Electronic Medication Administrati...
Electronic Medication Administration Record (eMAR) alongside
Barcode Medication Administration (BCMA) technologies are the dual ways used in
the improvement of safety for inpatient medication. They do this through automation of the
procedure of inspecting drug and creating the electronic medication
administration record. Nevertheless, error in medicine is avertable through
putting preventive measures. To prevent such failure instigated by human
dynamics and improving the safety of the patient medication, numerous hospitals
tried to host information technology (Borycki, & Keay, 2010).
Leaders in the nursing field are in charge of medication
safety and management in any setting of health care. Errors in medication can
happen at any phase in the therapeutic usage of treatment starting with a
prescription to administration. The technology would contribute to the first
line workforce carrying out identification of the patient in collaboration with
the process of medication administration, barcode wristband for patients,
unit-dose packing and a system for barcode scanning came top of the list for
the most prevalent types of information technology solution (James, 2013). The
change agent promotes the execution of an electronic system for medication
management to minimize errors of medication alongside improving the safety of
patients. Therefore, the paper will stipulate the planning, implementation and
evaluation of the change agent which is a barcode electronic medication system
to decrease errors in medication while improving the quality of care and safety
of patients in the medical sector.
Medication administration error (MAE)
Errors in medication remains a concern for patient safety.
Limited studies have examined the influence of bar-coded technology on the
reduction of medication error through the administration practice in situations
of acute care. The focus and purpose of the systematic evaluation involved determining
whether the Bar Code Medication Administration System implementation is related
with regressions in the rate of Medication Administration Error. Results of the
systematic assessment disclose different findings between research alongside
the five rights of administration of medicine such as a timely manner, right
drug, right patient, right route and right dose in overall (Leung et al.,
2015). Even though the BCMA did not steadily decline the widespread occurrence
of Medication Administration Error, the technology did detect medication errors
categories previously left unnoticed with the outdated approach of the five
rights. The chance to examine the additional classifications of Medical
Administration Error recognized by Bar Code Medication Administration contains
inferences for the safety of the patient.
Medication errors denote to any inaccuracy in either
prescription, dispensation or supervision of drugs whether adverse penalties
exists or not, entail the most avertible root of injury on the patient. The
mistakes can happen at any phase in the process of drug usage between
administration and prescription of the patient. The IOM, Institute of Medicine,
made public a report concentrating on the safety of patient approximating that
between 44,000 to 98,000 persons in American health facilities die yearly due
to medical mistakes (James, 2013). Indisposition emerging from errors in
medication lead to high costs of financing for medical care organizations and
unfavorably impacts the quality of life of a patient. However, a successive
report of the Institute of Medicine acknowledged information technology (IT)
among the vital factors that can considerably advance safety and quality of
It is an authoritative bedside administration of medication
solution which aids hospitals to accomplish better levels of well-being for
improved care outcomes for patients. Merging of cutting-edge clinical decision
support, automated workflow, safety technology, and bar-code verification by
KBMA empowers nurses to confidently and quickly authenticate the five rights of
Medication Administration and decreases the quantity of stages for significant
enhancements in precision (Carayon et al. 2014).
Knowledge-Based Medication Administration functions as an
essential portion of a closed-loop medication administration unit. Employing a
patient electronic health record that gets shared and integrated clinical data
views and rules through the structure to encourage continuous handoffs while
preventing poor communication during the health information system of the
Since the solution gets incorporated with other entire
constituents of treatment management, health care nurses work with the recent
statistics alongside contribution from other nurses and organize care through
the organization (Borycki, & Keay, 2010). KBMA aids to decrease the
extensive amount of stages in the administration process of medication and
provides hospitals the true interoperability and connectivity that drives them
in the direction of significant usage of their information technology in
A Technical Review of Bar Codes
The degree of rational comprehension of bar coding that a
pharmacologist must have continues to become a topic of discussion. A number of
individuals feel that a chemist employing a bar coded medication system ought
to have a thorough information on bar code symbols and standards (James, 2013).
Others think that taking into consideration of the mass and complexity of the
facts; such aspect is not essential to construct an operational safety for
medication process using bar codes.
