Archive for the ‘Electronic Medical Record’ Category

Medication Error Reduction Using Scanning System

October 4, 2013

I have worked at a Medical Center for 5 years. During that time frame I have seen many changes in the way that orders are processed and medication administration to patients has gone from manual paper MAR system to using a scanning computer system. Five years ago orders were handwritten by doctors on carbon copies that were then faxed to pharmacy and medication orders were printed out on a paper MAR system or transcribed on the MAR by nurses to update orders. This system led to many errors mostly due to illegible writing by doctors, errors in transcription by pharmacy/nurses, and, or errors by nursing in checking the doctors orders. Medication errors were reduced in part by the Pyxis system; however, the nurse could possibly pull the wrong medication from the wrong pocket or container and give the patient the wrong medication. This was and had been a problem at our hospital with sentinel events. The hospital eventually moved to doctors placing their orders through the computer system directly to pharmacy reducing errors of transcription because of illegible writing. However, this did not take care of the problem of nursing errors with wrong medication given to patients. Even with the 5 rights, errors still occur due to human error, fatigue, multitasking, and multiple medication administrations to several patients at one time. UCSD implemented the MAK system or Medication Administration Check System. This system uses a bar code scanning system that corresponds with a bar code on the medication packaging and also with the patient’s identification band upon admission. The computer system also checks times so that alerts are given if a medication is given too soon or was given late. Pain medication is assessed for a pain scale and where pain is located and that information is flagged so that the nurse can then go back and assess the patient for pain 2 hours after the pain medication is given and if the medication was effective for the pain or not. Also it has made insulin administration easier to follow with 2 nurses required to sign in and document correct insulins and dosages given for blood sugars entered into the MAK system. All this information can be accessed by the doctors in one easy to access place to see if pain medication, blood pressure medication or diabetic medications are effective and if changes need to be made based on the information entered into the MAK system. The Pyxis system has also been reconfigured to reduce medication errors. Medication used to be in an open container where a nurse could pull a medication from the wrong open container. If checks were not in place, a wrong medication could be given to the patient with dire consequences. The Pyxis is now loaded with closed containers that only open when the drawer is pulled out fully and the correct flap for that container opens. This reduces errors in pulling out the wrong drug from the wrong container. This system has worked very well on the unit with few or any problems. The major problem was getting people to CHANGE their routines. Many nurses were resistant to change from the MAR system to the MAK system. However, the MAK system has been far easier to use and with the use of laptop computers that are mobile with the scanning device attached, meds can be given anywhere. The only issues I have seen that were problems are when the MAK system goes down and a MAR paper must be instituted to chart medications. This seems now to be such an archaic system and more difficult to use. The other issue that is a problem specific to our inpatient psychiatric unit is that we work with very paranoid, suspicious patients or Chronic Paranoid Schizophrenics (CPS) who are extremely wary of scanning devices and refuse to have any “laser cross my skin.” The MAK system also has a bypass for ripped bar codes on medications or a refusal of patient’s band to be scanned so that medications can be given. I believe that these computers programs are designed to make our jobs easier, more assessable with less leeway for errors to occur. The real reward for me as a nurse is that I get to spend more time with my patients then spending time with my paperwork!

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Electronic Communication, comment

July 23, 2013

Healthcare informatics Resources, May, 24, 2013, Electronic Communication [blog post], https://healthcare-informatics-resources.com/2013/05/22/electronic-communication-comment/
My comment on electronic communications in the medical field is that this amazing tool often does not get the credit it deserves quite often because people that use these tools on a daily basis only think about how it makes their job easier, and true it does. However it does so much more than that. By reducing the amount of paper in the office it actually reduces the amount of accidents due to clerical errors, misdiagnosis, reduce the chance for under or overdosing of medications. And also increases the speed of information that travels that can mean a persons life in an emergency. There needs to be a study done on how (they’re probably already is one) many lives electronic records and systems save each year.

