- Make No Mistake About It -

The Importance of

Safe and Effective

Medication Delivery

This text seeks to increase the efficacy of the medication delivery process to ensure a safer future.

ABOUT THE AUTHOR

Creating content is all about making a connection with your audience, and I believe that each piece of content I create has a wonderful story to tell.

My Path

I am a freelance writer and editor specializing in the medical and financial planning spaces. With over 2 years in academic publishing and 5 in writing, I have been able to explore incredible industries by creating content that inspires.

About Me

I am a book lover and passionate about the study of literature. I'm also a coffee addict, music student, and nature enthusiast!

Lauren Genevieve Straley

Safe care is Quality Care

CHAPTER 1

Securing Medication

This chapter illustrates the importance of securing medication and the main causes as to why that doesn't always happen.

We hear it all the time: everyone makes mistakes. A multifaceted word, it can live as a noun, something that simply exists, something that can be quantified, pointed to, examined. Once placed into action, a mistake morphs into a verb, an active misjudgment, interpretation, or understanding. Some mistakes are more docile and easy to recover from, whereas others can leave a lasting imprint—one that has the power to alter ideas, principles, and practices.

In medicine, mistakes should be taken seriously and clear effective measures should be put in place to ensure that the same mistake is never made twice.

One prominent area within the healthcare sphere where mistakes occur alarmingly often is in medication delivery. This e-book takes an in-depth look at medication delivery, outlining its use, common errors, methods for improvement, and its importance to the healthcare industry.

This text seeks to increase the efficacy of medication delivery, adding to the overall state of patient and caregiver wellness.

In medication delivery, safety for medical personnel and patients alike drive experiments, innovations, and change. These changes will help lead the industry into a new era, one where errors are minimized and satisfaction is increased.

With this idea in mind, let's get started and take a look at the importance of safe medication delivery.

Why is it important to track, lock, and secure medication?

According to the Institute of Medicine’s first Quality Chasm Report To Err Is To Human: Building a Safer Health System, medication-related errors contributed to “one out of every 131 outpatient deaths and one out of 854 inpatient deaths.” As a result, this accounted for more than 7,000 deaths annually. The seriousness and commonplace nature of these medication-related errors should alert us to a huge problem in need of solving.

This same report also broke down the primary causes for medical administration errors by saying “most of the common types of errors resulting in patient death involved the wrong dose (40.9 percent), the wrong drug (16 percent), and the wrong route of administration (9.5 percent). The causes of these deaths were categorized as oral and written miscommunication, name confusion, similar or misleading container labeling, performance or knowledge deficits, and inappropriate packaging or device design.” What’s in a name? Well, frankly quite a lot when it comes to medication-related errors. Naming mix-ups for medicines, their packaging, and the patients taking them happen more often than we think. “Rates of medication errors vary, depending on the detection method used. For example, among hospitalized patients, studies have shown that errors may be occurring as frequently as one per patient per day.” According to this report, someone dies from medication errors every day. With such an elaborate delivery process, it can be difficult (almost impossible) to accurately portray the number of patients who are affected by a medicine error. Sometimes, the errors do not result in re-hospitalization or fatality, only when they do is when we have a sense of how often these mistakes are occurring.

A paradox comes to mind: sometimes receiving medical treatment can lead to more harm than good. We need to find ways to ensure that our healthcare system reacts to these statistics in a conscious way. Being aware of these statistics isn’t enough, finding practical solutions is the most natural next step. Medicine should be an area that can be trusted and relied upon, making the safety of tracking, locking, and securing medication imperative.

In a study in 1984 called The Harvard Medical Practice Study, lead researcher Leape and his colleagues examined over 30,000 hospitals in New York City. Their findings were shocking. 3.7 percent of hospitalizations involved “adverse events that prolonged hospital stay or were manifested as a new disability at the time of discharge.” They discovered that 25 percent of those adverse effects were due to negligence and 58 percent were deemed to be preventable. Preventing something doesn’t simply refer to adverting or hindering an occurrence, it seeks to find ways to forestall negative events in the first place. What measures can be taken to decrease the many ‘preventable’ mistakes that happen in medication distribution?

