Barcoded Medication Administration (BCMA). Group A Theresa Dallas Rachel Glenn Tiara Dennison Suzanne Clay Chelsea Borders. Topic search and using search engines.
Search engines are answer machines. When a person looks for something online, it requires the search engines to scour their billions of documents and do two things; first, return only those results that are relevant or useful to the searcher’s query, and second, rank those results in order of perceived usefulness. It is both “relevance” and “importance” that the process of search engine is meant to influence.
Start on the Bing homepage and stop for a minute of sightseeing. Each day a stunning photograph from somewhere in the world occupies most of the homepage. Sure, you can go right on typing your query in the prominent search bar, but instead, roll your mouse over the image and you will find four interesting facts about the location and links to learn more. Curiosity can lead you on a fascinating detour. Pretty, but distracting. Initial search for topic information did lead me to many sources with viable information. I had to use related searches to hone in on more relevant information. And, I must say, once that happened, the source information was very optimal and selected for anyone wanting to build on research on this topic. This I found interesting and had learned that Microsoft understood things like removing results 6 through 10 and replacing them with categorized results and adding a hover with additional content from the site could impact search traffic and for providing information about topic in specific. Bing strength lies more in social integrations as every topic you search has a blog link to get feedback. It also is a great search engine for imagery. Most of the imagery in this power-point was obtained through Bing. However, its weakness also lies with Bing’s strategy that is pointedly different, which is focused on building its own social network. Most site page information included blogs. In the methods of accessibility, key word searching and optimization, it was all there and quite adequate.
Yahoo! is one of the best known and most popular Internet portals. Originally a subject directory of sites, it now is a search engine, directory, and portal. To go to the Yahoo! portal and main starting point, use www.yahoo.com. Use the table of contents on the left to navigate direct access to the search engine: use; search.yahoo.com and for the directory use; dir.yahoo.com. Start on the Yahoo! homepage and stop for a minute of the latest news events (local, entertainment and sports). Initial search for topic information did not lead me to many sources with viable information. I had to use “also try” searches to hone in on more relevant information. This sight also offered the same quality of information and availability as Bing. In design, one could say Yahoo! is boring. However, in the methods of accessibility, key word searching and optimization, it was all there eventually and more for the taking once in the relevant information.
Ask anyone on the street what they know of Google and chances are you will get either that it is a great search engine or in some cases it is The Internet. The fact is that Google’s strength and popularity rests entirely on its search engine which for the majority of people is oh so technical and geeky. And Google has added to that perception by its drive for simplicity in design and use. Google’s strength lies that it is one of the premier internet brands in the world. The company is ranked among the top brands worldwide. Google has tapped into just about every market available. Its weakness could lie in how big and integrated they are. Following several similar redesigns from competitors, Google has changed the look of their homepage. The new logo features a more “flat” design and the black menu bar at the top of the screen has been removed. Regardless of your routine, getting around Google should be seamless, and once you’re inside an app, you don’t want any distractions. Initial search for topic information led me to a plethora of relevant sites to obtain information pertaining to research. This sight also offered the same quality of information and availability as Bing and Yahoo!. Methods of accessibility, key word searching and optimization, it was all there and immediate for search building.
Bing's front page is distinctly flashy, thanks to its stunning photography. Nevertheless, navigation for specialized search is easy to find. Bing’s front door also includes plenty of shortcuts to other Microsoft-owned Web destinations such as MSN, Windows Live, and Bing Travel. It would be nice to see a shortcut to my Microsoft-managed inbox. For Yahoo!, the search bar is now centered, and is part of a darker toolbar that is fixed to the top of the page as the user scrolls down. The word “search” has been replaced with a magnifying glass icon. Local weather has its own module. What’s trending has been deemphasized and instead of just headlines, the news has story summaries. For its part, Google embraces the elegant simplicity of a white background and the Google Search text field. This reflects the company's desire to be not just a search engine, but a starting point for Internet surfing. Its scattershot approach features search, news, communications tools, and such specifics such as a horoscope.
