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Health Informatics

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Erikah Bohanan

on 4 February 2013

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Transcript of Health Informatics

Reducing Medication Errors•Computer generated prescriptions are more legible and eliminates issues related to transcription errors oAccording to the article, Impact of health information technology on detection of potential adverse drug events at the ordering stage, hospitals belonging to the same academic medical affiliation had rates of transcription and dosage errors of 11.3% and 13%, respectively, before implementation of *CPOE and *eMAR. Studies performed showed errors reduced to 0% after implementation of these tools. *eMAR- electronic medication administration records*CPOE – computerized provider order entry Search Engines Google
Yahoo Listserv's and Blogs Healthcare professionals made suggestions for ways to reduce adverse drug events which included:
Additional layers of protection for patients
Legislation that punishes health care facilities for gross negligence in relation to adverse drug events Consumer Oriented Websites Social Media Sites Health Informatics

in reducing
adverse drug
events Enhance the bar code system
part of the computer system that flags medications
make them flag high risk drugs such as Warfarin and Insulin Regulations and Policies
make it mandatory for two healthcare professionals to check that both the dose and medication are prescribed correctly for the patient **Ensure that a
reconciliation has been
preformed prior to
order being sent to
pharmacy to be filled.** Federal Government
Create legislation to put pressure on healthcare workers to be more cautious when prescribing, filling, and administering all drugs. Penalties
financial penalties should be placed on hospitals that surpass a certain number of incidents each quarter ** Financial penalties would decrease incidents because it would be more cost effective for them to place more safeguards than to pay penalties.** In order to prevent adverse drug events it's imperative that all healthcare providers have good communication between each other and the patient.
Increased undergraduate education and continuing education are extremely important when it comes to decreasing adverse drug events Computer- based decision support systems (CDSS) and electronic prescribing should be encouraged
When problems occur, healthcare providers and nurses need to be aware of their professional responsibility to report adverse drug events and adverse drug reactions. Food and Drug Administration The FDA classifies adverse drug reactions into a number of categories such as:
1.Defective Drug
2.Medication Error
3.Medical Error: An outcome could have been avoided if optimal care had been provided. Some examples would be, errors in misdiagnosing, improper choice of treatment, failure to avoid drug interactions with other products, and failure to monitor therapy
4.Patient or consumer error: This is primarily due to lack of knowledge on the patient’s behalf. Comparison: Google has more formats and allows for more advanced, specific searches. Yahoo has many articles and websites, but most need more information for verification purposes. Bing is the youngest search engine but offers more up to date, relevant results. However, it doesn't have as many articles or web pages as google and yahoo. Google Hospitals and health care systems have
instituted many initiatives to prevent ADEs:
developing a culture of safety,
improving the processes for ordering and administering medicines
reconciling medications at all transition points
reducing harm caused by high-hazard medications Yahoo Read the drug label carefully Never take a medication with alcohol.Never mix the medication with food or drink, unless your doctor says it's ok.Ask your doctor or pharmacist any questions.Be mindful of any drug reactions you've had beforeDon't take any OTC medication along with vitamins. Bing In principle, medical professionals are required to report all adverse effects related to a specific form of therapy. In practice, it is at the discretion of the professional to determine whether a medical event is at all related to the therapy. Every minute of the day:
•100,000 tweets are sent
•684,478 pieces of content are shared on Facebook
•2 million search queries are made on google
•48 hours of video are uploaded to YouTube
•47,000 apps are downloaded from the App Store
-60 million of these same users now use social media sites to share their health experiences online -In 2011, there were 5,724 registered US hospitals but only:
•216 US hospitals use social media
•142 US hospitals have You Tube channels
•132 US hospitals maintain Twitter accounts
•83 US hospitals have Facebook pages Pros of Social Media Allow consumers to report incidences in a more timely manner
In 2012, the FDA announced plans to create an app for individuals to report any adverse reactions and to use for national and global crises.
Social Media allows for a more updated and relevant drug information database. Allows for medical personnel to access information instantly.
social media is not just for the consumer, it can utilized by a health care provider to increase patient care quality.
Provides a larger database for consumer's as well third party organizations to pull from and research. Allows patient's to report events after they leave the hospital and doctors office.
