Informatics Technologies for P atient Safety

1. Informatics Technologies for Patient Safety Presented by Moira Jean Healey

2. Objectives • Identify the goals of healthcare technologies • Review some current technology that supports patient safety

3. Health care technologies are designed and implemented to: • Support nursing practice • Organize work processes • Improve efficiency • Improve patient safety • Improve the quality of care to improve patient outcomes • The effectiveness of the healthcare technology is dependent upon the user of the technology. • To implement new technology and have it work effectively, the nursing staff needs to have sufficient training and adequate tech support.

4. Computerized Physician Order Entry • (CPOE) • An electronic prescribing system to assist physicians and nurse practitioners in writing appropriate and clear medication and care orders for patients • It eliminates unclear, difficult to read and incomplete orders • Orders are entered quickly and can be submitted from a remote site so verbal orders are no longer necessary

6. Orders are electronically submitted to the pharmacy eliminating the paper system, reducing transcription errors, lost orders and unreadable faxes • Medications can be given in a timely fashion • CPOE provides current drug information, warns of possible allergies, drug interactions or an overdose

7. Clinical Decision Support (CDS) • Technology designed to aid clinical decision- making • The clinical knowledge base of the CDS system reflects the most recent evidence-based research and best –practice sources • Patient characteristics are compared to the computerized knowledge and a recommendation is made to the clinician • The CDS assists in ordering the right medication • It checks for allergies, drug interactions, and duplications

8. Printable handouts are also available to educate patients on their medications Bar Code Medication Administration (BCMA) • Technology to assure that the correct medication and dose is given to the right patient at the right time • Medications ordered, approved by the pharmacist, appear on the patient’s electronic record (eMAR) • To administer a medication, nurse’s scan the bar codes on the patient’s wristband and on the medication

10. If the medication scanned is pharmacist approved and the patient is due the dose, documentation of the dose being given is automatic Radiofrequency Identifier (RFID) • RDIF is a wireless system that uses tags and readers to communicate information • Tags use radio waves to send their information to a reader • Readers have one or more antennas that discharge radio waves and receive signals from the tags

12. Hospitals and health care settings use RFID for the following reasons: • Keeping track of inventory and equipment • Fall and Out of bed detection • Patient tracking during testing and procedures • Supplying information for EHRs • RFID technology automatically identifies the item or person and allows data input and documentation quickly and accurately. • There are no side effects linked to RFID at this time. • There is some concern about the possible adverse effects of electromagnetic interference (EMI) , from radio frequency transmitters, to electronic medical devices (e.g. Pacemakers and implantable cardio-verter defibrillators (ICDs).

13. Smart Pumps • Technology used to deliver high risk intravenous medications in a safe manner • Standardized concentrations are programmed into the pumps that reflect the hospitals policy • If the rate programmed into the pump does not reflect normal dosing, an alarm is generated to alert the nurse to a discrepancy • A soft alarm can be bypassed but a hard alarm needs to be reprogrammed to fall within the hospital guidelines • Data from the Smart Pump can be added into the EHR and BCMA system

14. Summary Health care technology is implemented to improve patient safety. This new technology helps to prevent errors previously made but needs to be continuously evaluated to prevent future errors in the work flow processes. Technology changes rapidly and troubleshooting is necessary to process improvements.

15. Organizations need to invest in technology that is interoperable and can be upgraded easily as these healthcare technologies advance. Commitment to patient safety should always be the key goal for all organizations.

16. References Food and Drug Administration. (2013). Radio frequency identification (RFID). Retrieved from www.fda.gov/Radiation- EmittingProducts/RadiationSafety/Electromagnetic Compatibility McGonigle, D., & Mastrian, K.G. (2012). Nursing Informatics and the foundation of knowledge. Burlington, MA: Jones and Bartlet Learning. Poon et al. (2010). “Effects of bar-code technology on the safety of medication administration”. The New England Journal of Medicine, 362, 1698-1707. doi:10.1056/NEJMsa0907115 Simet al. (2001). “Clinical decision support systems for the practice of evidence-based medicine”. Journal of the American Informatics Association, 8(6), 527-34.