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Improving Quality of Care

In: Science

Submitted By kokonaye
Words 1344
Pages 6
Annually, millions of Americans receive high-quality health care that restores their health to the best it can be and allows them to carry on functioning in society at their optimum best. Unfortunately this story does not resonate with some Americans who are far from happy about the level of care they received while sick. Quality problems are present in wide variation across board when talking delivery of health care services, in some instance, the issue could be with underutilization of a particular service, and other instances may include misuse of service which is generally preceded at onset by prior unacceptable level of errors. The purpose of this paper is to highlight medication errors as a health care safety issue. One solution involving automation would be explored since it has long been recognized as an important factor in reducing human errors in work processes. It is crucial to showcase this because numerous studies have substantiated the positive effects of health IT on quality and safety improvements, Slovenky & Menachemi (2011).
A safety Initiative
With new tools provided by the Affordable Care Act, hospitals can now aggressively implement programs with sole aim of assisting in the reduction of preventable errors. The act provides hospitals with incentives to improve the quality of health care, and provide real assistance to medical professionals, to support their efforts to reduce harm, McKinney & Zigmond (2011). The government predicted that this could save 60,000 lives over the next three years and potentially save up to $50 billion in Medicare bill. The federal government is encouraging providers to adopt and effectively use electronic health record (EHR) systems, Heubusch (2011). The goal in the development and use of EHR’s is to enable effective and measurable improvements in the health of individuals and fully involve them in the process.
Reasons for the Initiative The Institute of Medicine (1999), defines a medical error as "the failure to complete a planned action as intended or the use of a wrong plan to achieve an aim". An adverse event is defined as "an injury caused by medical management rather than by the underlying disease or condition of the patient". One of the reasons why the EHR initiative was developed was because it became apparent that about 80 percent of serious medical errors was due to miscommunication between caregivers when a patient is transferred or handed off, American college of Surgeons (2011). Complete and accurate information is of utmost importance in health care, providers will be in a better position to manage and advocate for patients when they have access to a patient’s entire complete and accurate health history, in effect, better access to information. Complete and accurate electronic health information will facilitate the ability of multi-dimensional teams to diagnose and treat patients.
It is reported that there are between 44,000 and 98,000 individuals who die every year in hospitals due to preventable medical errors, Medscape (2011). As earlier mentioned, there are several ways in the ‘medication use processes’ where errors can occur. These include; prescribing, documenting, transcribing, dispensing, administering, and monitoring. Prevention of medication errors has therefore become a high priority worldwide. There is mounting evidence that systems that use information technology (IT), such as computerized physician order entry, automated dispensing cabinets, bedside bar-coded medication administration, and electronic medication reconciliation, are key components of strategies to prevent medication errors, Agrawal (2009).
Strengths and Limitations of the Initiative
Strengths: Hospitals with automated notes and records, order entry, and clinical decision support have fewer complications, lower mortality rates, and lower costs, Amarasingham et al (2009). IT systems have also been reported to have the potential to save up to $88 billion over 10 years in costs in the USA. Clinical decision making is a complex process that depends on human ability to provide undivided attention and to memorize, recall, and synthesize huge amounts of data – all vulnerable areas. IT systems can improve access to pieces of information, organize them, and identify links between them. Clinicians often ‘know’ the information (such as a patient's allergies, a drug recall warning, or a drug–drug interaction) but forget to consider it at the time of prescribing. IT systems are effective in bridging this ‘knowing–doing’ gap, by presenting the relevant information to the clinician at the time of decision making, Pfeffer & Sutton (2000).
Limitations: With growing recognition that many inpatient medication errors occur at care transition points, reconciliation of medication lists during admission, transfer and discharge is an important step in improving safety. Computerized Physician Order Entry (CPOE) systems are effective in reducing errors during prescribing; however, a CPOE system cannot detect an error if the physician does not remember to prescribe a medication that the patient was taking at home. Another concern that has been raised by evidence of the potential negative consequences of IT systems on patient safety is that IT systems can adversely affect clinical care by generating more work or new work for clinicians, causing workflow problems, or even generating new kinds of errors, Koppel et al (2005). The current approach to IT standardization and certification is focused on the functionality of the system, but does not address its implementation or usability by clinicians.
Role of Nursing Nursing as a profession has a long history of regarding patient safety as a primary precept of the profession. Nurses have 2 roles in medication error prevention, first they must check to see that other healthcare providers have not made any errors in any part of the medication order chain; next they must ensure that they themselves do not make an error. Ordering or prescribing the wrong drug, dosage, or route contributes to 48% of medication errors. Nurses intercept 48% of these types of ordering errors. Transcription errors account for 11% of all errors, of which 23% are intercepted by nurses. Dispensing errors comprise 14% of all medication errors; however, nurses intercept 37% of them. Overall, nurses intercept 58% of all medication errors. Administration errors account for 28% of all errors, Medscape (2006).
Summary
Quality healthcare depends on the availability of quality data, Ahima(2007). IT systems are key components of a multifaceted strategy to prevent medication errors and improve patient safety. However, we need to be mindful of their potential to affect clinical workflow adversely, with attendant complications. Improving standardization and certification of the design and implementation of such systems should help. In addition, creating an economic and policy environment conducive to the financial goals of hospitals and physicians will facilitate wider adoption. Nurses can take a more prospective, risk-reduction approach to medical errors (Wolf, 1989). Adoption of appropriate technology blended with a confidential error reporting system that protects the professional interests of nurses will be effective in reducing, preventing and correcting medical errors.

References
Agrawal, A (2009). Medication Errors: Prevention using information technology
Systems. Retrieved from http://www.ncbi.nlm.nih.gov.
AHIMA (2007) Assessing and Improving EHR Data Quality Journal of AHIMA (78) 3.
Amarasingham. R., Ptantinga.,L., Diener-West M., Gaskin.D(2009) Clinical Information
Technologies and Inpatient Outcomes: a Multiple Hospital Study. Arch Intern Med 169: 108 114.
American College of Surgeons (2011) ‘TJC Tackles Miscommunication among
Caregivers’. Bulletin of the American College of Surgeons (1) 96.
Heubusch, K (2011) Advancing Quality and Patient Safety Initiatives. Retrieved from http://www.journalahima.org. Koppel. R., Metlay.J., Cohen.A., Abaluck. B., Localio. A., Kimmel. S., Strom. (2005). Role of Computerized Physician order entry systems in facilitating Medication errors. JAMA 293: 1197- 1203.
Medscape (2006). Medication Error Prevention for Healthcare Providers. Retrieved from http://www.medscape.org.
McKinney. M,. Zigmond. J(2011) HHS Launches $1 Billion Patient – Safety initiative.
Retrieved from http://www.modernhealthcare.com.
Pfeffer. J., Sutton. R (2000). The Knowing – Doing Gap: How Smart Companies Turn Knowledge into Action. Boston, MA: Harvard Business School Press: 2000.
Slovenky, D., Menachemi, N (2011). How Information Technology can Improve Safety:
Error reduction in Health Care: A Systems Approach to Improving Patient Safety,
3rd Edition. San Francisco. CA, Jossey –Bass.
Wolf. Z (1989) Medication Errors & Nursing Responsibility. Holistic Nursing Practice.
4(1) 8- 17.

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