scholarly journals Implementation of an Automated Dispensing Cabinet System and Its Impact on Drug Administration: Longitudinal Study

10.2196/24542 ◽  
2021 ◽  
Vol 5 (9) ◽  
pp. e24542
Author(s):  
Yi-Chen Wang ◽  
Chin-Yuan Tsan ◽  
Meng-Chun Chen
Keyword(s):  
Longitudinal Study ◽  
Drug Administration ◽  
The United States ◽  
Medication Administration ◽  
University Hospital ◽  
Drug Preparation ◽  
Stock Management ◽  
Preparation Time ◽  
Before And After ◽  
The Impact

Background A technology that has been widely implemented in hospitals in the United States is the automated dispensing cabinet (ADC), which has been shown to reduce nurse drug administration errors and the time nurses spend administering drugs. Objective This study aimed to determine the impact of an ADC system on medication administration by nurses as well as safety before and after ADC implementation. Methods We conducted a 24-month-long longitudinal study at the National Taiwan University Hospital in Taipei, Taiwan. Clinical observations and questionnaires were used to evaluate the time differences in drug preparation, delivery, and returns in the inpatient ward by nurses before and after using the ADC. Drug errors recorded in the Medical Incident Events system were assessed the year before and after ADC implementation. Results The drug preparation time of the wards increased significantly (all P<.005). On average, 2 minutes of preparation time is needed for each patient. Only 1 unit showed an increase in the drug return time, but this was not significant. There were 9 (45%) adverse events during the drug administration phase, and 11 (55%) events occurred during the drug-dispensing phase. Although a decrease in the mean number of events reported was observed during the ADC implementation period, this difference was not significant. As for the questionnaire that were administered to the nurses, the overall mean score was 3.90; the highest score was for the item “I now spend less time waiting for medications that come from the pharmacy than before the ADC was implemented” (score=4.24). The item with the lowest score was “I have to wait in line to get my patient medications” (score=3.32). Conclusions The nurses were generally satisfied with ADC use over the 9 months following complete implementation and integration of the system. It was acknowledged that the ADC offers benefits in terms of pharmaceutical stock management; however, this comes at the cost of increased nursing time. In general, the nurses remained supportive of the benefits for their patients, despite consequences to their workflows. Their acceptance of the ADC system in this study demonstrates this.

scholarly journals Implementation of an Automated Dispensing Cabinet System and Its Impact on Drug Administration: Longitudinal Study (Preprint)

2020 ◽  
Author(s):  
Yi-Chen Wang ◽  
Chin-Yuan Tsan ◽  
Meng-Chun Chen
Keyword(s):  
Longitudinal Study ◽  
Drug Administration ◽  
The United States ◽  
Medication Administration ◽  
University Hospital ◽  
Drug Preparation ◽  
Stock Management ◽  
Preparation Time ◽  
Before And After ◽  
The Impact

BACKGROUND A technology that has been widely implemented in hospitals in the United States is the automated dispensing cabinet (ADC), which has been shown to reduce nurse drug administration errors and the time nurses spend administering drugs. OBJECTIVE This study aimed to determine the impact of an ADC system on medication administration by nurses as well as safety before and after ADC implementation. METHODS We conducted a 24-month-long longitudinal study at the National Taiwan University Hospital in Taipei, Taiwan. Clinical observations and questionnaires were used to evaluate the time differences in drug preparation, delivery, and returns in the inpatient ward by nurses before and after using the ADC. Drug errors recorded in the Medical Incident Events system were assessed the year before and after ADC implementation. RESULTS The drug preparation time of the wards increased significantly (all <i>P</i>&lt;.005). On average, 2 minutes of preparation time is needed for each patient. Only 1 unit showed an increase in the drug return time, but this was not significant. There were 9 (45%) adverse events during the drug administration phase, and 11 (55%) events occurred during the drug-dispensing phase. Although a decrease in the mean number of events reported was observed during the ADC implementation period, this difference was not significant. As for the questionnaire that were administered to the nurses, the overall mean score was 3.90; the highest score was for the item “I now spend less time waiting for medications that come from the pharmacy than before the ADC was implemented” (score=4.24). The item with the lowest score was “I have to wait in line to get my patient medications” (score=3.32). CONCLUSIONS The nurses were generally satisfied with ADC use over the 9 months following complete implementation and integration of the system. It was acknowledged that the ADC offers benefits in terms of pharmaceutical stock management; however, this comes at the cost of increased nursing time. In general, the nurses remained supportive of the benefits for their patients, despite consequences to their workflows. Their acceptance of the ADC system in this study demonstrates this. CLINICALTRIAL

scholarly journals The impact of Interruptions on Medication Errors in Hospitals: A Direct Observational Study of Nurses

