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P238

MEDINFO 2007 HISA Ltd Australia

© 2007 The authors. All rights reserved.

Patient-Safety Improving Medication Information System for Care

Workers in Taiwan

Tun-Yang Lawrence Sung

a

, Chung-Lei Huang

b

, Woei-Chyn Chu

b

, Hung-Wen Chiu

a

aGraduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan R.O.C.

b Institute of Biomedical Engineering, National Yang-Ming University, Taipei,Taiwan R.O.C.

Abstract

In Taiwan, 23% of medical errors come from medication error, however, pharmacists are barely possible to prevent or correct these errors at present. To reduce them, we con-structed a computerized drug deliver cart with a drug information system plus drug image and a Web-based intravenous drug incompatibility system to assist first-line care workers practicing medication monitoring such as adverse drug reactions (ADR), educating patients correct medication usage, and reducing medication errors which are preventable. Both of these two systems are passive sys-tems, and we think that maybe we could increase the frequency of using these systems by fixing them become more active, increases the rate of systems usage, and raise the pharmaco-vigilance of care worker in Taiwan.

Keywords:

drug information system, drug image, intravenous drug incompatibility system, care workers, adverse drug reactions, medication monitoring, pharmaco-vigilance

Introduction

Medication error is one important kind of medical errors. In America, at least 4,000 patients died due to medication errors every year, furthermore, 42% of medication errors were caused from anthropogenic source. Same as America, a study made in Japan shows that 16% of care workers had ever administrated drug to wrong patients, as a result, many computerized assistive system are provided, but few of medication administrating.

In Taiwan, especially for hospitalized patients, adminis-trating and monitoring of medication are often executed by nurses. Care workers use paper-based drug administration records and IV solution administration records to insure if medications fit to physician’s order sheets or not, which is a complicated but an important job. And the truth is, the currency of medication errors for inpatients is approaching 2%, which is very serious. To reduce this kind of error, we designed a computerized drug deliver cart combined with drug information system which could help checking these looks of drug, and let it be much easier for nurses to iden-tify if adverse drug events occurred.

Another important issue for care workers in Taiwan is lan-guage problem, lots of medical and drug information were written in English, whereas information written in tradi-tional Chinese form will be much easier for nurses to comprehend, therefore, to build a traditional Chinese-based drug information system seems to be a requisite. Last but not the least, intravenous drug incompatibility is an important drug information for care workers in medica-tion administrating, especially when dispensing intravenous mixture, therefore , we constructed an intrave-nous drug incompatibility system which would provide nurses an easy way to check when mixing different intra-venous medicines, it could also reduce the working load of pharmacists.

Materials and methods

In our study, we designed three assisting systems to reach our goal to reduce medication errors caused by care work-ers, figure 1 shows these three structures of our system.

Figure 1 - Flowchart of computerized drug deliver cart

The first part is a drug deliver assisting system with RFID and bar-code devices which could help care workers prac-ticing such as three-read five-right checks. The second part is to construct a drug information system with drug image for care workers. To build an easy-to-use drug information system for care workers in Taiwan, drug information have to be written in Chinese form, drug images is also added, moreover, we use bar-code and RFID query interface. Automatic update process is a necessity for our system, once a hospital changed their brand of a medicine, our sys-tem could respond immediately. Language translating is never an easy job, especially when it’s in medical spe-cialty, to find the way out, we cooperated with MIMS poc, MIMS poc have a complete drug information database

User interface

Drug information refer system

IV drug incompatibility refer system

Medication administrating triple-check system

RFID Barcode Key-in Key-in RFID Barcode Key-in

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T. L. Sung et al. / Patient-Safety Improving Medication Information System for Care Workers in Taiwan

P238 written in mandarin, it could also provide us accessible up-to-date drug information, and images of Taiwan’s currently used medicines.

The last part is to construct an intravenous drug incompat-ibility system, in this system, we use key-in from touch panel instead of RFID or bar-code devices as input, care workers will choose two to three medicines’ generic name by their fingers to check if intravenous incompatibility occurred, then the system will show four kinds of results to present if there is any problem adding them together.

Results

Figure 2 shows the prototype of our computerized drug deliver cart we’d constructed and the information display result of our drug information system with drug image. Ten kinds of drug related issues are chosen to provide care workers adequate drug information, they include brand name, generic name, usage, package, contraindication, precaution, side effects, drug interactions and drug image.

Figure 2 - The prototype of our computerized drug deliver cart and a Chinese translated drug information chart with

drug image

Another function of our drug information system is MIMS poc SDK, combined with EMR information, four kinds of Alerts are provided, drug alert could find if any drug pre-scribed conflict with another, health alert also finds if any disease is contraindicated with those drug prescribed, allergy alert finds drug allergic problems, duplicate alert warns users when any medication is duplicate ordered. Figure 3 shows the drug decision support module.