Search results for Bing have two main components: a left-hand navigation panel of Quick Tabs that allow you to focus your search fast; and a center row of Categorized Search results, which simply group results in logical categories. Search results include instant answers, deep links, and multimedia. Google and Yahoo search results are delivered no-frills-style with blue links descending from most to least relevant. Both of these search engines deliver results that may include instant answers, deep links, and multimedia.
From what I can tell, Bing provides shortcuts to top-notch health resources such as the Mayo Clinic when you search for diabetes, influenza, or other health-related issues. Using the Explorer Pane, you can drill down into symptoms and prevention categories. Yahoo Health search results pull up details on topics such as influenza, plus additional information on symptoms, causes, and treatments. Yahoo Health also lists informational videos related to your search. Google search results for topics such as influenza fetch Wikipedia entries and information from the Centers for Disease Control and Prevention. Google's big health strategy has less to do with search and more to do with Google Health, a program for storing your medical records online, finding doctors, and connecting with online health services.
In conclusion, everyone‘s choice of search engine use comes down to personal preference. They all deliver in information gathering without much fuss. Homepage designs differ and this can be appealing to user personalities. For me, I'm sticking with Google until Bing is able to claim a much greater advantage over the web's largest, most preferred search engine.
Because so many consumers are using social networking sites now, many healthcare providers and healthcare facilities are adding their own sites and information to the internet.
The use of barcoded medication administration (BCMA) technologies has been recommended by many organizations, including the Institute of Medicine, the National Patient Safety Foundation, the American Society of Health-Systems Pharmacists, and the National Alliance for Health Information Technology. On February 25, 2004, the U.S. Food and Drug Administration finalized a rule for bar-code labeling medications and blood components to prevent adverse events.The Director of the National BCMA Joint Program Office published a report of fifteen best practices for BCMA administration. These recommendations are intended to maximize the effect of BCMA technologies and to reduce the risk of iatrogenic injury to patients. They are as follows:
3.) Communicate known problems. Develop a way for personnelto be able to view examples of nationally recurring problems; this information should be available 24 hours per day, 7 days per week. This will allow users to see the problems that are occurring nationally, the status of the resolution of the problems, as well as frequently asked questions. This will reduce the amount of calls to the call center and will allow the user to determine whether his or herproblem is local or national.
4.) Display Contact Information for Resources to Resolve Different Types of Problem. Display contact information for resources to deal with common, recurring problems and ensure that this information is updated as necessary. Time spent searching for resources is time not spent with patients.
5.) Do not Employ a Double-Documentation System. Do not employ a paper-based medication administration system in parallel with a BCMA for more than an few weeks. A double documentation system reduces nurses productivity and can lead to medication errors.
6.) Scheduled Planned Downtimes to Minimize Disruptions. Planned downtimes should be scheduled to minimize disruptions to the staff and patient care. Unexpected downtimes can result in missed doses of medications or even double doses due to conflicting gaps in documentation.
7.) Replace Malfunctioning equipment During its Servicing. All hospitals should have a minimum of two complete replacement units to ensure that equipment can be replaced efficiently without causing disruption to nurses.
8.) Develop a Procedure for Cleaning BCMA Related Equipment. A procedure should be in place, along with the collaboration of infection control, to ensure that equipment is cleaned appropriately to decrease the risk of nosocomial infections.
9.) Scan Wristbands and Medications Prior to Medication administration. Nurses should be required to scan the patient’s barcoded identification bracelet prior to medication administration. Nurses should scan the actual medication immediately prior to medication administration. BCMA is used to reduce medication errors through electronic validation of the Five Rights of Medication Administration.
10.) Caregivers Should Personally Document at the Time of Medication Administration. The person administering the medication should be the one to document medication administration (if the system does not automatically do so). The medication should be documented immediately following its administration.
11.) Verify Allergy Information Displayed in BCMA Prior to Administration. The allergy information displayed by the BCMA system should be verified by a nurse prior to medication administration. The prominent display of allergy information in red will not necessarily deter nurses from administering medications that are contraindicated for the patient.