2020 ◽  
Vol 5 (2) ◽  
Keyword(s):  
Observational Study ◽  
Medication Errors ◽  
Drug Administration ◽  
Sampling Technique ◽  
Medication Administration ◽  
P Value ◽  
Drug Preparation ◽  
Close Monitoring ◽  
Phone Calls ◽  
The Impact

Aim: Aim this study is to observe the existence of interruptions during drug preparation as well as administration including the cause of interruptions, time taken from the primary purpose (drug administration), secondary activities performed and the extent of clinical. Background: Many researches on the frequency of occurrence of medication administration faults or errors have been conducted but only a few have examined the occurrence of drug administration associated variations from safe practice. During the medication administration cycle conducted by staff nurses in hospital surroundings, interruptions are common and have been shown to be correlated with an development in the occurrence and medication administration errors. Methodology: A observational study conducted. Convenient sampling technique used in this study. Inside a large government teaching hospital in Lahore, a suitability sample of six medical unit, surgical unit. Result: A significant association has been found between medication administration and medication preparation errors and interruption like talking with other health care personnel, patients or attendant queries, phone calls (p-value=<0.001). Nearly 96% of the study nurses who were interrupted during medication committed medication errors. During medication administration incidents, close monitoring of nurses culminated in 100 percent recorded medication administration activities. One third of the interruptions were by other nurses trying to share patient and process details, including asking queries, providing orders, recording details and finding support. Clinical and operational problems found in incidents relevant to drug administration. 72 percent of the reported drug incidents have been shown to involve administrative deficiencies. Conclusion: It is confirmed that interruptions sometimes arise and are related to operational deficiencies and clinical errors. There is an immediate need for instructional programs that reflect on the significance of interruptions, their connection with procedure malfunction and clinical negligence.

scholarly journals Impact of the first COVID-19 shelter-in-place order in the United States on emergency department utilization, Marin County, California

2020 ◽  
Author(s):  
Brett R. Bayles ◽  
Michaela F George ◽  
Haylea Hannah ◽  
Patti Culross ◽  
Rochelle R. Ereman ◽  
...  
Keyword(s):  
United States ◽  
San Francisco ◽  
Large Scale ◽  
Temporal Dynamics ◽  
The United States ◽  
Emergency Department Utilization ◽  
Marin County ◽  
Before And After ◽  
Ed Visits ◽  
The Impact

Background: The first shelter-in-place (SIP) order in the United States was issued across six counties in the San Francisco Bay Area to reduce the impact of COVID-19 on critical care resources. We sought to assess the impact of this large-scale intervention on emergency departments (ED) in Marin County, California. Methods: We conducted a retrospective descriptive and trend analysis of all ED visits in Marin County, California from January 1, 2018 to May 4, 2020 to quantify the temporal dynamics of ED utilization before and after the March 17, 2020 SIP order. Results: The average number of ED visits per day decreased by 52.3% following the SIP order compared to corresponding time periods in 2018 and 2019. Both respiratory and non-respiratory visits declined, but this negative trend was most pronounced for non-respiratory admissions. Conclusions: The first SIP order to be issued in the United States in response to COVID-19 was associated with a significant reduction in ED utilization in Marin County.

scholarly journals An Automated Software Application Reduces Controlled Substance Discrepancies in Perioperative Areas

2019 ◽  
Vol 131 (6) ◽  
pp. 1264-1275
Author(s):  
Nirav Shah ◽  
Anik Sinha ◽  
Aleda Thompson ◽  
Kevin Tremper ◽  
Arjun Meka ◽  
...  
Keyword(s):  
Regulatory Focus ◽  
The United States ◽  
University Hospital ◽  
Web Based ◽  
Software Application ◽  
Before And After ◽  
Implementation Period ◽  
Controlled Substance ◽  
Deep Integration ◽  
Automated Software