If 58 percent of the issues that affected patients in the study could have been prevented, that begs the question of current prevention tactics, and how they can be improved to decrease the number of these preventable errors. All healthcare professionals, and the businesses that cater to them have a mission to find new ways to contribute to change—prevention being a key tenet in that conversation. How can prevention be applied to medication delivery? One answer would be the development of a streamlined medication delivery process, one where the medication is properly tracked upon arrival as well as being locked and secured in appropriate channels.

A recent U.S News & World Report study concluded that “medical errors are the 3rd leading cause of death in the United States, after heart disease and cancer.” Dedicated research teams are funded to find the cure for cancer, a disease that takes so many lives every year. In the news, we hear about America’s inclination to obesity and the many medications that exist to help patients with heart disease. All of these advancements are noble, just worthy, and help to advance the overall healthcare of this country, but if medical errors are the 3rd leading cause of deaths we should also be taking a more universal and critical look at these errors: why they happen, and what can be changed to prevent them from taking another life.

We can look at all of these statistics and studies in two ways: as a reflection of the ways our medical system has not measured up, or as a call to action. I know that there are many ways to take control of this issue. One way to think about this is through a thorough vetting and tracking system for medications and safeguards for preventative strategies.

Due to the mortality factors outlined in the statistics above and the patients who continued to be afflicted by these mistakes, tracking, locking, and securing medication becomes of utmost importance to medical professionals and that is why many companies are working to create new and more effective ways to contribute to the solution. One, omniscient solution does not exist, which should lead us to think about combining many ideas. Through a combination of ideas, strategies, technologies, and practices, mitigating preventable medical mistakes sounds like an easier pill to swallow.

I’m late, I’m late for a very important date

Before digging into medication errors a bit deeper, we need to consider an important and ever more ephemeral factor that escapes medical professionals: time.

Time management along with the allocation and distribution of time is a good place to start.

In a typical day, how do most nurses spend their time? More often than not, they are engaged in a tornado of patients, medications, dosages, messy handwritten notes, and (perhaps most importantly) a lack of time. If we pinpoint time and work on ways to improve that we can contribute to one of the primary factors of medical distribution errors.

By securing medication distribution, nurses are able to spend less time worrying about the medication, and more time with their patients and their individual needs. Don’t get me wrong, thinking about medication is incredibly important, but when a nurse is on the brink of hour 11 of a 12-hour shift, overseeing 13 bedside patients, some with the similar if not the same medication in varying doses, it becomes easier to visualize and contextualize the reasons why preventable mistakes happen. In To Err is To Human, it was found that “in one survey of nurses in 11 hospitals, both pediatric and adult nurses reported staffing ratios and the number of medications being administered as being the major reasons why medication errors occur.” Ample time is a heartsease for nurses, allowing for an increased devotion to their patients’ unique medical needs.

Time for a nurse also involves the amount of time they work in a given shift. “In a national survey by Rogers and colleagues, self-reported errors by nurses found that the likelihood of a medication error increased by three times once the nurse worked more than 12.5 hours providing direct patient care. Among nurses working more than 12.5 hours, the reported errors, 58 percent of actual errors and 56 percent of near misses were associated with medication administration,” found in the research from To Err Is To Human. In this way, we see time in a new way: in excess. Working long hours, sometimes over 12 hour shifts, can be a leading cause for medication-related errors.

The development of technology that can track, store, and secure medications is a great way to save time and resources. A practicing nurse in the greater Michigan area says, “As a bedside nurse, technology and equipment that allows me to spend less time passing medications and more time with patients is a game-changer.”

Greater time spent with patients and being able to focus more on the patient and their needs will lead to a decrease in the amount of preventable errors we looked at above. Often it is the nurse who is the final safeguard between the patient and a medication administration error which is why technology that focuses on making medication administration safer and more efficient is invaluable.

With a more thorough examination of time and time management, we can see the inherent value of the nurse-patient relationship—adding to the argument that efficiency of medical delivery (found in better workstations and medical technology) can really make a huge difference in workflow and also patient/caregiver well-being.

In order to better understand how to make a process more efficient, we must first understand how that process operates.

CHAPTER 2

The How-To of Safe Medication Administration

In this chapter you will learn about the steps of medication distribution, the 5 Rights, and organization of medication.

