Automated parenteral chemotherapy dose-banding to improve patient safety and decrease drug costs

2019 ◽  
Vol 26 (2) ◽  
pp. 345-350
Author(s):  
Olivia G Fahey ◽  
Sara M Koth ◽  
Jason J Bergsbaken ◽  
Heather A Jones ◽  
Philip J Trapskin
Keyword(s):  
Patient Safety ◽  
Electronic Health Record ◽  
Improve Patient Safety ◽  
Cost Savings ◽  
Health Record ◽  
Total Drug ◽  
Implementation Period ◽  
Chemotherapy Dose ◽  
Electronic Health ◽  
Improve Patient

Purpose To improve patient safety and reduce drug waste through implementation of automated parenteral chemotherapy dose-banding within an electronic health record. Methods Parenteral chemotherapy dose-rounding practices were transitioned from a manual, pharmacist-driven workflow to an automated process within the electronic health record. Initial medications transitioned included bevacizumab, rituximab, and trastuzumab. Dose-banding tables were built to standardize rounding within a 10% parameter and then subsequently incorporated into the electronic health record after receiving multidisciplinary approval. Following implementation, a retrospective chart review was performed to compare drug and associated cost savings with manual dose-rounding and automated dose-banding. Medication safety improvements were measured by comparing the change in the number of clicks needed for pharmacist verification as well as by evaluation of submissions to our event reporting system. Results After implementing automated parenteral chemotherapy dose-banding, reported medication errors associated with the parenteral chemotherapy rounding process decreased. The number of event submissions related to incorrect rounding decreased from four submissions in the pre-implementation period to zero in the post-implementation period. Automation saved pharmacists at least 9,297 additional clicks and 11,363 additional keystrokes and also led to notable increases in total drug savings as well as drug cost savings. Conclusion Overall safety of our parenteral chemotherapy ordering processes within our electronic health record was improved after the implementation of automated dose-banding. By standardizing the administered doses for three chemotherapy agents, we were also able to increase total drug savings and associated drug cost savings.

scholarly journals Preventing Retention of Vaginal Packing in Obstetrics: Implementation of a Protocol to Improve Patient Safety

2018 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Patient Safety ◽  
Electronic Health Record ◽  
Chart Review ◽  
Improve Patient Safety ◽  
Retrospective Chart Review ◽  
Health Record ◽  
Enhance Patient Safety ◽  
Electronic Health ◽  
Improve Patient

Background: Retained vaginal packing can be associated with serious psychological and physical complications. The purpose of this study was to enhance patient safety by implementing an obstetrical vaginal packing protocol and to evaluate its efficacy. The study occurred in a tertiary maternity center with roughly 6,000 deliveries a year. Methods: A vaginal packing protocol was instituted. The protocol added a “vaginal packing” button to the electronic health record that subsequently prompted a notification to remove and document removal of the packing. A retrospective chart review of compliance with the protocol was performed on all deliveries that occurred during a 1-year period after implementation. Results: Of the 6,118 deliveries, 92% (5625/6117) completed the vaginal packing section of the delivery summary. Vaginal packing was placed in 1% (63/5625) of the deliveries in which the delivery summary was completed. A note documenting removal of the packing occurred in 73% (46/63) of the deliveries. There were no cases of retained vaginal packing. Conclusions: This is an effective and sustainable protocol to prevent retention of vaginal packing. This process could be adopted in the gynecologic setting and among many hospitals.

Decreasing drug waste, reducing drug costs, and improving workflow efficiency through the implementation of automated chemotherapy dose rounding rules in the electronic health record system

2021 ◽  
Author(s):  
Vishal Shah ◽  
Alexis Spence ◽  
Trace Bartels ◽  
Jeffrey Betcher ◽  
Scott Soefje
Keyword(s):  
Electronic Health Record ◽  
Cost Savings ◽  
Dose Calculation ◽  
Professional Organizations ◽  
Health Record ◽  
Record System ◽  
Calculated Dose ◽  
Chemotherapy Dose ◽  
Electronic Health ◽  
Drug Waste

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To decrease drug waste and cost by implementing automated chemotherapy dose rounding rules in the electronic health record (EHR). Dose rounding of chemotherapy is a recognized method for reducing drug waste, and professional organizations have published guidelines recommending dose rounding when possible. Summary On the basis of current literature and guideline recommendations, Mayo Clinic developed system-wide consensus to allow dose rounding for biologic and chemotherapy agents to the nearest vial size if rounding resulted in the dose being within 10% of the originally calculated dose or to a convenient measurable volume, based on concentration of the drug, if rounding to the nearest vial size resulted in the dose being outside the 10% range. Oncology pharmacists reviewed and analyzed all drugs listed in the EHR used in injectable form for the treatment of cancer and developed dose rounding rules. The rules were implemented and applied at the dose calculation stage before provider signature. From January to June 2019, approximately 40,000 cancer treatment doses were administered. The rounding rules saved a total of 9,814 vials of drug, of which 5,329 were for biologic agents and 4,485 were for oncolytic drugs. This resulted in a total 6-month cost savings of $7,284,796 (in 2019 dollars; biologics, $5,727,402; oncolytics, $1,557,394). Conclusion Systematic implementation of dose rounding rules utilizing the EHR can result in significant reduction of drug waste and realization of savings.