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Perioperative controlled substance diversion and tracking have received increased regulatory focus throughout the United States. The authors’ institution developed and implemented an automated web-based software application for perioperative controlled substance management. The authors hypothesized that implementation of such a system reduces errors as measured by missing controlled substance medications, missing controlled substance kits (a package of multiple controlled substance medications), and missing witness signatures during kit return. Methods From December 1, 2014 to March 31, 2017, the authors obtained missing controlled substance medication, controlled substance kit, and witness return signature data during the preimplementation, implementation, and study period of the controlled substance management application at a single university hospital. This before and after study was based on a QI project at the authors’ institution. The authors included all cases requiring anesthesia services. The primary outcome of this study was the rate of missing controlled substance medications. Secondary outcomes included rates for kits not returned to pharmacy and missing kit return witness signatures. Results There were 54,302 cases during the preimplementation period, 57,670 cases during the implementation period, and 65,911 cases during the study period. The number of missing controlled substance medication (difference 0.7 per 1,000 cases; 95% CI, 0.38–1.02; P &lt; 0.001) and kit return errors (difference 0.45 per 1,000 cases; 95% CI, 0.24–0.66, P &lt; 0.001) declined after implementation of the application. There was no difference in the number of missing witness return signatures (difference 0.09 per 1,000 cases; 95% CI, −0.08 to 0.26, P = 0.350). A user survey with 206 of 485 (42%) response rate demonstrated that providers believed the new application managed controlled substances better than the previous system. Conclusions A software application that tracks perioperative controlled substance kits with deep integration into the electronic health record and pharmacy systems is associated with a decrease in management errors.

Analisi di minimizzazione dei costi del trattamento della leucemia cronica con fludarabina fosfato (Fludara®) e.v. e p.o.: metodologia e risultati di un’indagine empirica

2004 ◽  
Vol 5 (4) ◽  
pp. 265-272
Author(s):  
Carlo Lazzaro
Keyword(s):  
Hospital Stay ◽  
Drug Administration ◽  
Drug Acquisition ◽  
Oral Formulation ◽  
Drug Preparation ◽  
Day Hospital ◽  
Hospital Perspective ◽  
Fludarabine Phosphate ◽  
Before And After ◽  
Outpatient Drug

The aim of the paper is to compare healthcare-related costs of a 5-day course with fludarabine phosphate i.v. vs a 5-day course with oral fludarabine phosphate in Italian patients with chronic leukemia. A cost-minimization analysis was performed from both Italian National Healthcare Service (INHS) and hospital perspectives. Healthcare-related costs were collected from 2 out of a sample of 28 Ematology wards and included those of drug acquisition, drug preparation, drug administration, reception and discharge of patient before and after drug administration; hospital overheads were calculated as a percentage of the total healthcare-related costs. The reimbursement schemes for acquisition and administration of fludarabine phosphate i.v. were gathered from the whole sample of 28 Ematology wards taken into account. Costs were expressed in euros 2004. When compared to fludarabine phosphate i.v., oral fludarabine phosphate allowed savings ranging from 223,47 euros (hospital perspective) to 477,05 euros (INHS perspective) per patient. As far as hospital perspective was concerned, savings associated with oral fludarabine phosphate were due to hospital overheads (115.1%), drug preparation (19.6%), drug administration (17.3%), reception and discharge of patient before and after drug administration (2.9%), whereas costs for drug acquisition was higher for oral formulation (-54.8%). When INHS perspective was taken into account, 3 out of 28 Ematology wards (11%) were reimbursed on a drug-plus-outpatient-drug-administration-basis, whereas 25 out of 28 Ematology wards (89%) were reimbursed on a day-hospital-stay-basis. Savings associated with oral fludarabine phosphate were due to day-hospital stay (253.4%), outpatient drug administration (1.1%), whereas cost for drug acquisition were higher for oral formulation (-154.5%). Sensitivity analysis confirmed the robustness of basecase results. Savings associated with oral fludarabine phosphate may be of relevant interest for INHS policies aimed at reducing public expenditure for drugs in Italy.

