Med Fast Pak Logix TPN Software Solution Automix Compounder 6 1
Admin Rx Pros Improves medication safety, patient safety and helps prevent medication errors by providing real time alerts and warnings for new, changed, or canceled orders Ensures the 5 rights (right patient, right drug, right dose, right route, right time) Admin Rx Pros (cont.) Compiles information in an accurate and legible medication record (MAR) for all caregivers Interfaces with pharmacy, physician, and nursing Scanning a three way barcoded match of the care giver s ID badge, patient s ID and the medication barcode. 7 Improves documentation required by regulatory agencies 8 Admin Rx Cons User must scan medication and patient barcode or the system does not work Pharmacy needs to make sure all inventory has readable barcodes Work Arounds nurses can override Alert fatigue getting too many alerts! 9 10 AcuDose Rx Pros AcuDose Rx Pros (cont.) Improves inventory management and strengthens compliance Assign medications from the cabinet or the pharmacy Reduces stock outs bulletins print to specific printer Clinical safety features include multiple locked and lidded pocket options Bar code scanning, allergy alert indicators Medication availability for patients 11 12 2
Acudose Rx Cons Work Arounds Nurses can override which is always a potential for error Look Alike/Sound Alike drugs stocked kdin wrong cabinets Creates a potential for diversion 13 Computerized Physician Order Entry Pros Averts problems with handwriting, similar drug names, drug interactions, and specification errors Integrates with electronic medical records Ensures standardized, legible, and complete orders Potentially reduces errors at the ordering and transcribing stages 14 Physician adoption CPOE Cons DoseEdge Pros Integrated drug verification eliminates the primary cause of wrong drug medication errors Automatic dose and dilution calculations ensure right dose, right concentration Step by step workflow ensures IV preparation best practices 15 16 17 18 3
DoseEdge Pros (cont.) Pharmacy Check Station facilitates complete dose inspection and approval, anywhere on your health system s intranet Digital images are captured at Prep Stations for dose verification i Barcode tracking prevents drug waste due to lost and missing doses On line data storage of prepared doses. Can access information on line for up to 6 months 19 20 Clarity of pictures DoseEdge Cons Work Arounds Can trick computer Single dose vs multi dose Auto Med Fastpak Pros Canister dispensing increases patient safety with every dose being clearly labeled with drug name, strength and description Patient s name and time of administration can be applied Flexible barcode labeling meets standards for compliance packaging 21 22 Auto Med Fastpak Cons All the packages look alike LOGIX TPN Software Solution Pros Order Entry templates for neonates and adults Create problems in AcuDose Empty packs Double pills 23 Compatibility calcium and phosphate p solubility Label Clarity Process Controls 24 4
Logix TPN Software Solution Pros (cont.) Proof of Individual Ingredients Clinical Warnings Osmolality li (central vs. peripheral) Electrolyte limits Volume limits Requires Input to Override Logix TPN Software Solution Cons When drugs are ordered by different units of measure there is potential for error the units are not preprogrammed must be manually entered Meq/kg vs. Meq/bag Two different concentrations of potassium phosphate Neonates mmol/kg Adults meq/bag 25 26 Automix Compounder Pros Overfill warnings when an order cannot be prepared in the volume specified Ability to add and set minimums and maximums for ingredients 27 Positive identification of hanging solutions using the built in refractometer Reads the refractive index of each solution and will shut down if incorrect 28 Automix Compounder Pros (cont.) Positive identification of patient orders Automix Compounder Cons A minimum of three patient types: adult, pediatric and neonate Refractometer sensitivity Premasol 6% vs. Heptamine 8% possibility of not reading the difference A minimum of three level user security access levels: administrator, pharmacist, technician Measures as little as 5 ml accurately 29 30 5
31 32 Who is responsible for medication safety Doctors Nurses Pharmacists Pharmacy Technicians Manufacturers clear labeling, adequate supplies 33 How to make it safer Proper training and certification for technicians As a technician remember you may be the patient s first line of defense. Don t assume the order or label you receive is correct. Technology and computers are not perfect information may be incorrect Do your math Don t assume the person you are working with is right 34 How to make it safer cont. Trust your instincts don t be afraid to question your pharmacist Pharmacists allow your techs to question you without penalization Don t become complacent Eliminate distractions Take more time upfront when planning on implementing a system Implementation is key policies and procedures assure we are all on the same page 35 Take Home Message With heightened concerns about medication errors, many organizations are looking to technology as a means to enhance patient safety. Technology is a start, but will not solve all problems related to medication errors. As pharmacists and pharmacy technicians, we must be diligent in making patient safety first and foremost. 36 6