The survey shows that pharmacists and nurses are most outspoken when it comes to medication administration. Why is this so?

Pharmacists and nurses are the most outspoken because they are ultimately responsible for patient safety. Physicians order the medications, but the pharmacists check the order, procure the medications, compound the dose if needed, and dispense them to the patient care area. Nurses are then responsible for administering the medications to patients. Nurses are the final touch, and also the final point at which an error can be averted.

As a nurse, I worked at the bedside for eight years, and I never wanted to make a medication error, but I did. I was lucky that the patient was fine, but when that happens you just feel awful.

If a nurse makes a mistake, they could get sued, or lose their license and potentially their career. There are horror stories about nurses who make a medication error and the patient dies, and then the nurse ends up taking their own life because the guilt and grief are too much. Giving medications to patients is certainly one of the scariest things that nurses do.

Almost 70 percent of clinicians believe the benefits of a single integrated EHR have been realized. Can you describe these benefits?

With a single EHR, clinicians and others can view and act upon the same information regarding a patient’s medications. Many EHRs also have applications built into them. For example, when the physician writes a new order, the EHR might generate a list of recommended or approved medications. The nice thing is, when using a single EHR, it will display the patient’s historical information – making the medication ordering process easier. Some systems also prompt the medication reconciliation process. Of course, if the patient was treated in a different health system that uses a different EHR, the digital transfer of information could be incomplete. Health information exchanges are helping to improve this situation – but the clinicians still often need to rely upon the patient or family to get an accurate account of the patient’s medications.

Infusion was cited as a key medication management function that exists outside of the EHR. What makes infusion so important?

About 65 percent of medication errors happen when medications are infused directly into a patient. This process is more prone to errors for two reasons: 1) the most critical drugs, such as narcotics and blood thinners, are administered via IV, most often through infusion pumps, and 2) by administering medications directly into the blood stream, these drugs can have immediate effect. It’s not like an oral dose of drugs that must be absorbed through the intestines. If a clinician makes a mistake, it takes effect right away.

The problem historically has been that the infusion pump was an isolated medical device. The nurse would program it, and it would infuse. Dose error reduction software (DERS) helps to catch programming errors, but the process is still manual and outside of the EHR. Furthermore, the nurse would manually document what’s going on, how fast it’s running, how much volume went in and the dose. Pharmacy had no clue how fast the infusion pumps were running or if the bag was almost empty or if they needed to send up another one.

Some healthcare organizations are addressing this problem by integrating infusion pumps into other systems, most notably the EHR. This creates a bi-directional link between the pump and the EHR. This link allows order parameters in the EHR to wirelessly populate on the pump, so the nurse doesn’t have to manually program and worry about making a key-press error.

More than 70 percent of respondents acknowledged the value in moving to a single vendor for medication management. What are some of the benefits?

With a single vendor, it is easier to get systems to communicate with each other, which is what medication management is all about. By sharing information across different medication management technologies, you can impact clinical decision making in real time and through predictive and retrospective analytics.

With one integrated system, one vendor is responsible for enabling the various technologies to work with one another. For example, computerized physician order entry (CPOE) ensures that pharmacists and nurses can actually read the physician’s order while barcode medication administration (BCMA) ensures that the right medication is administered to the right person at the right time. Such systems, though, can’t work in isolation. All of the components need to be connected across the care experience to create an efficient system that makes it easy to prevent errors.

“About 65 percent of medication errors happen when medications are infused directly into a patient.”

- NICOLE WILSON, BD

About BD

BD is a global medical technology company that is advancing the world of health by improving medical discovery, diagnostics and the delivery of care. BD leads in patient and healthcare worker safety and the technologies that enable medical research and clinical laboratories. The company provides innovative solutions that help advance medical research and genomics, enhance the diagnosis of infectious disease and cancer, improve medication management, promote infection prevention, equip surgical and interventional procedures and support the management of diabetes.

Disclosure: The survey conducted by HIMSS Analytics, 2017 Medication Management and Safety Study, was sponsored by BD.