Medication Management: A Closed Computerized Loop

This project implemented and evaluated an electronic system for medication management. The system was implemented in a rural hospital, including automated medication dispensing units, bedside computer stations, three levels of bar coding (patient, staff, and medication), and an electronic medication record. Evaluation included multiple perspectives and data sources, using a pre- and post-intervention comparative mixed methods design (performance improvement reports, medication administration observations, surveys of stakeholders, and focused interviews). There was a 56 percent reduction in the number of reported unexpected adverse drug reactions and a 10 percent decrease in errors causing harm. Observations of medication administration yielded a 45 percent reduction in observed medication errors (from 19.5 percent prior to the electronic system, to 10.8 percent two years later). Staff satisfaction with medication management improved with increased perceptions of the system's ability to improve patient safety. Benefits include improved accuracy in identification of patients, medications, doses; easily accessible information; reduced redundant data entry. The system created new challenges in explicating work processes and standardizing practices. The process of implementation proceeded remarkably well, due to the essential commitment of the administrative team to the requisite resources, and to the Implementation Team who did an excellent job of planning and executing the process. There were notable improvements in patient safety, timeliness of medication delivery and communication, and effectiveness. The project resulted in heightened awareness of patient safety and a loss of complacency about the sources of errors during usual clinical care.