What Can Human Factors Contribute to Improve Electronic Health Record Usability and Patient Safety?

2012 ◽  
Author(s):  
Robert Schumacher ◽  
Robert North ◽  
Matthew Quinn ◽  
Emily S. Patterson ◽  
Laura G. Militello ◽  
...  
Keyword(s):  
Patient Safety ◽  
Human Factors ◽  
Electronic Health Record ◽  
Health Record ◽  
Electronic Health

Uji Validitas Dan Reliabilitas Kuesioner Pengukuran Kompetensi Sistem Informasi Keperawatan: NICAT Dalam Bahasa Indonesia

2019 ◽  
Vol 8 (1) ◽  
pp. 39-43
Author(s):  
Stephanie Dwi Guna ◽  
Yureya Nita
Keyword(s):  
Patient Safety ◽  
Electronic Health Record ◽  
Assessment Tool ◽  
Competency Assessment ◽  
Health Record ◽  
Nursing Informatics ◽  
Cronbach’S Alpha ◽  
Cronbach's Alpha ◽  
Electronic Health ◽  
Bahasa Indonesia

Integrasi Teknologi Informasi (TI) di bidang kesehatan terbukti meningkatkan kualitas pelayanan kesehatan dengan meningkatkan patient safety serta mempercepat waktu layanan. Salah satu inovasi TI di bidang kesehatan yaitu rekam medik elektronik (electronic health record). Rekam medik jenis ini sudah umum digunakan di negara maju namun masih jarang digunakan di negara berkembang termasuk Indonesia. Sebelum pengimplementasian suatu sistem informasi baru di pelayanan kesehatan, perlu dipastikan bahwa user dapat mengoperasikannya dengan baik sehingga hasil dari sistem tersebut optimal. Perawat sebagai tenaga kesehatan dengan jumlah paling banyak di suatu pelayanan kesehatan seperti Rumah Sakit merupakan user terbesar bila rekam medik elektronik ini diterapkan.  Oleh karena itu diperlukan suatu alat untuk mengukur kemampuan atau literasi sistem informasi keperawatan (SIK). Salah satu alat ukur kompetensi SIK yaitu NICAT (Nursing Informatics Competency Assessment Tool) yang memiliki 3 bagian serta 30 item pertanyaan. Penulis melakukan alih bahasa pada kuesioner ini, kemudian melakukan uji validitas dan reliabilitas. Jumlah sampel pada penelitian ini yaitu 233 perawat di salah satu Rumah Sakit Pemerintah di Pekanbaru, Indonesia. Hasil uji validitas pada 30 item dengan r tabel 0.128 menunjukkan r hitung diatas nilai tersebut dengan Cronbach’s Alpha 0,975. Dapat disimpulkan kuesioner pengukuran kemampuan SIK (NICAT versi Bahasa Indonesia) telah valid dan reliabel sehingga dapat digunakan mengukur kemampuan SIK perawat Indonesia.

scholarly journals An Analysis of Patient Safety Incident Reports Associated with Electronic Health Record Interoperability

2017 ◽  
Vol 08 (02) ◽  
pp. 593-602 ◽  
Author(s):  
Katharine Adams ◽  
Jessica Howe ◽  
Allan Fong ◽  
Joseph Puthumana ◽  
Kathryn Kellogg ◽  
...  
Keyword(s):  
Patient Safety ◽  
Electronic Health Record ◽  
Health Record ◽  
Health It ◽  
Specific Patient ◽  
It Systems ◽  
Safety Incident ◽  
Patient Safety Incident ◽  
Incident Reports ◽  
Electronic Health

SummaryBackground: With the widespread use of electronic health records (EHRs) for many clinical tasks, interoperability with other health information technology (health IT) is critical for the effective delivery of care. While it is generally recognized that poor interoperability negatively impacts patient care, little is known about the specific patient safety implications. Understanding the patient safety implications will help prioritize interoperability efforts around architectures and standards.Objectives: Our objectives were to (1) identify patient safety incident reports that reflect EHR interoperability challenges with other health IT, and (2) perform a detailed analysis of these reports to understand the health IT systems involved, the clinical care processes impacted, whether the incident occurred within or between provider organizations, and the reported severity of the patient safety events.Methods: From a database of 1.735 million patient safety event (PSE) reports spanning multiple provider organizations, 2625 reports that were indicated as being health IT related by the event reporter were reviewed to identify EHR interoperability related reports. Through a rigorous coding process 209 EHR interoperability related events were identified and coded.Results: The majority of EHR interoperability PSE reports involved interfacing with pharmacy systems (i.e. medication related), followed by laboratory, and radiology. Most of the interoperability challenges in these clinical areas were associated with the EHR receiving information from other health IT systems as opposed to the EHR sending information to other systems. The majority of EHR interoperability challenges were within a provider organization and while many of the safety events reached the patient, only a few resulted in patient harm.Conclusions: Interoperability efforts should prioritize systems in pharmacy, laboratory, and radiology. Providers should recognize the need to improve EHRs interfacing with other health IT systems within their own organization.Citation: Adams KT, Howe JL, Fong A, Puthumana JS, Kellogg KM, Gaunt M, Ratwani RM. An analysis of patient safety incident reports associated with electronic health record interoperability. Appl Clin Inform 2017; 8: 593–602 https://doi.org/10.4338/ACI-2017-01-RA-0014

scholarly journals Validation of a Crowdsourcing Methodology for Developing a Knowledge Base of Related Problem-Medication Pairs