Barcodes form part of the most extensively documented
machine-readable symbols. The several accessible formats of barcodes could get
puzzling. In fact, each kind of bar code performs a similar function such as
representing a sequence of characters. Subject to the kind of bar code, the
characters can consist of letters, numbers, or unusual characters. These
characters denote data to become transmitted to an electronic structure, and
there is when the bar code gets delivered. An illustration, the data kept in a
medication bar code would hold an exclusive digit like the National Drug Code
number which recognizes a factory-made prescription, or a clinical-specific
code to signify a particular patient-specific dosage arranged by a chemist (Radley
et al., 2013). Therefore, barcode scanning is a highly accurate and fast
technique of recording or collecting data.
It is performed to establish the particular details of the
alteration alongside the creation of a comprehensive sustenance for the
prearranged change. It concentrates on constructing energy, commitment and
ability to adjust. The change agent struggled to exhibit more perceptible act
through accumulative engagement and participation in the procedure for change.
The change agent wanted to convey the idea for change with interested party
commence to allocate functions to people and recognize outstanding quality and
performance measures (James, 2013).
Planning comprises of three phases.
a. Constructing commitment:
This stage of the planning phase is a vital step that
entails opposition to adjustment and converts the confrontation into an
obligation. Opportunities were provided to give opinions, thoughts, and answers
to complications developing from the entire system method (Borycki, & Keay,
2010). Examination of the change project got performed to review the key
interior strengths of the organization, flaws, alongside a valuation of the
threats and opportunities in the outside environment that might create an
effect on the outline of the software structure. Within the institution, there
were several strengths, but mostly the high points emerged from an incredibly
the aspect of the change:
The modification agent conversed the vision of the business
with the group and entire staff personnel engaged with the amendment. Emails
were successfully utilized by the team to notify workforce of scheduled gatherings
alongside other facts.
The change agent evaluated the gap amid the present
condition and the idea through interviews and observations. In the findings, it
was clear that the team had to discover out additional statistics about
appropriate tools such as electronic tablet devices, script printers and proof
of approval of signatures that are electronic (James, 2013). A group was
assigned to visit an institute where the electronic system was already in the
actual functioning state. The change agent paid a visit and made an observation
of the management and the system in another nurturing home. They deliberated on
the electronic system outlining the opinions with the Department of Nursing and
involvements of the staff personnel utilizing the system.
During this phase, the details of implementation are stated,
such as the series of the activities necessary for the subsequent step, the
persons liable for the period and every deed to achieve accomplishment. A
comprehensive plan for implementation gets drawn with particulars for sequenced
schedules as well as the duration for completion. Preliminary goals got
reconsidered to guarantee soundness to carry on the implementation. The
strategy of implementation effect got evaluated by finalizing the Health and
Safety Executive effect evaluation template. Based on the data obtained from
the examination, it would become probable to measure the influence on the
existing services, organization, teams, as well as service and staff operators (Carayon
et al. 2014).
Creation of a Patient Safety and Awareness Culture
The safety of a patient remains a priority for medical care
institutions from the pharmacist and front line nurse practitioner to the Chief
Executive Officer of the medical facility. Today’s healthcare has become a
complex, high-risk, labor-intensive and fast-paced industry. These concerns
have contributed to the escalating rates of medication error. Methods that have
functioned for several years have become less safe and sufficient for patients
in the nowadays’ hospital setting (James, 2013). A precondition to the safety
program basis for medication is a culture of error-reporting without fear of
punishment from peers and management. Such an atmosphere will result in
improved error reporting, and the information proceeding can get utilized to
demonstrate the necessity for changes in the system.
Evaluating the Readiness of a Hospital
The addition of numerous layers of computerization without
planning, integration and proper research can get the bar-code electronic
system off to an unsteady beginning. As a result, it is appropriate to start
with carrying out a detailed assessment and review centered on the contemporary
medication practices. The purpose of the evaluation is towards determining the
most suitable structure, comprising automation and processes, upon which to
complement the bar-code system for administration of treatment (James, 2013).
