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Learning Scope #335
1 contact hour
Expires June 21, 2012
You can earn 1 contact hour of continuing education credit in three ways: 1) For immediate results and certificate; take the test online; grade and certificate are available immediately after taking the test. 2) Mail your completed exam (or a photocopy) along with the $8 fee (check or credit card) to ADVANCE for Nurses, Learning Scope, 2900 Horizon Dr., King of Prussia, PA 19406. 3) Fax the completed exam to 610-278-1426. If faxing or mailing, allow 30 days to receive certificate or notice of failure. A certificate of credit will be awarded to participants who achieve a passing grade of 70 percent or better.
Merion Publications Inc. is an approved provider of continuing nursing education by the Pennsylvania State Nurses Association (No. 008-0-07), an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. Merion Publications Inc. is also approved as a provider by the California Board of Registered Nursing (No. 13230) and by the Florida Board of Nursing (No. 3298).
The goal of this program is to educate nurses about medication safety and health information technology. After reviewing the information, you will be able to:
1. Discuss the use of health information technology (HIT) in decreasing medication errors.
2. Describe the function of CPOE, CDS and BCMA technologies in improving medication safety.
3. Identify the barriers to implementing an HIT system in healthcare organizations today.
On the morning of July 5, 2006, a 16-year-old patient came to St. Mary's Hospital in Madison, WI, to deliver a baby. During the process of her care, she was to receive an IV antibiotic for treatment of an infection. An infusion was connected to the patient's peripheral IV line and infused by pump. Within minutes, the patient experienced cardiovascular collapse. A cesarean section resulted in the delivery of a healthy infant, but the medical team was unable to resuscitate the mother.
Resuscitation efforts continued for 80 minutes, with multiple causes of the collapse considered and ruled out. The patient remained asystolic and apneic, and resuscitation was discontinued at 1:43 p.m. A few moments later, a partially infused epidural solution bag (with medication intended exclusively for administration via the epidural route) and an unspiked penicillin bag were discovered, and it was determined that the patient had received an IV infusion of fentanyl and bupivacaine instead of penicillin.1
Growth of HIT
This shocking error and the number of deaths related to medication errors reported in the Institute of Medicine's "To Err is Human" report has fueled the movement to improve medication safety.2 A primary area of focus has been the rapid adoption of technology in the quest to reduce human error, particularly as related to the complex medication administration process.
Marked growth in the health information technology (HIT) industry has been noted as the push to improve medication safety, decrease costs and improve efficiency accelerates. While growth in the HIT sector has been distributed across many different service lines, medication safety efforts have hastened the adoption of computerized provider order entry (CPOE), clinical decision support (CDS) and barcode medication administration (BCMA) technology.
Numerous studies point to the value of HIT-enabled processes for improving medication safety; recently detailed by a systematic review of the impact of electronic prescribing on medication errors and adverse drug events.3
In a study of CPOE in ambulatory care settings, Devine, et al., showed a significant decline in the frequency of medication errors, a 97 percent reduction in the rates of errors related to illegibility, an 85 percent decrease in the amount of missing information related to medications, and a 94 percent reduction in the use of inappropriate abbreviations.4 BCMA systems, pioneered in the Veterans Affairs Health System in the early 1990s, have been reported to reduce medication administration error rates by 54-86 percent.5 The FDA asserts BCMA could prevent 84,000 adverse drug events (ADE) per year in the U.S.6
When CPOE is combined with CDS, the potential to reduce medication errors potentiates significantly. CPOE with robust CDS has the potential to improve medication safety and reduce medication-related expenditures because it has the power to automatically compare orders with existing data and assist with adherence to knowledge-base guidelines.
For example, drug-allergy comparisons are made at the moment an order is generated, dosing guidelines can be automatically provided, and advice about alternative therapies or less-expensive drugs can be offered, all at the moment of need.
Overall, HIT-enabled care is rapidly infusing all aspects of professional practice, from acute care settings to the patients home to remote locations where health services are limited. The growing focus on "never events," unreimbursed care, cost containment, and calls for patient safety measures is driving CPOE, BCMA and CDS into the forefront of patient care. Medication error, as a leading cause of patient related injury in the U.S., is preventable - hence the efforts to use technology to assist in its elimination.