Allows affected family and friends to create awareness of particular drugs and effects for the general public to pull information from.
The biggest benefit social media provides is more effective communication and more up-to-date health information to millions of people instantaneously. Current Best Practices and Processes Evaluation:
1) Recognize client outcomes following medication administration including the effectiveness, side effects, and signs of drug interactions.
2) Follow up with the prescriber regarding any concerns or questions about the effectiveness of the medication, side effects, and signs of interactions.
3) Refer clients to the appropriate care provider for further assessment and follow-up when necessary
4) Document on the client’s plan of care if they are capable of self-administering medications, including the type of assistance they need, if any, and if they are able to continue self-administration. 1) Accepting a medication order that is complete and includes the order date, client name, medication name, dosage, route, frequency (STAT, one-time, prn), duration, and prescriber’s name, signature and designation.
2)Withholding the medication and following up with the prescriber in a timely manner in the event that a medication order is incomplete, unclear, inappropriate or misunderstood.
3)Assessing personal knowledge, skill and judgment to competently carry out medication administration and intervene during an adverse reaction.
4)Calculate the amount of medication required if the medication is ordered in one unit and supplied by the pharmacy in another unit. 5)Preparing and administering medication according to evidence-based rationale and practice setting policies
6)Obtaining a new supply of medication if there are concerns about the way in which the medications have been maintained
7)Applying principles of infection prevention and control when administering medication 8)Verifying
-the right client
-the right drug
-the right dosage
-the right time
-the right route
-the right documentation
- Discard of any medication appropriately. Medications should not be left unattended, and avoids abuse or misuse of the medication. 9) Administering medication in a timely manner considering
- the client’s condition
- the nature of the medication
- the dosage
-the route
-the action
-the resources available
10) Ensuring the client receives appropriate monitoring during and after administering the medications and intervening if necessary
11) Documenting during or after medication administration in the client’s record according to documentation standards and practice setting policies and procedures. How health informatics can improve the quality of nursing practice related to adverse drug events Patient Safety
-Reducing Medication Errors
-Better Interdisciplinary Communication
Better Individualized Care
Maintaining Patient Privacy Patient Safety Reducing Medication Errors
• Computer generated prescriptions are more legible and eliminates issues related to transcription errors
- According to the article, Impact of health information technology on detection of potential adverse drug events at the ordering stage, hospitals belonging to the same academic medical affiliation had rates of transcription and dosage errors of 11.3% and 13%, respectively, before implementation of *CPOE and *eMAR. Studies performed showed errors reduced to 0% after implementation of these tools.
*eMAR- electronic medication administration records
*CPOE – computerized provider order entry eMAR:
Dispensing errors are reduced by implementing the barcode eMAR system- if done correctly per best practice
Patient’s medication list in “real time”
Supports nurses in their decision making
Checks orders for accuracy and completeness and decrease adverse drug events Patient Safety Better Interdisciplinary Communication
•Healthcare personnel utilize same electronic health system therefore improving communication
•Quick time response to the provider’s orders, or any questions or concerns related to medication
-A study conducted in a hospital setting implementing CPOE in adult units showed reductions in the time between the order and administration of medications, the time for completion of radiology procedures, and the time for reporting the results of laboratory test compared to that of pre
-CPOE system
•Better communication amongst the healthcare team demonstrates a caring environment to the patient Better Individualized Care for Patients •Less time charting medications means more time caring for patients
-CPOE enhances staff productivity by making medication dispensing more quick and efficient
•According to the research article, Health Information Technology Impact on Productivity, in evaluating the medication cycle time, in one hospital department the time it took to fill an order and administered to the patient was reduced in 2011 to 8 minutes from 68 minutes.
•Implementing *HIT grew productivity in the hospital sector 37.8% from 2000 to 2011 (Eastaugh, S. R., 2012, p 16) •Personalized username and password allows personnel to login and log off computer system when task are complete.
•This complies with HIPPA law and keeps the patient’s drug information confidential. Maintaining Patient Privacy How health informatics can improve patient outcomes related to adverse drug events Patient Outcomes •Mortality or morbidity rates in hospitals would decrease
•Insurance and hospital cost will and can stay down
-The Rand Corporation Study suggests reducing 404,000 unnecessary deaths through *EHR improvements (this encompasses CPOE and eMAR system), disease management, and prevention would save hospitals $51.7 billion.