There are six steps of medication management:

Selection and Procurement
Storage
Ordering and Transcribing
Preparing and Dispensing
Administration
Monitoring

This list simply illustrates the process by which medications are handled from their initial ordering to the effect of the medication on the patient.

Moving in the right direction

When administering medication, medical professionals should always consult the five rights. These rights are in place to help healthcare professionals and their patients with the efficacy of the medication administration process. Please note that the additional recommendations provided underneath each right were drawn from “NursingCenter’s Nursing in the Round Blog” written by Lisa Morris Bonsall, MSN, RN, CRNP, Clinical Editor for Lippincott’s Nursing Center.com.

Right Patient
- Be sure that the patient is able to self-identify
- Use two forms of identification
- Make use of appropriate technology to ensure patient’s identity
Right Drug
- Double check the medication label
Right Dose
- Check the order
- Use reasonable judgement if the order and patient conditions match up
- Ask for confirmation if you are unsure at any time
Right Route
- Ensure the route is clear and makes sense for the patient
Right Time
- Confirm the time of previous doses to be sure you give the medication on the correct schedule
- Double check the time requirements of the medication you are administering

In addition to these five key rights, there are an additional three that all nurses and medical professionals designated with the task to distribute medication should be aware of.

Right Documentation
- Be sure to document the administration of the medication after you have given it
- Clearly document any necessary information of the administration process or any areas that should be checked both before and after the next dose.
Right Reason
- As stated above, be sure the medication being administered makes sense for the patient.
Right Response
- Monitor the patient’s reaction to the medication. Is it normal? Are there any additional response signs that should be documented in their chart?

These rights provide key benchmarks for the practice of administering medication. They are in place to ensure best-practices and help to create a foundation of equity. It is important to note that these rights are goals for nurses and are not the end-all-be-all of proper and sufficient care. These rights are good to know and can be helpful when thinking about medication delivery and the ways that the process might be streamlined for nurses and other caregivers alike.

After the medication is prescribed, the patient has to receive it. There are three routes most common for medication administration.

Enteral.

This process is most easily recognized and known as oral transmission.

Topical.

When talking about topical administration, both the application location and the pharmacodynamic effect (the area affected by the medication) are local-- located directly in the spot where the medication was administered.

Parenteral.

This administration technique is performed by injection or insertion.

Now that we have familiarized ourselves with the practices and procedures for medication administration, we can take a closer look into workflows and organizational tactics to give medication correctly.

The Importance of Giving Medication Correctly

The evaluation of current medication distribution errors would provide a strong indication that the current workflow for medical professionals is flawed. It is not conducive to the individual needs of the patients, as seen through the continued ‘preventable’ mistakes. Long hours, a large patient load, and insufficient communication and resources are factors that contribute to the inefficiencies in the current workflow.

Though more research is needed into these qualitative factors, it seems one way to proceed would be to optimize time and the different ways current technology can be used in these spaces to make that a reality.

How to get and stay organized

One of the ways our society measures success is through the status of how busy we are. But being too busy can contribute to many negative lifestyle actions including forgetfulness and silly mistakes we would not otherwise make.

This is where a regimented organizational process can be incredibly useful. Organization in terms of medical administration can come from the tools that are used to prepare, track, and store the medication itself. Keeping medicine in a secure space severely decreases the chances for medicine to get lost or misplaced. Having quick access to patient medical records aids in ensuring that the right patient receives the right medicine. Through safe administration, dosage can be monitored in a more regular fashion.

The best way to think about how to stay organized is to look at some of the reasons the mistakes are made in the first place.

CHAPTER 3

Oops It Happened Again: Medication Errors and How to Prevent Them

This chapter will take an in-depth look at medication errors through a literature review of many studies and new practices of reducing said errors.

Mistakes are like thorns in a rose. Sometimes their sharp edges miss your fingers as you gently draw the blooming flower to your nose, but other times its breath catches your hand striking blood the very color of the flower itself.

When discussing a medical mistake concerning medication, it is important that we have our bearings on what we mean when we talk about drugs and mistakes.

