Effects of Technological Interventions on the Safety of a Medication-Use System, Article Critique Example

Kathleen A. Skibinski, Barbara A. White, Lawrence I-Kuel Lin, Yuping Dong, and Wenting Wu

This experimental design study was conducted in order to measure the effectiveness of introduction of novel technologies to the medication-use process. The research team hypothesized that the number of system errors would decrease with the implementation of each innovation, and staffing and inventory levels would increase. The objectives were identifying and specifying standards for medication administration and dispensing equipment, measuring the effect of the innovations applied on the performance of medication administration system, and ideal medication-use system design characteristics in redesigning the system. The technological innovations that were implemented were pharmacy computer system, automated dispensing cabinets and point-of-care products. Interviews of the hospital staff who participated in the study (registered nurses, pharmacists, physicians, nursing-unit clerks, licensed practical nurses, pharmacy technicians, physician assistants) were conducted using a scripted questionnaire. The interviews were conducted before and after the implementation of the innovations. In addition, the statistics were gathered about the quantity and types of medication errors from between November 2002 and July 2005 by the number of errors per 1000 patient days. The study examined the accuracy of the medication administration record, accuracy and timeliness of the dispensing process. In addition, it examined the accuracy of medication administration and observed staffing changes. The results of the study were that with the implementation of novel technologies, the turnaround time of medication administration had decreased, accuracy of patient identification had increased, and potential failure modes had been identified due to the process changes and technological design. The study also showed that inventory and stuffing of nurses and pharmacists had increased.

The results of this study are practically meaningful, as they provide facts on the effectiveness of implementing technological innovations in the medication-use process. Many researchers state that applying BCMA and other innovations decrease error rates, but this study measures the actual effectiveness. The clinical significance of the study is also high, as it provides data on the effectiveness of certain methods of automation mediation-use process, which can be used for further research.

The authors of the article state that there is a lack of studies that validate technology, and do not reference any of the existing studies. It creates the impression that there was not any valuable research conducted on this or similar topic, putting this study in a certain vacuum. At the same time, similar research programs have been conducted in past years. Therefore, the theoretical framework of the study is insufficient.

The authors provided information about the implementation of each innovation, reaction of the staff to this innovation, problems they faced and results of implementation of the innovation element. This makes this research valuable, as these results can be used both for further scientific research, and developing protocols for introduction and usage of the equipment and technologies used within this research.

The authors of the study identified three limitations. These were that patient outcomes were not identified, conflicts with organization due to the length of the study, and the fact that the implementation was researched within a single organization. The conclusions of the study are related to the study findings. The evidence of clinical significance is compelling, as even the ordinary observation of medication administration process shows that implementing pharmacy computer systems and dispensing cabinets decreases the amount of medication errors and abuse. The costs of implementation the innovations described are worth the benefits, as they provide a significant decrease of medication error rates and decreased medication processing turnaround time.

The problem of medication errors exists in all the medication units worldwide. Numerous findings have proved that introducing pharmacy computers and automated dispensing systems, are effective solutions to this problem. Introducing the complex of innovations offered by the authors of the study allows applying a systematic approach to different sides of the problem of medication errors. Nevertheless, the absence of references to the similar studies should make the hospital administrators double-check for other innovation opportunities before deciding about the type of error-preventing strategies for their units.

Reference

Skibinski, K., White, B., I-Kuel Lin, L., Dong, Y., and Wenting, W.(2007). Effects of technological interventions on the safety of a medication-use system. American Journal of Health-System Pharmacy, 64 (1), 90-96.