Procedure for Evaluation and Selection of Vendors
The Oversight Team can recognize prospective vendors for the
bar-code medication system based on the functioning framework examination and
more importantly the subsequent comprehension of the workflow within nursing.
Major constituents of the selection procedure of the vendor entail:
Identification of Suitable Vendors
Prospective vendors recognized ought to get requested to
address to the Oversight Team. For the best outcomes, the team has to provide
every vendor with a quick list of compulsory points to address when doing demonstration
(Leung et al., 2015). Illustrations may comprise:
• Business history alongside the demographics such as
quantity of staff and locality among others.
• Summary of drug store system
constituents, containing database maintenance and setup that is methodical in addition to capabilities of bar
• Outline of nursing system components and features,
including issues such as;
for electronic documentation
linked to the simple check for the 5-Rs
alerts. An example that which notifies if content of package varies
from dose ordered
collection of clinical data during time of treatment
for informing the operator that the system is lagging and the order or
patient information at the date of care is outdated.
The Period of Development
The point of care bar code medication is quite an
undeveloped technology. Consequently, it is suitable to hire a development time
within a small or limited locality such as within a single nursing unit in
advance to officially signing off on approval and spreading out of the system.
With the implementation of the bar-code electronic medical administration
system, the word development period gets chosen over “probationary” or “assessment”
since it evades consequences that the technology could get short-term and
clearly expresses the goal of the project stage. The period of development
becomes significant for authenticating the technical competencies of the
system, user acceptance, usability and interconnected changes in workflow.
Throughout the period, any interface alongside system bugs gets fixed by the
seller while procedural modifications get done by the medical facility. The
step is crucial and a significant one which is not advisable to get done in a
hurry (Radley et al., 2013).
A unit that employs numerous medications of changing forms,
such as a group of surgery, provides a worthy choice as the preliminary unit.
Units of specialty like the pediatrics or the Intensive Care Unit would
probably get evaded when considering units for the pilot since they address
particular subjects that will get less easy to address when experience on the
system gets mastered.
Also, adding to sustenance obtained from information
systems, nursing and pharmacy, the vendor should ensure the provision of both
clinical and technical onsite support during the commencement of the pilot.
There exists no suggested size for the period of development. As an
alternative, some of the concerns identified will define its time (Borycki,
& Keay, 2010). Nevertheless, the Oversight Team ought to deliberate on
establishing the duration which no major issues before the development time
The Plan for Roll-Out
The program must become concluded during the period for
development to ensure immediate onset of the roll-out once it gets done. This
is essential in ensuring a reduction in time utilized for the two systems while
starting to make advantage of the new regime's safety benefits (Leung et al.,
2015). The plan for the entire hospital roll-out to should get finalized
The components of the roll-out plan would entail:
• Enlargement of new areas on a weekly basis
• Scheduled training alongside unit conferences in new zones
a week before the date of going
• Coverage sustenance
Evaluation of the Barcode System
The Evaluation System Action team will carefully observe for
the proper utilization of the system alongside its connected procedures. To
effectively do so, the development of a process flow measurement is necessary.
The measurement of process flow should recognize problems within the process
that may emerge. Such corrupt practices sidestep the care benefit of bar code
of work around which have to exist on the point of attention scanning structure
• Additional bar-coded wristbands for patients are generated
to circumvent scanning the worn
wristband by a patient. In particular cases, they get taped to a wall in the room
of the patient. However, some
get reserved in the patient’s room such that the operator can scan treatments before heading to
• Prescriptions get detached from packages that are bar
coded in the medication room, while
the new packages get perused later after passing the meds.
• Treatment scanning gets avoided in total and documentation
of drugs done much later.
• Providing medication through indicating that it is non-bar
coded when the treatment bar coded.
The system of measurement must also assist in identifying
the procedural matters that make users to create the special workaround. As an
illustration, when no procedure existed for a clinical practitioner to initiate
a program alteration for a medication scheduled, the practitioner could have
administered the prescription but scanned it later. The project team should
endeavor to solve the problems of the process and suggest enhancements remove
such concerns permanently (Borycki, & Keay, 2010).
