Organizational Responsibility and Current Health Care Issues, Research Paper Example

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Research Paper

Medication errors have been a serious issue impacting the health care industry for decades.  They are considered to be the single most prevailing cause of medical errors across the board in the hospital industry. This is largely due to the antiquated methodology used as standard hospital protocol to write or document prescriptions. Medication prescribed by doctors, transcribed by nurses and delivered to patients ultimately results in physician and pharmaceutical medication errors. Research has shown that implementing the use of Electronic Medication Administration Records (eMAR) in hospitals shows nearly a 100% reduction of medication errors, but there are many obstacles preventing this technological advancement from being utilized.

In a Houston news article covering a story about a pharmacist who was fired for blowing the whistle on medication errors in their hospital of employment, it was noted that, “During the interview process, defendants explained to plaintiff that the Texas Department of Health had reported a number of medication errors following the department’s previous visits to defendant’s facility (Stefanie, 2012).”  When the woman attempted to correct the issue, by informing the patients they were being prescribed with the wrong medication, she did so in the hopes of sustaining accreditation for Medicare and Medicaid patients, as noted, “Defendants expressed a desire to correct the problems before the next Joint Commission examination scheduled for February 2012, the results of which could affect defendants’ accreditation to begin accepting Medicare and Medicaid patients (Stefanie, 2012).” These actions by the pharmacist resulted in here removal from the hospital. She later files a lawsuit against the hospital for being unlawfully discharged. Medication errors are predominantly the most documented medical error in hospitals worldwide. This Houston news report proves that implementing new standards or policies to counteract these issues are needed but often avoided due to the difficulties involved with implementation. Changes in organizational structure and governance, as well as hospital industry culture, are needed. The main resource that could be implemented to fix this problem is the use of eMAR.

Current research knowledge on Electronic Medication Administration Records (eMAR) implementation suggests that eMAR is expected to enhance nurse/pharmacy communication, but a lack of improvement in nurse/pharmacy communication may be a reflection of broader communication needs beyond eMAR. In evaluating the place eMAR implementation plays in improving inefficient medical operations in ICUs, there are two types of problems worth recognition. The first issue involves the deficiency in the medical industry. The implementation of eMAR can specifically medication errors that occur based on transcription, written medical records exchanges and a diverse medical units each with their own respective standards and protocol. The other problem directly relates to the eMAR implementation process and the obstacles that impede it from being realized.

Medication administration record (MAR) is a log containing information about the order and documentation of administration of medication to the patient. Electronic Medication Administration Record (eMAR) is particularly useful for electronically track medication administration via bar coding to verify compliance with the five rights of medication administration for the right patient, proper medication, proper dose at right time and the right route. There are also controversial issues surrounding the concept of this type of technology used in collaboration with eMAR, such as the infringement of civil liberties imposed by accessing medical history through digital bar codes.

Implementing eMAR across the board as a resource for all CCU data management systems requires more than just technology; it requires the willingness of medical practitioners to adapt to change, and the foresight of Tort legislation to withstand the unintended impact of learning curve errors within the medical community. Ultimately, it is in the best interest of the medical industry as a whole to make the transition to eMAR. After assessing numerous medical cases of CCUs in their process of adapting to eMAR based protocols, it is found that through the use of technology to streamline the process, integrate complex tasks, and provide medication safety teams with real-time data, the benefits of eMAR can be enhanced and the unintended consequences reduced enough to far outweigh alternatives to applying an electronic medical record system.

In evaluating the place eMAR implementation plays in improving inefficient medical operations in ICUs, there are two types of problems worth recognition. The initial problem deals with the deficiency in the medical industry, which eMAR seeks to resolve, specifically the medication errors that occur through transcription, or written medical records exchanges, across diverse medical units each with their own respective standards and protocol. The other problem directly relates to the eMAR implementation process and the obstacles that impede it from being realized. While there are numerous sub-issues that contribute, the main problem eMAR faces is the indecisiveness of hospital management initiate the adaption process.  Electronic medical records are currently not the standard because in addition to There is also a learning curve factor that accompanies eMAR implementation that results in veteran nurses having difficulty unlearning old protocols as they relate to utilizing traditional medical record format verses electronic medication administration records. While studies show this learning curve is ultimately overcome after three months of complete implementation, the problem is that with intensive care units, three months can result in an increase in medical errors that could be crippling to hospital sustainability.