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Seasonal Allergies, comment

May 24, 2013

I do think having having thing available electronically is very helpful, but at the same time I do not.The doctor may read what you have written him in an email but may not completely understand it. It is good to have oral communication available if need. If he were to have a question, he could call you but having a person right there in front of you is much easier I believe. Everything is becoming electronic now and days, so I better start getting used to it.

Seasonal Allergies (April 22, 2013) Healthcare informatics [Blog Post] Retrieved from https://healthcare-informatics-resources.com/2013/04/22/seasonal-allergies/

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Electronic Communication, comment

May 22, 2013

RE: Electronic Communication

My comment regarding Electronic Communication is that its a wonderful idea. Currently at my job now we are able to access the hospitals system to view the accounts of patient we are both servicing. This allows us to see there chart and why they were admitted into the hospital and what was done and so on. Its just so nice to be able to see the information our self rather then calling the hospital and speaking with the patients RN or case manager. The electronic communication really has made the process getting the durable medical equipment to the patient much faster. 

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Nursing And The Electronic Invasion, comment

May 16, 2013

Human Informatics Resources. (2013, May 3). Nursing And The Electronic Invasion [blog post]. Retrieved from: https://healthcare-informatics-resources.com/category/patient-bedside-care/.
My comment regarding nursing and the electronic invasion is that I finding it shocking that nurses have gone from paper to computer monitoring systems. I would believe that computers would allow for more mistakes and take longer for the nurses to get into the correct spot to put the information in.
Also in this blog it states that at her hospital they have 30 minutes before and after each medication time for each patient to document it correctly, then a report gets printed and the director looks at it and reads who was late for their times and they are posted. This would be very difficult if they are short staffed and there are to many patients to each nurse and they have a hard time getting all of the information put into the system because some patients take more time then others.
I am not sure if it the a good thing that nurses are put under so much pressure because if they are having a bad day and they are having a hard time inputting the information at the correct times it could make them even more over whelmed.

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Human-Computer Interaction (HCI)

April 29, 2013

HCI is the study of interaction between people and computers. Interaction between users and computers occurs at the user interface, which includes both software and hardware. According to the Association for Computer Machinery, HCI is concerned with the design, evaluation, and implementation of interactive computer systems for human use and with the study of major phenomena surrounding them. In the healthcare environment, and specifically implementing and electronic medical record (EMR), it is important to understand HCI to ensure the users and the computers interact successfully. The goals of HCI are to deploy usable, safe, and functional systems. Developers must try to understand how people use technology in order to produce computer systems used by their intended audience, which will improve the collection of accurate data. Consulting with the end users is important in gaining the understanding of their needs. Also, maintaining the involvement of the end user will often result in an increased acceptance of the new process or new system to be used. When evaluating the computer system, identifying the appropriate end user is important. Receiving feedback from someone who will interact with the interface on a daily basis is a good resource. Tasks the users will be performing and how often these tasks will be performed, need to also be defined. Measurements should be established, such as the number of users performing the tasks, the time it takes to complete the tasks, and the number of errors made. Once these evaluation procedures are in place, a system can be designed and tested. After the initial testing, the interface should be analyzed using the same established evaluation criteria. The developers should make changes where necessary as identified from the analysis of the testing, then, repeat the testing and evaluation process until an acceptable user interface is developed. Designing health care information systems utilizing HCI methodologies and usability resources is a critical aspect of increasing patient safety. Well designed computer interfaces and systems allow for correct data entry, understanding the display of information, and assisting with making skillful clinical decisions, which results in reduced errors. Additionally, using HCI concepts ultimately has a positive return on investment to the organization by identifying time needed to complete tasks, time needed to train staff, and the level of support staff involvement. Utilizing these concepts will result in reducing the end users frustration with the system and increases their productivity. Studies prove the benefits and the value of using HCI concepts in developing computer systems. As healthcare organizations implement EMRs, it is imperative to understand the need for human factors in developing computer systems to ensure their systems and their users work together effectively and efficiently.