Patient Safety and Quality: An Evidence-Based Handbook for Nurses defines a ‘drug’ as “a substance intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease; a substance (other than food) intended to affect the structure or any function of the body; and a substance intended for use as a component of a medicine but not a device or a component, part or accessory of a device.” Medications include, but are not limited to, any product considered a drug by the Food and Drug Administration (FDA).

‘Medical errors’ is not an easily definable term. Definitions range by internal organization, but an overarching approach, as outlined in Patient Safety and Quality, to the topic can be thought of as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. These mistakes are susceptible to occurring at any stage of the medical administration process. (See the six steps above for a refresher on the process).

The prevalence of human error

Medical administration errors (MAE) most typically occur in hospital settings. Hospitals can be a swirl of scrubs, dressing gowns, patients, and medicine. Amalgamated together, these factors can contribute to an overworked mind—which can, unfortunately, lead to mistakes. With the myriad of tasks assigned to all of the medical professionals in the building, having a system that could not only store medicine for you but individually lock and secure that medication could make all the difference in the long process of tracking medication.

According to To Err is to Human, “Error-provoking conditions influencing administration errors included inadequate written communication, problems with medicines supply and storage, high perceived workload, problems with ward-based equipment, patient factors, staff health status, and interruptions/distractions during drug administration.”

Interestingly enough most of these errors, about 30 percent, occur during the administration stage. The National Library of Medicine suggests that “prescribing and drug administration appear to be associated with the greatest number of medication errors.”

If we break the percentages down further, within the 30 percent of administration errors, the top two reasons for these errors were a late delivery of the medicine and the wrong dose of the medicine. Both of these factors are related to the “supply and storage” of the medication in question. Technology that secures medication would not only increase the safety of the medicine itself, but it would also lead to working to eliminate one of the primary ‘error-provoking conditions’ above.

Given the administration area lends itself to the highest percentage of mistakes, we should think more critically about the ways we can abate the frequency of such errors. Using new medical technology, specifically to secure individual medication drawers, can help on both of these fronts and therefore would help minimize the top 2 medicine administration errors.

Many errors that occur in medication delivery are from Medical Administration Errors (MAE) and such errors occur most frequently in the hospital setting. It is important to consider space in this issue. Different spaces lend themselves to different practices. But one universal truth in all spaces is safety.

The money game

Making errors in medicine distribution can lead to some costly consequences. Many insurance providers including Medicare and Medicaid offer patients’ reimbursement opportunities tied to medical related errors. This profound shift in the healthcare industry means moving it toward an outcomes-based payment model. Lippincot says that “the volume-based payment model that incentives utilization is fading...therefore incentivizing and placing new emphasis on quality of care and performance.” A new way of paying for care has emerged.

As the Centers for Medicare and Medicaid (CMS) reimbursements said, “Instead of only paying for the number of services a hospital provides, Medicare is also paying hospitals for providing high quality services.” This system has revolutionized the way that insurance companies, hospitals, healthcare professionals, and patients conceive of quality care. The CMS has implemented three programs in order to ensure that quality care is at the top of the list for hospitals and their employees.

The Hospital Readmissions Reduction Program.

This program was put in place with the aim to reward hospitals if they keep their readmission numbers low. When a medical procedure is performed, patients expect that it is done right, but what happens when it isn’t successful on the first try? This program works to combat that very issue, one that patients undergo far too often.

The Hospital Value-Based Purchasing Program (VBP).

The CMS has access to detailed information for the link between any given hospital’s quality of care and their payment received from Medicare. This performance-based payment system “accounts for the largest share of Medicare spending,” says the CMS and is affecting patients in over 3,000 hospitals in America.

Hospital Acquired Condition Reduction Program.

No one wants to recover from an aliment just to hop to another sick bed due to an internal mistake. Medicare has been authorized to reduce payments to hospitals based on conditions brought on from hospital exposure.

According to the CMS, its VBP program (discussed above) evaluates and rewards hospitals based on three care factors:

● The quality of care provided to Medicare patients

● How closely best clinical practices are followed

● How well hospitals enhance patients’ experiences of care during hospital stays

This new system introduces penalties and bonus based on a hospital’s performance on 24 unique factors which can be broken down further into four-equally measured segments.