Disentangling the Interaction of Migration, Mobility, and Labor-Force Participation

2002 ◽  
Vol 34 (5) ◽  
pp. 923-945 ◽  
Author(s):  
William A V Clark ◽  
Suzanne Davies Withers
Keyword(s):  
Labor Force ◽  
Labor Force Participation ◽  
Panel Study ◽  
The United States ◽  
Family Migration ◽  
Labor Force Status ◽  
Dual Earner ◽  
Before And After ◽  
The Impact ◽  
Status Of Women

The authors examine the impact of mobility on the labor-force status of two-earner households in the United States, in a longitudinal context. There has recently been a resurgence of interest within industry and academia in the impact of family migration on the labor-force status of women, and on dual-earner families in general. Much of the research in this field has documented the disruptive effects of migration on the labor-force status of women, particularly with respect to unemployment, under-employment, and interrupted careers. However, there is another body of research that has challenged the disruption assumption with findings that many women benefit from family migration. The conflicting results persist when the modeling procedures account for the selectivity of migrants. Missing from the literature is a comparison of the impact of mobility on the labor-force status of men as well as women at varying geographical scales. The authors have used a new methodology to extend previous work on the impact of family migration by directly comparing the labor-force status of dual-earner households who migrate long distances, with that of households who move within the same labor market, and with that of households who remain residentially stable. The authors have used data from the Panel Study of Income Dynamics to show conclusively that, although there are disruptive effects, these are relatively short lived for most households. In addition, the results suggest that average changes mask very large variations in what happens to husbands and wives who relocate. This study emphasizes the dynamic nature of wives' labor-force participation relative to their husbands' immediately before and after a move, a finding that has not been established by other work on migration and labor-force participation.

scholarly journals Changes in Patient Visits and Diagnoses seen in an Academic Ophthalmology Department during the COVID-19 pandemic

2020 ◽  
Author(s):  
Meghan K Berkenstock ◽  
Paulina Liberman ◽  
Peter J McDonnell ◽  
Benjamin C Chaon
Keyword(s):  
Practice Patterns ◽  
Low Vision ◽  
The United States ◽  
Viral Transmission ◽  
Pediatric Ophthalmology ◽  
Face To Face ◽  
Diagnostic Codes ◽  
Before And After ◽  
Icd 10 ◽  
The Impact

Abstract BACKGROUND: To minimize the risk of viral transmission, ophthalmology practices limited face to face encounters to only patients with urgent and emergent ophthalmic conditions, in the weeks after the start of the COVID-19 epidemic in the United States. The impact of this is unknown. METHODS: We did a retrospective analysis of the change in the frequency of ICD-10 code use and patient volumes in the six weeks before and after the changes in clinical practice associated with COVID-19.RESULTS: The total number of encounters decreased four-fold after the implementation of clinic changes associated with COVID-19. The low vision, pediatric ophthalmology, general ophthalmology, and cornea divisions had the largest total decrease of in-person visits. Conversely, the number of telemedicine visits increased sixty-fold. The number of diagnostic codes associated with ocular malignancies, most ocular inflammatory disorders, and retinal conditions requiring intravitreal injections increased. ICD-10 codes associated with ocular screening exams for systemic disorders decreased during the weeks post COVID-19. CONCLUSION: Ophthalmology practices need to be prepared to experience changes in practice patterns, implementation of telemedicine, and decreased patient volumes during a pandemic. Knowing the changes specific to each subspecialty clinic is vital to redistribute available resources correctly.

scholarly journals The Impact of the “Muslim Ban” Executive Order on Healthcare Utilization in Minneapolis-St. Paul, Minnesota

2020 ◽  
Author(s):  
Elizabeth A. Samuels ◽  
Lilla Orr ◽  
Elizabeth B. White ◽  
Altaf Saadi ◽  
Aasim I. Padela ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Emergency Department ◽  
Healthcare Utilization ◽  
The United States ◽  
Emergency Department Visits ◽  
Executive Order ◽  
Before And After ◽  
Muslim Majority ◽  
The Impact

AbstractObjectiveDetermine whether the 2017 “Muslim Ban” Executive Order impacted healthcare utilization by people born in Order-targeted nations living in the United States.MethodsWe conducted a retrospective cohort study of people living in Minneapolis-St. Paul, MN in 2016-2017 who were: 1) born in Order-targeted nations, 2) born in Muslim-majority nations not listed in the Order, and 3) born in the United States and non-Latinx. Primary outcomes were: 1) primary care visits, 2) missed primary care appointments, 3) primary care diagnoses for stress-responsive conditions, 4) emergency department visits, and 5) emergency department visits for stress-responsive diagnoses. We evaluated visit trends before and after Order issuance using linear regression and differences between study groups using a difference-in-difference analyses.ResultsIn early 2016, primary care visits and stress-responsive diagnoses increased among individuals from Muslim majority nations. Following the Order, there was an immediate increase in emergency department visits among individuals from Order-targeted nations.ConclusionsIncreases in healthcare utilization among people born in Muslim majority countries before and after the “Muslim Ban” likely reflect elevated cumulative stress including the impact of the Order.