•Adverse drug events is hospitals would decrease
-In a 6-year study involving pediatric inpatients, the units that implemented CPOE experienced a 40% reduction in medication errors compared with those units who did not utilize CPOE. Patient Outcomes Cons of Social Media Privacy and Piracy Concerns
Unreliable Sources Fraudavengers.org has released tips
1) Limit their use of personal information
2) Learn each sites privacy rules
3) “Restrict access” of your page to only those you consider to be your “real friends.”
4) Sign up for “Google Alerts,” as these “send email notifications every time your name is used in an online search.”
5) suggests that everyone “post for posterity,” seeing as how every post lives forever in the cyber world. For example, statistics from socialsellu.com and statuspeople.com state: Out of “12,837,573 followers on Twitter, 37% are fakers, 40% are inactive, and the other 23% are good.
Research suggests following the “criteria to evaluate the quality of information on a Web site.”
-Credentials, Availability to validate information, Accuracy, Comprehensiveness of information, Date of issue or revision, Bias or sponsorship, Ease of navigation, Intended purpose and audience, Disclaimers, Accreditation, and Privacy policy. Areas in where the FDA is trying to reduce adverse drug effects:
1. Medwatch
2. Drug Quality Reporting System (DQRS)
3. Adverse Event Reporting System (AERS)
4. FDA Task Force on Risk Management
a.) Premarket Review Program
•Ensure and document all professional education and competency training, complete the Good Review Practice (GRP), and keep them current, and incorporate the GRP’s as lessons learned. *GRP: Reviews the content of the product to make sure all areas are covered and current with policy standards.
b.) Postmarket Surveillance Programs
•Information about adverse drug effects is readily available to reviewers and up to date, enhance the surveillance on newly marketed products, and enhance lab studies to improve product safety. Key facts
•Unintended, harmful reactions to medicines (known as adverse drug reactions) are among the leading causes of death in many countries.
•The majority of adverse drug reactions (ADR) are preventable.
•People in every country of the world are affected by ADRs.
•In some countries ADR-related costs, such as hospitalization, surgery and lost productivity, exceed the cost of the medications.
•No medicine is risk free. Vigilant assessment of the risks and benefits of medicines promotes patient safety. World Health Organization •WHO promotes global drug safety through their Drug Monitoring Program that has national systems in place over 100 countries that report any incidences of adverse drug reactions that occur.
•Facilitates regular information exchanges among Member States on the safety and effectiveness of medicines, involving a network of national information officers.
•Promptly informs national health authorities about new information on serious adverse effects of pharmaceutical products.
•Provides guidelines to help countries set up national drug monitoring centers.
•Assists countries as they work to strengthen drug regulatory authorities and reporting systems.
•Trains health professionals on safety monitoring for new and complex medicines (e.g. antiretrovirals to treat HIV).
•Draws together regulatory authorities, police, customs officials and others to combat counterfeit medicines worldwide. Food and Drug Administration
World Health Organization
Healthcare Informatics
Agency for Healthcare Research and Quality Amednews •ADE’s send more people to the doctor and emergency rooms than pneumonia and strep each year adding up to 4.5 million visits per year.
•Patients over 65 were twice as likely as middle-aged people to experience ADE’s and three times as likely as patients between 25 and 44.
•A 2007 Institute of Medicine report estimated that 1.5 million patients are harmed each year by preventable medication errors.
•Health information technology may help by making it easier to track medications patients are on and alert physicians to counsel and monitor patients with complex drug regimens Healthcare Informatics •Researchers have been trying to find ways that technology could reduce the number of adverse drug events in long-term care facilities.
•In a 9 month study, over 800 adverse drug evens were recorded in two facilities and 40% were ruled preventable
•The researchers found that preventable adverse drug events occurred most often during the ordering and monitoring stages of care.
•They believed that “alert fatigue” contributed to most ADE’s. Agency for Healthcare Research and Quality •Patients who experienced adverse drug events (ADEs) were hospitalized an average of 8 to 12 days longer than patients who did not suffer ADEs, and their hospitalization cost $16,000 to $24,000 more.
•Anywhere from 28 percent to 95 percent of ADEs can be prevented by reducing medication errors through computerized monitoring systems.
•Computerized medication order entry has the potential to prevent an estimated 84 percent of dose, frequency, and route errors.
•Hospitals can save as much as $500,000 annually in direct costs by using computerized systems.**During 2001, AHRQ will continue to fund grants designed to reduce medical errors based on the integration of best practices, provider education, and advances in information technology.
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