scholarly journals Disappearing expertise in clinical automation: Barcode medication administration and nurse autonomy

2020 ◽  
Author(s):  
Jennifer Y Hong ◽  
Catherine H Ivory ◽  
Courtney B VanHouten ◽  
Christopher L Simpson ◽  
Laurie Lovett Novak
Keyword(s):  
Information Technology ◽  
Medical Center ◽  
Social Systems ◽  
Academic Medical Center ◽  
Knowledge Worker ◽  
Medication Administration ◽  
Task Completion ◽  
Nurse Satisfaction ◽  
Practice Nurses ◽  
Nurse Autonomy

Abstract Objective Using the case of barcode medication administration (BCMA), our objective is to describe the challenges nurses face when informatics tools are not designed to accommodate the full complexity of their work. Materials and Methods Autonomy is associated with nurse satisfaction and quality of care. BCMA organizes patient information and verifies medication administration. However, it presents challenges to nurse autonomy. Qualitative fieldwork, including observations of everyday work and interviews, was conducted during the implementation of BCMA in a large academic medical center. Fieldnotes and interview transcripts were coded and analyzed to describe nurses’ perspectives on medication safety. Results Nurses adopt orienting frames to structure work routines and require autonomy to ensure safe task completion. Nurses exerted agency by trusting their own judgment over system information when the system did not consider workload complexity. Our results indicate that the system’s rigidity clashed with adaptive needs embodied by nurses’ orienting frames. Discussion Despite the fact that the concept of nurse as knowledge worker is foundational to informatics, nurses may be perceived as doers, rather than knowledge workers. In practice, nurses not only make decisions, but also engage in highly complex task-related work that is not well supported by process-oriented information technology tools. Conclusions Information technology developers and healthcare organization managers should engage and better understand nursing work in order to develop technological and social systems to support it.

The Impact of Delayed Symptomatic Treatment Implementation in the Intensive Care Unit

Healthcare ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 35
Author(s):  
Lesley Meng ◽  
Krzysztof Laudanski ◽  
Mariana Restrepo ◽  
Ann Huffenberger ◽  
Christian Terwiesch
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Symptomatic Treatment ◽  
Medication Administration ◽  
Average Delay ◽  
Treatment Implementation ◽  
Medication Delivery ◽  
The Impact

We estimated the harm related to medication delivery delays across 12,474 medication administration instances in an intensive care unit using retrospective data in a large urban academic medical center between 2012 and 2015. We leveraged an instrumental variables (IV) approach that addresses unobserved confounds in this setting. We focused on nurse shift changes as disruptors of timely medication (vasodilators, antipyretics, and bronchodilators) delivery to estimate the impact of delay. The average delay around a nurse shift change was 60.8 min (p < 0.001) for antipyretics, 39.5 min (p < 0.001) for bronchodilators, and 57.1 min (p < 0.001) for vasodilators. This delay can increase the odds of developing a fever by 32.94%, tachypnea by 79.5%, and hypertension by 134%, respectively. Compared to estimates generated by a naïve regression approach, our IV estimates tend to be higher, suggesting the existence of a bias from providers prioritizing more critical patients.

Impact of Clinical Nurse Specialist Roles on COVID-19 Pandemic Care

2020 ◽  
Vol 14 (3) ◽  
pp. 141-146
Author(s):  
Kathleen Posa-Kearney ◽  
Samantha M. Aranda ◽  
Elizabeth M. Day ◽  
Erin Dowding ◽  
Kristen Fisher ◽  
...  
Keyword(s):  
Nurse Practitioners ◽  
Medical Center ◽  
Academic Medical Center ◽  
Nurse Specialist ◽  
Critical Care Nursing ◽  
Clinical Nurse ◽  
Certified Registered Nurse Anesthetists ◽  
Practice Nurses ◽  
Clinical Nurse Specialists ◽  
Academic Medical

Advanced practice nurses including nurse practitioners, clinical nurse specialists (CNS), certified registered nurse anesthetists, and certified nurse midwives contribute in many ways to improve care in the intensive care unit. This article reports on the roles of the CNS at an academic medical center and how they contribute to improving patient outcomes and support critical care nursing practice during the COVID-19 pandemic.

scholarly journals Decreasing the Time to Oral Antibiotics in a University Hospital Pediatric Emergency Department

2017 ◽  
Vol 22 (4) ◽  
pp. 272-275
Author(s):  
R. Zachary Thompson ◽  
Brian Gardner ◽  
Thomas Carter ◽  
Aric Schadler ◽  
Joye Allen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Academic Medical Center ◽  
Medication Administration ◽  
Pediatric Emergency ◽  
University Hospital ◽  
Pediatric Emergency Department ◽  
Oral Antibiotics ◽  
Time Period ◽  
Hospital Pediatric