Figure 3 - The drug decision support module, based on patients’ information in EMRs, this module could find

preventable medication errors

The Web-based intravenous drug incompatibility system could also assist care workers dispensing intravenous mix-ture, they could simply find the answer by choosing drug’s name through touch screen to check if incompatibility occurred. Since draw-down lists are not suitable when using on touch screen, we designed another kind of drug list to make it easier to choose form. Four kinds of answers would be displayed as the result, they are compatible, incompatible, variable results and no result. Nurses could then check the details of the result displayed which is writ-ten in traditional Chinese form. This system could also reduce the work burden of clinical pharmacists in Taiwan. Figure 4 shows the drug list we designed and the result of this system.

Figure 4 - The drug list of intravenous drug incompatibility system designed for touch panel (left side),

larger items could make it much easier to choose by fingers, on the right side is the result displayed of the system, four different icons represent different results

Discussion

The main purpose of our study is to promote patient safety by reducing medication errors caused from care workers, however, nurses in Taiwan seems too busy that the rate of using of our system were lower than our expectation. A key question is that shall we make our system acts from passive to active? Will this

action raise the rate of using, help reducing medication errors or actually nurses would be even bothered? In the other sub-project, they used active way instead of passive one’s, somehow nurses think it’s too clumsy. To find the threshold that would both reduce medication errors and

Electronic Medical Record

Prescriptions Medication history

Drug and food allergy history

MIMS Point of Care SDK

Drug Alert Health Alert

Allergy Alert Duplicate Alert

Warning Information

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T. L. Sung et al. / Patient-Safety Improving Medication Information System for Care Workers in Taiwan

P238 with good usability would be an interesting part that we might study in the future.

Another issue is some of workers in the field of medical informatics seem lack of clinical experiences, in this situa-tion the program designed might have low usability, to avoid trapping in the plight, maybe we have to spend more time communicating and observing. The most efficient way is to stay in a unit where we’re going to cooperate for a period of time. After increasing the real experience, the design should be far more functional.

Conclusion

Care workers in Taiwan are medication administrators who play important roles in adverse drug reaction (ADR)

reports. The adequate and easy-to-get drug information provided to nurses could raise their pharmaco-vigilance. Further more, it improves patient safety. Intravenous drug incompatibility system would also provide nurses an easy way to check when dispensing intravenous drug mixture, and reduce avoidable errors. Both of our programs exists as passive systems, we wonder that if they change to be more active, would the using rate raises or falls. It seems that we need to know clearly from their work and with our own experience, the design of assisting systems would be more acceptable.

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Patient-Safety Improving

Medication Information System

for Care Workers in Taiwan

Tun-Yang Lawrence Sung

a

, Chung-Lei Huang

b

, Woei-Chyn Chu

b

, Hung-Wen Chiu

a

a

Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan R.O.C.

b

Institute of Biomedical Engineering,

National Yang-Ming Un

(5)

Introduction

Medication errors

Most important kind of medical errors

[1]

Killed 4’000 patients per year [2]

42% of medication errors

Ш

anthropogenic source (USA) [3]

16% nurses had given wrong drug to wrong patients (Japan)

CPOE

Ш

Medication errors caused by

physicians and pharmacists

(6)

Introduction

(cont.)

To reduce medication errors caused by care

workers in Taiwan:

1.

A computerized Drug Deliver Cart

9

With Bar Code & RFID devices

2.

Drug Information System including Drug Image

9

Help nurses checking such as adverse drug events, educating

patients right usage, etc.

3.

Intravenous Drug Incompatibility System

9

(7)

Language Problem

Nurses in Taiwan:

English Information:

Have difficulty to read and comprehend

Chinese Information:

Easier and more friendly to use

Use Graph instead of script

Ex. Drug image

Language Translation:

Cooperate with

MIMS poc

(8)

Result -

Drug Deliver Cart with RFID

and Barcode Devices

Touch Screen:

Instead of keyboard to increase usability

Drug Drawers:

With patients’ medication dispensed by

pharmacists

Trash Can

(9)

Drug interactions:

To show which drugs are forbidden to use with

this medicine.

Side effects:

To show some side effects that patient would

complained, nurses would note them and inform

pharmacists

and doctors

Results – Drug Information System

Brand n

a

me &gen

eric n

a

me:

Basic Drug information

Indications:

To show if the drug fits to

the patient’s diagnose

Usag

e:

To show if there is any

special using way of this

medicine.

Precau

tion

:

To show that some patients with these special

conditions should be closely monitored or

consider withdraw this drug

Contraindication:

To show some diseases or other special

conditions that are contraindicated to the drug

Drug Image

:

Help recognizing the appearance of medicines

Package:

To show the package

(10)

Drug Decision Support Module

Electronic Medical Record

Prescriptions

Medication history

Drug and food allergy history

MIMS Point of Care

SDK

Drug Alert

Health Alert

Allergy Alert

Duplicate Alert

Warning Information

9

Drug Alert:

9

To find if any drug prescribed conflict with another

9

Health Alert:

9

To find if any disease is contraindicated with those drug prescribed

9

Allergy Alert:

9

To find drug allergic problems

9

Duplicate Alert:

9

Warn users when any medica

(11)

Drug Decision Support Module

Drug Alert

Health Alert

Allergy Alert

Duplicate Alert

Asthma

Patient

History

Prescribing

Anselol

Atenolol

Beta-Blocker

Prescribing

Resprim

Alprim

Trimethoprim

Cisapride

Erythromycin

Arrhythmia

Penicillin

Patient’s Allergic

History

Amoxil

Amoxycillin

(12)

In tr a v eno u s D rug Inc om p a tibi lit y S y stem In tra v e n o u s Dr u g In c o m p a tib il it y S y st em

No results:

No data available

Results - Intravenous Drug

Incompatibility System

Four kinds of results

would show

Incompatible:

Two drugs could

not added together

Compatible:

Two drugs could

added together

Variable results:

Consult pharmacists

to

in

su

re.

