Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals

Veen, Willem van der; Bemt, Patricia M. L. A. van den; Wouters, Hans; Bates, David W.; Twisk, Jos W. R.; Gier, Johan J. de; Taxis, Katja; Duyvendak, Michiel; Luttikhuis, Karen Oude; Ros, J. J. W.; Vasbinder, Erwin; Atrafi, Maryam; Brasse, Bjorn; Mangelaars, Iris

doi:10.1093/jamia/ocx077

Cited by 48 publications

(68 citation statements)

References 42 publications

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“…These findings echo the growing body of work exploring workarounds within health care settings, as well as the tensions among workarounds as a threat to patient safety and as a means of overcoming systemic shortcomings and resource constraints [ 28 , 29 , 35 ]. For example, a recent study of workarounds in hospital electronic prescribing systems found workarounds as a result of time pressures induced by learning new technological systems as well as increasing demands and duties tasked to clinic staff [ 28 ].…”

Section: Discussionmentioning

confidence: 52%

Blind spots in telemedicine: a qualitative study of staff workarounds to resolve gaps in diabetes management

Bouskill

Smith-Morris

Bresnick

et al. 2018

BMC Health Serv Res

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BackgroundNovel telemedicine platforms have expanded access to critical retinal screening into primary care settings. This increased access has contributed to improved retinal screening uptake for diabetic patients, particularly those treated in Federally Qualified Health Centers (‘safety net’ clinics). The aim of this study was to understand how the implementation of telemedical screening for diabetic retinopathy within primary care settings is improving the delivery of critical preventative services, while also introducing changes into clinic workflows and creating additional tasks and responsibilities within resource-constrained clinics.MethodsA qualitative approach was employed to track workflows and perspectives from a range of medical personnel involved in the telemedicine platform for diabetic retinopathy screening and subsequent follow-up treatment. Data were collected through semi-structured interviews and participant observation at three geographically-dispersed Federally Qualified Health Centers in California. Qualitative analysis was performed using standard thematic analytic approaches within a qualitative data analysis software program.ResultsThe introduction of telemedicine platforms, such as diabetic retinopathy screening, into primary care settings is creating additional strain on medical personnel across the diabetes eye care management spectrum. Central issues are related to scheduling patients, issuing referrals for follow-up care and treatment, and challenges to improving adherence to treatment and diabetes management. These issues are overcome in many cases through workarounds, or when medical staff work outside of their job descriptions, purview, and permission to move patients through the diabetes management continuum.ConclusionsThis study demonstrates how the implementation of a novel telemedical platform for diabetic retinopathy screening contributes to the phenomenon of workarounds that account for additional tasks and patient volume. These workarounds should not be considered a sustainable model of health care delivery, but rather as an initial step to understanding where issues are and how clinics can adapt to the inclusion of telemedicine and ultimately increase access to care. The presence of workarounds suggests that as telemedicine is expanded, adequate resources, as well as collaborative, cross-sectoral co-design of new workflows must be simultaneously provided. Systematic bolstering of resources would contribute to more consistent success of telemedicine screening platforms and improved treatment and prevention of disease-related complications.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3427-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 52%

Blind spots in telemedicine: a qualitative study of staff workarounds to resolve gaps in diabetes management

Bouskill

Smith-Morris

Bresnick

et al. 2018

BMC Health Serv Res

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“…24 As with most CDSS, errors can still be made if providers omit or deliberately work around the technology. 27 CDSS also improve patient safety through reminder systems for other medical events, and not just those that are medication related. Among numerous examples, a CDSS for blood glucose measurement in the ICU was able to decrease the number of hypoglycemia events.…”

Section: Functions and Advantages Of Cdss Patient Safetymentioning

confidence: 99%

An overview of clinical decision support systems: benefits, risks, and strategies for success

et al. 2020

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Computerized clinical decision support systems, or CDSS, represent a paradigm shift in healthcare today. CDSS are used to augment clinicians in their complex decision-making processes. Since their first use in the 1980s, CDSS have seen a rapid evolution. They are now commonly administered through electronic medical records and other computerized clinical workflows, which has been facilitated by increasing global adoption of electronic medical records with advanced capabilities. Despite these advances, there remain unknowns regarding the effect CDSS have on the providers who use them, patient outcomes, and costs. There have been numerous published examples in the past decade(s) of CDSS success stories, but notable setbacks have also shown us that CDSS are not without risks. In this paper, we provide a state-of-the-art overview on the use of clinical decision support systems in medicine, including the different types, current use cases with proven efficacy, common pitfalls, and potential harms. We conclude with evidence-based recommendations for minimizing risk in CDSS design, implementation, evaluation, and maintenance.

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“… 41–43 Recent studies also report high rates of false positive alerts using a BCMA system, which could contribute to alert fatigue and increase workarounds during medication administrations. 44 , 45 Although BCMA has been widely adopted and a small number of dose alert systems have been integrated into clinical environments to facilitate real-time error prevention, 4–6 , 19 , 21 , 28 , 29 few have measured the impact on harm mitigation subsequent to medication safety events. 8 , 46 As described in our earlier research, 25 , 26 rather than using static formulas and barcoding technology, we developed a set of computerized algorithms to analyze dynamic EHR content to identify MAEs.…”

Section: Background and Significancementioning

confidence: 99%

Designing and evaluating an automated system for real-time medication administration error detection in a neonatal intensive care unit

Lingren

Hall

et al. 2018

Journal of the American Medical Informatics Association

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BackgroundTimely identification of medication administration errors (MAEs) promises great benefits for mitigating medication errors and associated harm. Despite previous efforts utilizing computerized methods to monitor medication errors, sustaining effective and accurate detection of MAEs remains challenging. In this study, we developed a real-time MAE detection system and evaluated its performance prior to system integration into institutional workflows.MethodsOur prospective observational study included automated MAE detection of 10 high-risk medications and fluids for patients admitted to the neonatal intensive care unit at Cincinnati Children’s Hospital Medical Center during a 4-month period. The automated system extracted real-time medication use information from the institutional electronic health records and identified MAEs using logic-based rules and natural language processing techniques. The MAE summary was delivered via a real-time messaging platform to promote reduction of patient exposure to potential harm. System performance was validated using a physician-generated gold standard of MAE events, and results were compared with those of current practice (incident reporting and trigger tools).ResultsPhysicians identified 116 MAEs from 10 104 medication administrations during the study period. Compared to current practice, the sensitivity with automated MAE detection was improved significantly from 4.3% to 85.3% (P = .009), with a positive predictive value of 78.0%. Furthermore, the system showed potential to reduce patient exposure to harm, from 256 min to 35 min (P < .001).ConclusionsThe automated system demonstrated improved capacity for identifying MAEs while guarding against alert fatigue. It also showed promise for reducing patient exposure to potential harm following MAE events.

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Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals

Abstract: In hospitals using barcode-assisted medication administration, workarounds occurred in 66% of medication administrations and were associated with large numbers of medication administration errors.

Cited by 48 publications

References 42 publications

Blind spots in telemedicine: a qualitative study of staff workarounds to resolve gaps in diabetes management

Blind spots in telemedicine: a qualitative study of staff workarounds to resolve gaps in diabetes management

An overview of clinical decision support systems: benefits, risks, and strategies for success

Designing and evaluating an automated system for real-time medication administration error detection in a neonatal intensive care unit

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