If the Bar-Code Medication systems tolerate the provision of
non-bar coded goods, it might, as a consequence, be giving a constructed
workaround which can get utilized improperly. The funders to this system
recommend that entire prescriptions get barcoded without exemption and
that the features of the system allow the alternative to circumvent scanning
the drug bar code get cautiously assessed. Minimally, documentation through an
electronic method has to reflect if a dosage gets administered short of
scanning while establishing nursing processes for providing a dosage with a bar
code that is unreadable.
Considerations of Regulations
Although the Food and Drugs Act has suggested a guideline
for medications of bar coding by producers, that directive does not relate to
drug store repackaging at onsite. The pharmacy practice gets regulated by the
state panels of pharmacy and not the FDA. As the project progresses, no board
activities report linked to chemist bar coding got conveyed. However, the
inclusion of a bar code to an interior package for medication must not
influence the ability of the pharmacy to adhere to present state guidelines. On
the other hand, keep in mind that drugs which have got repackaged, as well as
those containing bar codes, should never get sold or transferred to alternative
amenities (Leung et al., 2015). If an outside bar coding and packaging
assistance are required, the chemist should sign a pact with a registered
medication repackaging corporation for such service.
For the pharmacy service which are non-24-hour, will demand
dosages for treatment orders transcribed during off times to get scanned and
issued before order entry the following daybreak. The pharmacy must function
with the nursing department to institute a process for doses reconciliation
administered before entry of order against current orders obtained during off
SMART Action Plan
The project aims got established
on the SMART action plan where they were determined to be Measurable, Specific, Attainable,
Time-bound and Realistic (James, 2013).
primary goal of the project entails implementation of an electronic system for
medication management as a fundamental part of the procedures in the nurturing
home. This to progress patients’ safety through decreasing medication errors
alongside the absence of adherence to regulations and policy.
will assist in improving the excellence of service through restructuring care,
supplementing decision making process and provision of response on performance.
The method will assimilate the general practitioner, the service of pharmacy
and the institution through an automated procedure.
The primary objectives of the project include:
• By 30th September 2017, reduction of medication errors by
20%, in contrast to the audit medication
error results conducted before the change.
• By 30th September 2017, reduction of near misses by 50% in
comparison to near misses obtained from previous audit results
before the modification process.
• By 30th September 2017, achieve a 45 minutes completion
time for treatment administration
rounds. The result will parallel with approximately a decline in time by 25%.
• By September 2017, the institution should have completely
executed the bar code medication
system of administration.
The change agent will provide training to achieve the above
set objectives, solving all obstacles towards execution and assessing the
change implementation against identified targets and goals. The business
possesses a vision of employing information technology for documentation in the
nursing sector while such a change initiates the introduction of that
Developing Multidisciplinary Project Groups
There are two primary multidisciplinary teams in the project
comprise of the Oversight and Assessment Team. A nursing in collaboration with
a pharmacy representative ought to function as co-chairpersons of the two teams
to demonstrate that the divisions similarly manage the task. Together, they
must plan routine conferences for the team alongside scheduled programs. If
needed, meetings could get rescheduled a single day in advance or upon agreement;
the team can hold additional meetings (Radley et al., 2013).
The Assessment Team
The process of
assessing readiness for Bar-Coding System devices starts with
suggestions for getting group evaluation membership. The team for assessment
will research and evaluate existing process of medication workflow alongside
interrelated processes to establish their readiness for the practice of
bar-coding. The group must commence the evaluation before bar-coding medication
management system vendor participation (James, 2013). Particular participants
of the assessment team tend to become the bar coding system Oversight Team
members which ultimately drives the project, hence it is advisable to be
prudent in the selection of the assessment team.
The Oversight Team
The team will comprise of a subset of participants obtained
from the original Assessment Team. Such a team is experienced and appreciates
the challenges ahead of them since they have undergone through the process of
evaluation. The Oversight team forms the change agents linked to the Bar-Code
Medication Administration System hence, should entail persons who are
responsible, reliable and valued affiliates of their divisions. The
long-lasting members of the team ought to slightl