OBJECTIVES To compare time to administration of oral antibiotics in the pediatric emergency department (ED) when antibiotics are stored in the pediatric ED versus when they were dispensed by central pharmacy services within an academic medical center. METHODS This was a retrospective review of patients who received a one-time dose of oral antibiotics within the pediatric ED and were subsequently discharged home. Two 3-month time periods were compared to determine the metrics of providing oral antibiotics before and after these medications were stocked in the pediatric ED automated dispensing cabinet (ADC). The primary outcome was to compare the time to administration. Secondary outcomes were to assess wastage of stocked medications and time to ED discharge. RESULTS In the ADC time period (n = 74), the median time to administration was 17.5 minutes versus 57 minutes in the central pharmacy time period (n = 34) (p &lt; 0.001). The ED length of stay during the ADC time period was 188.5 minutes versus 228.5 minutes (p = 0.094). 35.4% of doses from the ADC expired resulting in a wholesale acquisition cost of $53.14 wasted. CONCLUSION Stocking commonly used oral antibiotics in the pediatric ED led to a significant decrease in the time to medication administration. This decreased time to administration has the potential to lead to improved patient and nursing satisfaction. Routine surveillance is needed after implementation to ensure compliance and to minimize wastage.

scholarly journals Impact of holding home stimulant(s) on agitation in a child and adolescent inpatient psychiatric population

2021 ◽  
Vol 11 (2) ◽  
pp. 50-54
Author(s):  
Anupha M. Mathew ◽  
Sophie Robert ◽  
Clint Ross ◽  
Erin Weeda ◽  
Adrienne Pruitt
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Composite Endpoint ◽  
Child And Adolescent ◽  
Medication Administration ◽  
Psychiatric Facility ◽  
The Difference ◽  
Level I ◽  
Closed Door

Abstract Introduction This study aimed to compare the rates of agitation-related interventions associated with initial holding versus continuation of home stimulant(s) in a child and adolescent population at the time of admission to an inpatient psychiatric facility. Methods This retrospective chart review included patients less than 18 years of age who were admitted to an academic medical center between July 1, 2017, and July 1, 2018. Patients were divided into 2 groups: those continued on their home stimulant(s) and those who had them held. We compared both groups on agitation-related outcomes by examining the difference in the number of level I or II events or as-needed medication administrations. Mechanical restraints and closed-door seclusions were grouped as level I events, and level II events consisted of nonmechanical restraint. Results The analysis included 169 patients. In total, 126 (75%) patients were continued on their home stimulant, and 43 (25%) had them held. The occurrence of the composite endpoint of level I or II events or as-needed intramuscular medication administration was numerically higher in the group that had their home stimulant held (27.9% vs 23%; P = .52). Level I events were also numerically higher but not statistically significant in the group that had their home stimulant held (16.3% vs 11.9%; P = .46). Discussion The composite outcome of as-needed intramuscular medication administration and level I or II events was numerically higher in the group that had their home stimulant held. Use of a larger sample size and adjusted analyses may help elucidate covariates that impact agitation-related outcomes.

Evaluation of Medication Administration Timing—Are We Meeting Our Goals?

2020 ◽  
pp. 089719002090545
Author(s):  
Craig Furnish ◽  
Samantha Wagner ◽  
Angela Dangler ◽  
Kerry Schwarz ◽  
Toby Trujillo ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Medication Administration ◽  
Respiratory Therapists ◽  
Policies And Procedures ◽  
Academic Medical ◽  
Hospital Policies ◽  
Inpatient Nursing ◽  
Administration Timing ◽  
Time Critical

Background: Per the Centers for Medicare and Medicaid Services (CMS) Code of Federal Regulations (CFR) 482.23(c) regarding medication administration, hospital policies and procedures must identify time-critical scheduled medications which must be administered within 30 minutes either before or after the scheduled dosing time, for a total administration window of 1 hour. Objective: The general objective of this analysis was to determine whether there was a difference in meeting medication administration goals when comparing time-critical to non-time-critical scheduled medication administration in both intensive care units (ICUs) and general medical floors at a large, academic medical center. Methods: Data were collected in 6 inpatient nursing units (3 general medical units and 3 ICUs) during the month of June 2017. Electronic medical record charge data for medications were used to evaluate timeliness of medication administration. Results: In total, 69,794 medication administrations were evaluated. Of 389 administrations of time-critical scheduled medications, 268 (69%) were administered on time. Of 69,405 administrations of non-time-critical scheduled medications, 58,099 (84%) were administered on time ( P < 0.001). ICUs had a higher percentage of on-time administrations than general medical units (89% vs 77%, P < 0.001), and nurses had a higher percentage of on-time administrations than respiratory therapists (84% vs 63%, P < 0.001). Conclusions: Non-time-critical scheduled medications were more commonly administered on time compared with time-critical scheduled medications. Staff education and optimizations to the electronic health record (EHR) are interventions that may improve administration of time-critical scheduled medications.