scholarly journals The Impact of the Louisiana Master Gardener Program on the Perceived and Actual Horticultural Knowledge of Program Participants

HortScience ◽  
2006 ◽  
Vol 41 (4) ◽  
pp. 968E-969
Author(s):  
Bobby H. Fletcher ◽  
Michael F. Burnett ◽  
Krisanna L. Machtmes ◽  
Jeff S. Kuehny
Keyword(s):  
Best Management Practices ◽  
Management Practices ◽  
The United States ◽  
Master Gardener ◽  
Perceived Knowledge ◽  
Highly Educated ◽  
Best Management ◽  
Before And After ◽  
Knowledge And Practice ◽  
The Impact

The primary purpose of this study was to determine the impact of participation in the Master Gardener program on horticultural knowledge and practice. In 1972, the “Master Gardener” concept was initiated in Washington State due to the high demand to answer consumer horticultural questions. The main objective of this program is to increase horticultural knowledge of program participants so they can transfer this information to consumer horticultural clientele. The program quickly spread throughout the United States. It reached Louisiana in 1994 and was expanded throughout most metropolitan areas by 1997. No formal evaluation has been conducted to determine the horticultural knowledge impacts of this program. All 257 participants in the 2004 Louisiana Master Gardener (LMG) program were surveyed before and after participation in this program. The survey used was a researcher-developed instrument designed to measure self-perceived knowledge, tested knowledge, and Best Management Practices (BMPs) used. Data were collected by master gardener coordinators and submitted to the researcher after each phase of data collection (pre and post). Results of the study revealed that the LMG participants were highly educated, mostly Caucasian, and mostly female. Significant improvements were identified in all of the knowledge and practice measurements included in the study. These included self-perceived knowledge, tested knowledge, and use of BMPs. It was concluded that the 2004 Louisiana Master Gardener program was effective in increasing the self-perceived horticultural knowledge and tested horticultural knowledge of program participants. In addition, the study concluded that the 2004 Louisiana Master Gardener program improved the use of BMPs among the participants.

scholarly journals (312) Implementing and Assesing a Bilingual Educational Program for Hispanic Nursery Workers in Ohio

HortScience ◽  
2006 ◽  
Vol 41 (4) ◽  
pp. 1055E-1056
Author(s):  
Alejandra Acuna ◽  
Hannah Mathers ◽  
Luke Case
Keyword(s):  
United States ◽  
Social Skills ◽  
Educational Program ◽  
Life Skills ◽  
Family Relationship ◽  
The United States ◽  
Course Evaluation ◽  
Plant Structure ◽  
Before And After ◽  
The Impact

Hispanics are becoming the main source of labor in many productive- and service-oriented businesses in the United States, and the nursery industry is one example. Employers invest much time and money into employees, making the employees their biggest investment. However, the educational needs of Hispanic employees have not been adequately addressed, and no formal educational program for Hispanic workers in the nursery industry has been implemented and tested in Ohio. This project has two objectives: 1) measure the impact of a bilingual educational program containing instruction in horticulture and instruction in life skills to a Hispanic workforce, and 2) investigate which type of training is more essential to the stabilization of the Hispanic family unit, technical horticultural training, or training in life-skills. Eight nurseries throughout Ohio were selected to participate in this project. At each of the nurseries, an average group size of 15 employees was trained. Only half of this number participated in the social skills lessons to determine differences between the group who received social skills lessons and the group who did not. Three horticultural topics were selected: basic plant structure and development, pruning, and nutrition. Forty-minute lessons in Spanish with key concepts in English were prepared with the topics mentioned. Three social skills topics were selected: meeting your and your family's needs in the United States, social support in your community, and communication. In order to measure the impact of a bilingual educational program, two tests (The Rosenberg Selfeteem and Index of Family Relationship) were applied before and after the program was performed. A course evaluation was completed by each of the participants after the program was completed.

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