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RICHARDD. PAOLETTI, M.B.A., B.S.PHARM., is Director, Pharmacy Services; and TINAM. SUESS, R.N., A.S., is Bridge System Administrator, Lancaster General Hospital (LGH), Lancaster, PA. MICHAELG. LESKO, D.O., is Physician, Cardiology Consultants, P.C., Lancaster. ALFREDA. FEROLI, B.S.PHARM., M.S., is Pharmacy Inventory Supervisor; JAMESA. KENNEL, PHARM.D., is Pharmacy Clinical Manager; JOYEM. MAHLER, B.S., is Senior Project Leader, Information Services; and TIMOTHYSAUDERSis Pharmacy Information System Administrator, LGH.

Address correspondence to Mr. Paoletti at Pharmacy Services, Lancaster General Hospital, 555 North Duke Street, P.O. Box 3555, Lancaster, PA 17604-3555 (rdpaolet{at}lancastergeneral.org).

Purpose. The implementation of a multidisciplinary approach to systematically decrease medication errors through the use of observation methodology and the deployment of electronic medication administration records (EMARs) and bar-coded-medication administration (BCMA) is described. Summary. For a consistent and reliable approach to data collection, a direct-observation technique was used. The measurement of medication errors using the observation process occurred in two phases—preimplementation and postimplementation. Three inpatient nursing units participated. The control group was a 20-bed cardiac telemetry unit. Intervention group 1 was also a 20-bed cardiac telemetry unit. Intervention group 2 was a 36-bed medical–surgical unit. During the first phase of the study, all three study groups participated in evaluating the medication administration process associated with a manual five-day medication administration record (MAR). A total of 188 errors were reported. The pharmacy, nursing, and information services departments collaborated on the design and deployment of the EMAR and BCMA systems. The systems were implemented in one nursing unit in August 2003, with full implementation on all inpatient units by July 2004. During the second phase of the study, the control group continued to use the manual five-day MAR without a change in the process. Intervention groups 1 and 2 were measured to evaluate the medication administration process using EMAR and BCMA technology. The direct-observation accuracy rate before BCMA was 86.5%; after BCMA, the rate rose to 97%. Conclusion. The direct-observation methodology was used to monitor medication administration before and after the deployment of the EMAR and BCMA systems. A 54% reduction of medication administration errors was observed following implementation of a multidisciplinary, collaborative approach to medication safety. Index terms: Codes; Computers; Drug administration; Errors, medication; Hospitals; Methodology; Records; Technology

 

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