Impact of Anticipatory Batching of Pharmacy Compounded Sterile Products on Time to Nurse Administration

2021 ◽  
pp. 089719002110271
Author(s):  
Sophia Pathan ◽  
Danine Sullinger ◽  
Laura J. Avino ◽  
Samuel E. Culli
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Medication Administration ◽  
Patient Specific ◽  
Nursing Services ◽  
Academic Medical ◽  
Secondary Endpoints ◽  
The Mean ◽  
The Impact ◽  
Mean Time

Background: Timely medication administration is integral to patient care, and operational delays can challenge timely administration. Within an inpatient pharmacy of an academic medical center, intravenous medications were historically compounded on a patient-specific basis. In 2020, the pharmacy began batching frequently-utilized medications. This analysis explored the impact of compounded sterile batching on pharmacy and nursing services. Methods: This pre- and post-interventional study compared data from February through March 2020 with a seasonally matched period from 2019. The primary endpoint was difference in time to administration of urgent (STAT) medications. Secondary endpoints included timeframes for a pharmacy technician to prepare, a pharmacist to check, and a nurse to administer the medications, as well as reprinted labels and estimated waste. Results: On average, it took one hour and 43 minutes to administer a STAT medication in 2019 and one hour and 57 minutes in 2020 ( p = 0.122). It took about four hours to administer routine medications in 2019 and 2020 ( p = 0.488). The number of labels reprinted decreased from 616 in 2019 to 549 in 2020 ( p = 0.195), relating to decreased missing doses. The mean time to check and send a medication decreased from 2019 to 2020 for STAT orders ( p < 0.001), and there was no difference in wasted medications looking at all orders in this time. Conclusion: Anticipatory batching decreased time to prepare, check, and send medications, though there was no effect on waste or on time to administration. Future studies can examine the correlation between pharmacy operations and medication administration.

scholarly journals Clinical and Demographic Factors Associated with Antipyretic Use in Gram-Negative Severe Sepsis and Septic Shock

2011 ◽  
Vol 45 (10) ◽  
pp. 1207-1216 ◽  
Author(s):  
Nicholas M Mohr ◽  
Brian M Fuller ◽  
Lee P Skrupky ◽  
Hawnwan Moy ◽  
Robert Alunday ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Medical Center ◽  
Academic Medical Center ◽  
Demographic Factors ◽  
Medication Administration ◽  
Patient Treatment ◽  
Gram Negative ◽  
Factors Associated ◽  
Sepsis And Septic Shock

Background: Antipyretic therapy is commonly prescribed for patients with Infection, but studies of its impact on clinical outcomes have yielded mixed results. No data exist to characterize the use of antipyretic medications in patients with severe sepsis or septic shock. Objective: To identify clinical and demographic factors associated with antipyretic medication administration in severe sepsis and septic shock. Methods: This single-center, retrospective, cohort study assessed febrile patients [temperature ≥38.3°C) with gram-negative severe sepsis or septic shock at an 1111-bed academic medical center between January 2002 and February 2008, Patients were excluded if they had liver disease, acute brain injury, or allergy to acetaminophen. Generalized estimating equations were used to estimate the effect of clinical factors on treatment of patients with antipyretic medications, Results: Although 76% of patients in this febrile cohort (n = 241) were prescribed an antipyretic agent, only 42% received antipyretic therapy; 95% of the doses were acetaminophen. Variables associated with antipyretic treatment were maximum body temperature (OR 2.11, 95% CI 1.53 to 2.89), time after sepsis diagnosis (OR 0.88, 95% CI 0.82 to 0.95), surgery during hospitalization (OR 0.49, 95% CI 0.31 to 0.80), death within 36 hours (OR 0.35, 95% CI 0.15 to 0.85). and mechanical ventilation (OR 0.58, 95% CI 0.34 to 0.98). Severity of illness factors, demographic factors, and patient treatment location did not predict who would receive antipyretic therapy. Conclusions: Most febrile episodes in patients with gram-negative severe sepsis or septic shock were not treated with antipyretic medications. Further studies are needed to demonstrate the effect of antipyretics on clinically relevant outcomes in severe sepsis and septic shock.

Sign in / Sign up

Export Citation Format

Share Document