Safety 25%
Clinical Care 25%
Efficiency and Cost Reduction 25%
Patient and Caregiver-Centered Experience of Care/Care Coordination* 25%

The CMS believes that these reimbursement strategies are one of the main reasons driving change to medical practice. “Hospitals,” they say “must support the provision of quality care required for Medicare reimbursement, to comply with the healthcare law and healthcare payments, and to promote positive patient outcomes while increasing efficiency.”

The reports addressed 4 major issues:

(1) errors are common and costly
(2) systems cause errors
(3) errors can be prevented, and safety can be improved
(4) patient safety must become a national priority

This systematic payment changes call to mind the effects and changes that hospitals and other medical sites will have to maintain. How has this change influenced technological advances in this area? What are ways to grow and maintain proper patient care and satisfaction? With legal and insurance procedures in place to promote patient safety, it is time to look inside the hospital itself to search for methods of improvement.

CHAPTER 4

Tracking Medication All the Way to The Patient

This chapter will outline ways to optimize your company's digital fluency and how that effects medication delivery.

Hospitals are a place for change. Inherently, they seek to alter, fix, and preserve human life. One of the ways they do this is through the medication they prescribe. Medicine is an integral part of our healthcare system and the way it operates. Medication is used to help so many people, so shouldn’t we think about ways to best secure it?

Attaining secure medication delivery is a process. That process is comprised of many steps, and it is important to look at each step—how can the workflow can be maximized to ensure security and patient safety? How can tracking medication help with efficiency for employees and patients? If medication is properly tracked, and each stage of the process monitored the likelihood for error decreases dramatically. But tracking medication doesn’t have to be a long and laborious process. Workstation technology that has the capability to store, lock, and secure medication can be one way of streamlining the process.

It is important for hospitals, private practice-offices, nursing homes, etc. to take steps to optimize patient satisfaction and to take practical steps to reduce the possibility of human error. One way to do this is looking at your business’ ERAM score.

EMRAM scores – what they are and why they matter to you

EMRAM stands for Electronic Medical Record Adoption Model—an electronic model set to replace paper in medical offices. The score is based on a 0-7 scale which assesses the nuance of digital applications in your workspace. Based on your company’s digital fluency, you can easily see where you on the scale. Interested in learning more? Check out this website and get your score.

https://www.himssanalytics.org/emram

Being technologically savvy can have some real benefits for your business primarily through increased accuracy of delivering patient records, photos, and medicines. A stronger hold on the security of patient records can prevent such mistakes as loss, mix-up, or deletion.

Implementing and using automated information systems in your workplace has been shown to decrease medication errors. According to the World Health Organization’s 2016 ebook, Medication Errors: Technical Series on Safer Primary Care, “Computerized provider order entry (CPOE) with decision support may be effective if targeted at a limited number of potentially inappropriate medications and is designed to reduce the alert burden by focusing on clinically-relevant warnings. There is substantial evidence which supports the use of CPOE to decrease the frequency of medication errors in the inpatient setting. One study found that the likelihood of error occurrence was decreased by 48% when an order was processed via CPOE.” CPOE is just one example of using advanced technology to help mitigate the frequency of preventable medication errors.

The EMRAM model helps improve the quality, efficiency, and safety of the workplace. This can be done through an easy sharing capability amongst authorized medical professionals which decreases the amount of time nurses have to look for specific patients’ records.

Now that you know the best way to access, share, and interact with patient records and sensitive health information electronically, how can you continue to add security to your medication distribution processes? New technological advancements in this area are promising, and one of the most crucial steps is securing all patient’s medication in individual locking drawers.

Uniquely you

All patients come in with their own set of medical needs. No two patients are exactly alike, and they should be treated with the personalized and professional care that they deserve. Individual locking drawers for their medication is a way to decrease preventable MAEs while increasing the accuracy, security, and delivery methods for the nurses administering these medications.

Individual locking drawers can

Reduce medication errors and the risk that follows
Increase employee and patient satisfaction.
Set up the hospital for future practices by ensuring longevity and adaptability of the space.

CHAPTER 5

Altus: How We Can Help

This is a brief section on Altus: the company, its mission, and dedication to improving medication delivery for the healthcare industry.

All companies in the healthcare sphere have a duty to help improve medical practices and technologies in the best ways that they know how. At Altus, our main goals are patient satisfaction, healthy caregivers, and optimal mobility. Our technology workstations are built with these three tenets in mind. We place an emphasis on human factors, which work to contribute to a healthy and productive work environment.

