technology & automation in pharmacy- part 1
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Technology & Automation In Pharmacy- Part 1. Outline. Definitions Goals of automation in pharmacy Advantages/disadvantages of automation Application of automation to the medication use process Clinical decision support systems Computerized physician order entry . Definitions. - PowerPoint PPT PresentationTRANSCRIPT
Technology & Automation In Pharmacy- Part 1
Definitions Goals of automation in pharmacy Advantages/disadvantages of automation Application of automation to the medication use
process Clinical decision support systems Computerized physician order entry
Outline
Medical Informatics
The field of information science concerned with the analysis, use and dissemination of medical data and information through the application of computers to various aspects of health care and medicine
Definitions
ASHP. Am J Health-Syst Pharm. 2007;64:200–3.
Pharmacy Informatics
The use and integration of data, information, knowledge, technology, and automation in the medication use process for the purpose of improving health outcomes
Definitions
ASHP. Am J Health-Syst Pharm. 2007;64:200–3.
The pharmacy profession’s transition to pharmaceutical care
Shortages of qualified pharmacists and technicians
Shrinking operating budgets
Increasing Interest in Automation –Why??
Freeing pharmacists from labor-intensive distributive functions
Helping pharmacists provide pharmaceutical care
Reducing costs
Improving operating efficiencies
Growing revenues
Goals of Automation in Pharmacy
Enhancing safety and quality of care◦Automated medication management systems have
been shown to reduce medication errors by between 26% and 81% depending on the setting in which the machines are used
Integrating and managing data
Increasing patient satisfaction with the quality and delivery of care
Goals of Automation in Pharmacy - Cont’d
Improve efficiency (reduce work load)
Improve accuracy, reduce errors
Improve documentation
Enhance security (authorized access only)
Reduce job stress and staff turnover
Improve timeliness for medication delivery
Advantages of Automation
Complexity and function variations
Requires additional staff training and technical help
Downtime, system failure and inflexibility
Cost and space issues
Disadvantages of Automation
Medication Use Process
•Assessing the need for/selecting the correct drug•Individualizing the therapeutic regimen•Designing the desired therapeutic response
Prescribing•Reviewing the order for correctness of dosing and
indication•Compounding/preparing the drug•Dispensing the drug in a timely manner
Dispensing
•Administering the right drug to the right patient•Administering the drug when indicated
Administering
Medication Use Process - Cont’d
•Monitoring & documenting patient response•Reevaluating drug selection, frequency, &
duration
Monitoring
•Communicating and collaborating among caregivers
•Reviewing and managing the patient’s complete therapeutic drug regimen
Systems/Managemen
t Control
Technologies & Automated Devices Applied Throughout The Medication Use Process
Prescribing •Clinical decision support systems(CDSSs)•Computerized prescriber order entry systems (CPOE)
Dispensing •Centralized robotic dispensing technology•Centralized narcotic dispensing and inventory tracking devices•Decentralized automated dispensing devices•Unit dose medication repacking systems
Administering Bar code medication administration technology
Monitoring •Electronic clinical documentation systems•Medication surveillance applications for reporting medication incidents and adverse events
Clinical Decision Support Systems are "active knowledge systems which use two or more items of patient data to generate case-specific advice"
Clinical DSSs are typically designed to integrate medical knowledge base, patient data and an inference engine to generate case specific advice
Clinical Decision Support Systems (CDSS)
Advice on drug doses, routes, and frequencies. Drug allergy checks Drug-laboratory value checks Drug-drug interaction checks Providing reminders about corollary orders (e.g.
prompting user to order glucose checks after ordering insulin)
Drug guidelines to the physician at the time of drug ordering
Clinical Decision Support Systems (CDSS) Components
Four key functions of CDSS are outlined in :1. Administrative: Supporting clinical coding &
documentation, authorization of procedures & referrals
2. Managing clinical complexity and details: tracking orders, referrals follow-up, and preventive care
3. Cost control: Monitoring medication orders; avoiding
duplicate or unnecessary tests
4. Decision support: Supporting clinical diagnosis and treatment plan processes
Functions of CDSS
DXplain
◦Uses a set of clinical findings (signs, symptoms, laboratory data) to produce a ranked list of diagnosis
◦Provides justification for why each of these diseases might be considered, suggests what further clinical information would be useful to collect for each disease
CDSSs Examples
QMR Quick Medical Reference
◦A diagnostic decision-support system with a knowledge base of diseases, diagnoses, findings, disease associations and lab information
CDSSs Examples
CPOEs are clinical information systems that enables a patient’s care provider to enter an order for a medication, clinical laboratory or radiology test, or procedure directly into the computer
The system then transmits the order to the appropriate department, or individuals, so it can be carried out
Computerized Provider Order Entry (CPOE)
The most advanced implementations of such systems also provide real-time clinical decision support such as checking:
◦Dosage ◦Alternative medication suggestions◦Duplicate therapy warnings◦Drug-drug and drug-allergy interaction
CPOE
Replaces hand-written orders ( solves problems with legibility, completeness, order delay or loss)
Supports ready access to patient data and patient assessment
Can help improve patient safety and prevent medical errors and adverse drug events by checking doses, interactions, allergies.. etc.
Supports improved recording, data trails, quality assurance and error awareness and reporting
Advantages of CPOE
Potential to improve efficiency and resource usage by integrating different departments - laboratory, imaging, nursing and medication records
Cost-effectiveness benefits:
Can reduce costs associated with medication errors Can show test and medication costs - potential to
reduce prescription costs Can reduce the number of duplicate tests
Advantages of CPOE- Cont’d
Cost
Risk of a system generating medication errors e.g. through incorrect configuration or physician input
Systems may need medical terminologies not in local use
User resistance to introduction of computer-based technologies, requires training
Disadvantages of CPOE