It is felt that a continuous quality improvement approach is required primarily on bar-code implementation at hospital critical care units and acute wards. As Poon and authors note, “Serious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such errors, technology has been developed to verify medications by incorporating bar-code verification technology within an electronic medication-administration system (bar-code eMAR) (Poon et al, 2010).” Through eMAR use, nurses and medical practitioners can be better equipped to handle intensive care unit emergencies.

The most prevalent obstacle impeding the implementation of eMAR today is the learning curve and transitional errors that occur during the implementation process. Fear of the unknown, making mistakes, or perhaps not being able to adapt to the new technology, can results in nurses being reluctant to recognize it as a viable resource. Similar negative consequences have been documented in the context of essential practice before nurses of bar coding medication administration technology and smart intravenous pump technology. Much research with a longitudinal design is required to more recognize how EHR-related predictors of technology acceptance may change over time. This would help implementers of EHR technology identify serious problems that require being mention in the short- versus long term (Carayon, Cartmill, Blosky, Brown, R., Hackenberg, 2011).

Nursing staff at the intensive care unit spearheaded an endeavour to execute daily rounds based on undeniable changes in combined multidisciplinary team communication and patient results at hospital intensive care units.  Medical details and hospital measures are going online, varying the way nurses and other health professionals do their works. When the Cleveland Clinic Department of Nursing Informatics executed an electronic medication administration record (eMAR) method to develop efficiency and patient safety, the team wanted to know if nurses using the method were pleased (Poon, Keohane, Yoon, Ditmore, Bane, Levtzion-Korach, & Moniz, 2010).

Karen M. Hunter provides further support for the idea that nothing much has changed and eMAR is effective in reducing medical errors, but still lacks implementation initiatives. In her study published in 2011, “Implementation of an Electronic Medication Administration Record and Bedside Verification System,” she notes that, “Due to staffing shortages and the expectations placed on staff today, human errors are becoming more prevalent in the administration of medications… Information technology has been shown to decrease medication errors… The percentage of the decrease of errors related to bar-coding ranges from 60 to 97% (Medical News Today, 2008, Patel 2009, Figge, 2009).  Unfortunately, only 10 to 12% of hospitals have bar-coding in place (Hunter, 2011).” Hunter shows how even 15 years after the study done by Hersh, only 12% of hospitals take advantage of this technology. This is proof that eMAR implementation is an important issue to solve, because otherwise there is no foreseeable reason to assume it will resolve itself.

In sum, the transition from hand written prescriptions to eMAR and bar coding is an urgent need and progressive technology that must be implemented if to reduce the current amount of medication errors by nearly 100%. Over 15 years ago, information technology in the medical industry was recognized as an effective way to reduce the occurrence of medical errors. The problem, as William R. Hersh notes, was few hospitals took advantage of these resources. In his study “The Electronic Medical Record: Promises and Problems,” he supports the theory that a major obstacle for eMAR adaptation is overcoming the familiarity the medical industry has with the status quo. He notes that, “Despite  the  growth  of  computer  technology  in  medicine, most  medical  encounters  are  still  documented  on  paper medical  records. The  electronic  medical  record  has  numerous  documented  benefits,  yet  its  use  is  still  sparse (Hunter, 2011).”  While this study was taken in 1995 it is till reflective of the current state of the medical industry. These studies prove that medication errors is a critical issue for the healthcare industry.

References

Carayon, P., Cartmill, R., Blosky, M.A., Brown, R., Hackenberg, M., Hoonakker, P., Hundt, A.S., Norfolk, E., Wetterneck, T.B. & Walker, J. (2011). “ICU Nurses’ Acceptance of Electronic Health Records.” Journal of the American Medical Informatics Association 18 (6): 812-9.

Hunter, K. (2011). Implementation of an Electronic Medication Administration Record and

Bedside Verification System. Online Journal of Nursing Informatics (OJNI), 15 (2), Available at http://ojni.org/issues/?p=672

Poon, E. G., Keohane, C. A., Yoon, C. S., Ditmore, M., Bane, A., Levtzion-Korach, O., Moniz, T., Rothschild, Kachalia, Hayes, Churchill, Lipsitz, Whittemore, Bates, Gandhi. (2010). Effect of bar-code technology on the safety of medication administration. The New England Journal of Medicine.

Stefanie, T. (2012). Pharmacist files suit against humble hospital citing medication errors, retaliation. . Retrieved from             http://www.yourhoustonnews.com/pharmacist-files-suit-against-humble-hospital-citing-medication-errors-retaliation/article_771000d7-ec8a-561d-8a4a-3f6b79f5e971.html

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