(13)

Discussion

The main purpose:

Reduce medication

errors made

by nurses

Information

System

Improve

patient safety

Drug information system tailored for nurses

Web-based Intravenous Drug Incompatibility system

Passive Systems

Using rate

Ц

Active Systems

Too clumsy

(14)

Conclusion

Care workers in Taiwan

Medication administrators who play important roles in adverse

drug reaction (ADR) reports where physicians and pharmacists

would hardly to.

Two of our systems:

The adequate and easy-to-get drug information system

Х

Pharmaco-vigilance [11]

Х

Patient safety

Intravenous drug incompatibility system

An easy way to check when dispensing intravenous drug mixture,

and reduce avoidable errors

Both of our systems exist as passive systems

Change to be more active, would the using rate raises or falls?

(15)

References

[1] Kaush

al

R, Bates DW. Informa

tion techn

ol

ogy a

n

d

medica

ti

on s

a

fety: wh

at is the b

e

n

e

fit? Qual S

a

f Hea

lth C

a

re

2002; 11: 261-265

[2] Linda TK, Janet MC, and Mo

lla

SD, editors. To Err is Hu

man: Building A Safer Health System. America: Committee

on Quality of Healthcare in Amer

ic

a, Institute of Medicine. 1999.

[3] Mari

a R

T

, Carol H, Jerry P. Me

d Erro

r Re

ports to FDA Show

a Mixed Bag. America: Drug

Topics 1, 2001: 145 (19) ;

23.

[4] Alex M, Laura K, Jennife

r B. Assistive computi

n

g

devices: A pil

ot study to explore nurses’ preferences and needs.

Computers, Informatics, Nursin

g 2006; Vol. 24, No. 6: 328-336

[5] Christine GH, Peter JP, Fe

rn D, David AT, Albert WW, Li

sa HL, Maureen F,

Donald MS, Lilly E, Ali J, Laura LM,

Todd D. Creati

ng th

e web

-b

ase

d

intensive care un

it safety re

porti

n

g

system. J Am Med In

form Assoc 200

5; 1

2

:

130-139

[6] Mari

e C

, Sylvia P, Francoise A, J

ean-Jacques M, Michel D, Patrice D. Impac

t of CP

OE on docto

r-nurse cooperation

for the medication orderi

ng and admi

nist

ration process. Internati

onal Journal

of Me

dical Informatics 20

05; 74: 629-

641

[7] Dibb

i H

M

, Al-Abra

shy HF, Hussain WA, Fatani MI, Karin

a

TM. Caus

es a

n

d

Outcome

of med

icati

on e

rrors i

n

hospitalized pati

ents. Saudi Med J 2006; 27(10):1489-1492

[8] Bisbol J, Grimson J, Grimson

W, Berry D, Hede

rma

n

L. Fr

om p

a

ssive to a

ctive el

ectr

onic he

alth

care record

s.

Methods Inf Med 2003; 42: 535-43

[9] Paul RD

, Susan MP, Kati SM,

Kath

y J, Clement JM. Inpati

e

nt computer-based standing orders vs physici

an

remi

nders to increase influenza and pneumococca

l vaccination rates. JAMA 2004; 292: 236-2371

[10] Karsh BT. Beyon

d usa

bi

lity: desi

g

nin

g e

ffective tech

n

o

logy imple

me

ntati

on syste

ms to pro

mote

patie

nt safety. Qual

Saf Health Care 2004; 13: 388-394

[11]

Johanna U, Stefan M, Ulf B. Nurses are incr

easi

n

gly involved i

n

phar

macovi

gil

ance in

Sweden.

Pharmacoepidemiol

ogy and D

rug Safety;

2006 Oct 30; [Epub ahead of print]

Ackn

owledg

emen

ts

This study i

s

supported by th

e National Science C

ounci

l of

Taiwan (NSC 95-2627-B-038-001). In addition, we thank al

l

the partici

p

ators i

n

Taipei Medical

Univer

sity and Nati

onal Yang-Mi

ng U

niversi

ty.

Address for correspo

nd

en

ce

Hung-Wen Chiu (hwchiu@t

m

u.edu.

tw

)

Graduate Institute of Med

ica

l Informatics

Taipei Medical University

250 Wu-Hsing Street, Taipei C

數據

Figure 1 - Flowchart of computerized drug deliver cart
Figure 2 - The prototype of our computerized drug deliver  cart and a Chinese translated drug information chart with

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