Altus provides world class technology workstations and now offers one of the most innovative medication delivery solutions on the market: RedMed. Our integrated touchless RFID badge reader seamlessly merges with current hospital RFID systems, making this system easily adaptable in any work environment. The RediMed model supports Pharmacy-Fill Applications with an easy to fill and move cassette and transfer cart system.

With our technology and electronically labeled bins, clinicians have easy view, access, and alteration options for patient medication. Categorization confusion is combated by providing the option to sort by patient name, room number, or supply type. All of that information is backed up, tracked, and saved at the RediMed unit as well as on the central management software (CMS).

Another one of our top workstations is called Cliomed, an all-inclusive workstation which can allow for nurses to securely carry and administer the many medications they are responsible for. Along with the RediMed model, the Cliomed offers the ease of medication distribution to any location. With its moveable features, it works to reduce the steps in the administration process. With a secure system and customizable factors, nurses can use these workstations to suit their particular and unique needs.

What components make up a good workstation?

Workstations and healthcare technology that streamline the process of medication administration is helpful to nurses and healthcare professionals in all settings. Not all workstations are created equal. A crucial distinguishing factor among work stations is the implementation of secure, individual locked drawers. Secure, individual locked drawers are used to store frequently used medicines together. In an article found in American Nurse Today the authors argue that, “many [medication administration] errors could be prevented by decreasing availability of floor-stock medications and restricting access to high-alert drugs.” With secure, individual locked drawers these high-alert drugs would not simply be located in a medicine stock room. They would be able to be secure and unable to get mixed-up with any other medications that may have a similar packaging or nomenclature. This practice of securing medication decreases the amount of time nurses spend with medication and increases the time they are then able to spend with patients.

The main emphasis here is on individuality—treating the patient as a human first and foremost, with their own unique set of needs, wants, desires. Individuality distinguishes one person from another, and this secure individual locking drawer works to ensure patient’s medications are accurate and entirely theirs.

Some workstations have locking features, but do not have the individual drawers, which could lead to medication mix ups and confusions. Remember the statistic at the beginning of this ebook, where I told you that 58 percent of medical related errors were preventable? Individual, locked drawers can work as a catalyst to help decrease that percentage. With the individual drawers, patients and nurses alike can feel secure in the distributing and receiving of the correct medication. Since one of the most common factors for medical administration errors is distraction, using this accuracy tool can help reassure the caregiver and the patient that the medicine they are receiving is correct.

Another common factor contributing to medical administration errors is a lack of documentation, these workstations provide immediate access to all of the patient record information, making documentation and administration a seamless and intertwined process. This stage is where your ERAM score will come into good use. Our workstations have laptop hookups which makes your patients’ electronic records and medical information simple to access and examine.

With so many options on the market, what makes Altus stand out? Our dedication to human needs, our innovations for flexible, customizable, and security assurance. Altus’ ergonomic nature seeks to improve caregiver and patient safety alike.

Ergonomics is an applied science concerned with designing and arranging things people use so that the people and things interact most efficiently and safely— called also biotechnology, human engineering, human factors. Its first known use is 1949 and comes from the Greek ergon ‘work’, on the pattern of economics. The pattern and system of economics, through which this word is born can have many implications for the future to which we use it now. If we think about ergonomics as a pattern, something to be figured out, we can think of ways to optimize that pattern, conducive to its needed use. Each system is different and the plural malleable nature of an ergonomic workspace, contributes to this overarching problem of medication accuracy and how we can take action to offer changes, solutions, promises for a safer tomorrow.

The pattern we are concerned with at Altus is the optimization of the human experience. Through our customizable and flexible workstations, we seek to accommodate all of our invaluable health care professionals.

In the dynamic medical market, accuracy is gold. We would like to participate in the conversation of one of the most pivotal issues that faces the medical industry: medical administration. We all should do what we can to contribute to a solution, and the way we know how is through the products we offer.

Healthcare is a fast-paced and ever-changing industry, but one area that should never be compromised is safety, and the companies dedicated to protecting and advancing that core value play a beautiful role in its development and sustentation.