2015 ◽  
Vol 06 (02) ◽  
pp. 334-344 ◽  
Author(s):  
A. Wright ◽  
M. Krousel-Wood ◽  
E. J. Thomas ◽  
J. A. McCoy ◽  
D. F. Sittig ◽  
...  
Keyword(s):  
Health Care ◽  
Electronic Health Record ◽  
Knowledge Base ◽  
Health Care System ◽  
Related Problem ◽  
Improve Patient Safety ◽  
Knowledge Bases ◽  
Health Record ◽  
Electronic Health ◽  
Care System

SummaryBackground: Clinical knowledge bases of problem-medication pairs are necessary for many informatics solutions that improve patient safety, such as clinical summarization. However, developing these knowledge bases can be challenging.Objective: We sought to validate a previously developed crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large, non-university health care system with a widely used, commercially available electronic health record.Methods: We first retrieved medications and problems entered in the electronic health record by clinicians during routine care during a six month study period. Following the previously published approach, we calculated the link frequency and link ratio for each pair then identified a threshold cutoff for estimated problem-medication pair appropriateness through clinician review; problem-medication pairs meeting the threshold were included in the resulting knowledge base. We selected 50 medications and their gold standard indications to compare the resulting knowledge base to the pilot knowledge base developed previously and determine its recall and precision.Results: The resulting knowledge base contained 26,912 pairs, had a recall of 62.3% and a precision of 87.5%, and outperformed the pilot knowledge base containing 11,167 pairs from the previous study, which had a recall of 46.9% and a precision of 83.3%.Conclusions: We validated the crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large non-university health care system with a widely used, commercially available electronic health record, indicating that the approach may be generalizable across health-care settings and clinical systems. Further research is necessary to better evaluate the knowledge, to compare crowdsourcing with other approaches, and to evaluate if incorporating the knowledge into electronic health records improves patient outcomes.Citation: McCoy AB, Wright A, Krousel-Wood M, Thomas EJ, McCoy JA, Sittig DF. Validation of a crowdsourcing methodology for developing a knowledge base of related problem-medication pairs. Appl Clin Inf 2015; 6: 334–344http://dx.doi.org/10.4338/ACI-2015-01-RA-0010

scholarly journals An analysis of electronic health record-related patient safety concerns

2014 ◽  
Vol 21 (6) ◽  
pp. 1053-1059 ◽  
Author(s):  
Derek W Meeks ◽  
Michael W Smith ◽  
Lesley Taylor ◽  
Dean F Sittig ◽  
Jean M Scott ◽  
...  
Keyword(s):  
Patient Safety ◽  
Electronic Health Record ◽  
Health Record ◽  
Safety Concerns ◽  
Electronic Health

The role of electronic records in reporting adverse drug reactions.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 309-309
Author(s):  
Alanna M. Poirier ◽  
Paul Nachowicz ◽  
Subhasis Misra
Keyword(s):  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Electronic Health Record ◽  
Adverse Drug Reactions ◽  
Improve Patient Safety ◽  
Cancer Center ◽  
Health Record ◽  
Drug Reactions ◽  
History Of ◽  
Electronic Health

309 Background: The Pharmacy and Therapeutics committee at a regional cancer center is responsible to report and trend existing adverse drug reactions. The electronic health record did not have an option to document the history of an event or have an alert function if a medication was re-ordered. The frequency of documented adverse drug reactions did not correlate to what was being observed on the units with the use of a paper document. Methods: InAugust 2010 a Lean Six Sigma project was initiated to improve adverse drug reaction reporting. An adverse drug reaction document along with standard work instructions was completed by March 2011. A report was built in the electronic health record and a computer based learning module was created and rolled out to clinical staff by October 2011. Results: The turn-around time in days to document an adverse drug reaction in the patients chart decreased from 6.8 days to 0.7 days. The documented adverse drug reactions increased by 37%; verified by the use of supportive medications. Conclusions: The root cause for under-reporting was attributed to lack of knowledge, process, and automation. The history of an adverse drug reaction can now be viewed and an automatic alert is produced requiring physician acknowledgement decreasing the chance of repeated discomfort or harm to the patient. Adverse drug reaction documentation can be retrieved within 24 hours, analyzed, trended, and used for educational purposes to improve patient safety. [Table: see text]

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