12.) Support Staff Personnel Should Print a Report at the Beginning of a Shift for Nurses to Use as an Overview Worksheet. This should be printed by the nurse at the beginning of her shift and will serve as an overview of the workload of medications to be administered. This should only serve as a supplementary tool because the information can become quickly outdated. It is also important for nurses to periodically refresh the screen to ensure that they are not missing any new orders and have the most current information. Nurses can better plan their days if they have an overview of orders and medications due. This will also help them make fewer errors of omission.
13.) Nurses Should Print Missed Medication Reports Once a Shift. BCMA systems have the ability to print a missed medication report; this should be used to verify medications that were not administered.
14.) Alert Nurses to New (Stat) Orders. Methods to alert nurses to new stat orders, such as having an overview display on a dedicated monitor in a central location with information about new orders, should be developed. In addition, physicians writing the new/stat order should verbally notify the nurse of the new stat order. Relying on nurses to manually access the electronic medical record to detect new orders, or to refresh their screen, is inefficient and contributes to delayed or missed medication orders.
15.) Replace Wristbands as Needed and Periodically in long Term Care. Replace worn, missing, or innacurate wristbands as soon as discovered by personnel. If wristbands cannot be applied to wrists, they may be applied to ankles. If absolutely necessary (and only if absolutely necessary!), identification bands may be applied to items unique to the patient or stapled to the patients chart. Scanning wristbands is more likely to happen when the wristband reliably scans on the first attempt.
Deployment of BCMA technology in the clinical setting requires a thoughtful and comprehensive approach. It is important to continuously improve BCMA technologies over time. It is also important to tailor technologies to particular contexts. This is why it is so important for nurses and other healthcare providers to be a part of the development process.
Technology that is used to enhance health and delivery systems “should be designed to make it easy to do the right thing and hard to do the wrong thing”
The implementation of barcoded-medication administration has radically transformed the process of medication administration, as well as the process of medication documentation. BCMA has also been shown to improve nurse satisfaction, improve nurse confidence, and decrease medication administration time, leaving nurses more time for other patient care activities. BCMA also helps hospitals comply with Joint Commission standards and patient safety goals.
Example A: Pre-BCMA, nurses spent more time giving and documenting medications and less time conversing with patients. This changed significantly with the implementation of BCMA.
Example B: A 2009 study conducted in a medical center in North Taiwan showed a decrease in oral medication administration time from 36.49 seconds to 18.42 seconds with the implementation of BCMA. 66.7% of nurses participating in the study felt that BCMA would consistently cut the time required to administer oral medications by 50%.
NOTE: Studies have shown that the implementation of BCMA initially results in an increase in medication administration time due to the learning curve imposed by new technology.
The implementation of barcoded- medication administration has been shown to reduce medication errors, thereby improving patient outcomes. BCMA has been known to reduce errors between 50% and 85%.
High-Incidence Preventable ADE’s
A: Through automated warnings and error messages– these messages arise if there is any disparity with the Five Rights of Medication Administration.
Example A: A 2005 study of a 175-bed community hospital in Beloit, Wisconsin noted an 82% decrease in medication errors post-implementation of BCMA for the five units studied
Example B: A 2009 study by Moriss, et. Al examined the frequency of medication errors pre and post implementation of BCMA across multiple hospital systems. The most significant decrease in medication errors was seen with errors of omission. The overall number of errors decreased with the implementation of a BCMA system for all types of errors at the point of administration.
Example C: A 2005 study observed the incidence of medication administration errors with and without BCMA. Observers noted 776 non-timing errors in medication administration on units that did not use BCMA (an 11.5% error rate) versus 495 such errors on units that did use BCMA (a 6.8% error rate) — a 41.4% relative reduction in errors. The rate of timing errors in medication administration fell by 27.3%.
BCMA has the potential to prevent medication errors through the electronic validation of the Five Rights of Medication Administration. Nursing and pharmacy workarounds can limit the recognition of optimal safety outcomes; therefore workflow processes must be continually analyzed and restructured to yield the full benefits of BCMA technology.
This technology helps us to go beyond our non-punitive self-reporting system for medication errors, and to begin to identify the total scope of potential errors and near misses. It has incorporated patient safety as part of the basic mission to improve quality, prevent medication and other errors, promote practice and have made it a commitment to patients and the community.