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Electronic Communication

April 26, 2013

Computers have made information in the medical field more efficient. It is now possible for a physician to pull up a patients previous hospitalization, med list, and other important information about the patient. This information is helpful because the patient may not be able to tell you his medications or is unable to. This aids the physician in treating the patient wholly. In the future it would be nice to be able to view citywide hospitalizations as well as office visits. Ideally this would include alternative healthcare practitioners such as ND’s, herbalists, and kinesiologists, just to mention a few.

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Use of informatics between schools and healthcare providers

April 25, 2013

School children are required to have a complete physical exam prior to starting school. The report is hand written by the physician and turned in by the parent to the school office. . During the school year, the child is only in contact with the school nurse if he/she is sick while in school or if he/she has an accident at school that requires medical intervention. If a child experiences problems after starting school and goes to see the physician, the school is not necessarily aware of what transpires during the visit. I see this as a potential breakdown in communication and a place where informatics could help. For instance, if the parents gave consent to the child’s doctor to release medical information to the school, then the doctor could have ongoing communication with the school nurse. I believe that if the information could be provided electronically, it would make it more convenient for the physician to share the information. Most health care providers are extremely busy and may not be willing to hand write information. With the use of electronics, the doctor could dictate the information for input by a medical assistant. The school nurse could then have easy access to that information. The school nurse could have a database for every child where this information could be stored. I think this information would be especially helpful in assessing/detecting problems associated with hearing. A child who is having difficulty hearing may be mistaken for a child who is having behavioral difficulties. The child may be placed in a special program without identifying the root of the problem. If the child’s complaints are properly identified, then the nurse could tailor her interventions accordingly. The nurse could also use this form of communication to inform the child’s physician of problems that may be initially identified at the school.

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Seasonal Allergies

April 22, 2013

I have two children who suffer from seasonal allergies. Their symptoms are similar, usually characterized by rhinitis and frequent sinus infections. These recurrent problems often lead to frequent trips to the doctor’s office. In the past, I’ve been asked by the doctor to keep a hand written account of their symptoms to take back to the office. I believe that if the information could be sent to the doctor electronically, it would be more convenient for the pt, and the doctor could share the information with other clinicians. The data could also be organized to look for any patterns between patients.

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Progress, Change, Future

January 22, 2012

The future of healthcare information systems and a career in healthcare informatics holds exciting opportunities for healthcare organizations. Many improvements will be made in current technologies available. Although the concept of the electronic medical record (EMR) has been around for quite some time, we are just starting to see some advances in the actual implementation of automating portions of the patient medical record. To get to a fully automated health record, where all aspects of the legal medical record communicate to all systems, seems like a daunting task and yet so exciting to be a part of during these times. A career as a healthcare informatics professional will continue to be a desired profession and will gain momentum in the value these professionals will bring to an organization. Identifying their roles and responsibilities will become unique to each organization’s needs. Because of the many abilities and knowledge of healthcare informatics professionals, one healthcare facility may utilize these professionals in a different way and environment than another facility. Perhaps if there is not a developed informatics department, these professionals may even have different reporting structures based on where the organization sees them contributing and fitting into the organizational chart for that particular facility. The healthcare informatics field of study will be fundamental to bridging the gap between Information Technology Departments, Administration, clinical staff, physicians, vendors, and end-users. These positions are knowledgeable in a vast amount of areas, such as: information literacy, human computer interaction, human factors, usability testing, project management, working as change agents, standardizing language, evidence-based healthcare, numerous types of computer software such as database systems and spreadsheets. One cannot argue the fact that these knowledgeable individuals have developed skills, which bring much value to an organization. If these positions are utilized, directed, and supported, they will be extremely beneficial within a healthcare facility. Implementing, supporting, and maintaining an EMR is progress for any organization. The power of progress is amazing and builds upon each generation’s knowledge. Suppose each new generation had to rediscover numerals or language or medicine. The world would see no progress. Each generation stands on the shoulders of the previous generation to reach higher. Therefore, change is the price we pay for progress, and the EMR will bring about change for healthcare organizations. Change itself is not progress; it is the price we pay for progress. We will see some of the most advanced technology and the quest for a fully developed electronic health record will begin to take hold. As generations replace older generations an environment of automation will be expected and accepted by healthcare consumers and healthcare providers.

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