1. Strategic Change Electronic Medication Administration And Computerized Physician Order Entry By Kesia Kibue

2. Introduction Medication errors result in at least one death per day and 1.3 million injuries per year (Patel, 2009). Figge (2009) found that information technology has been shown to decrease medication errors (as cited in Hunter, 2011). In 2009, Patel found that barcoding decreased medication errors by 60 to 97% (as cited in Hunter, 2011).

3. Change Theory To implement changes in medication administration, Lewin’s change theory will be employed. Lewin’s theory involves 3 stages in the change process: Unfreezing Moving Refreezing

4. Unfreezing It has been noted that the current system of medication administration is flawed and prone to multiple errors. The current system of medication administration begins with a written physician order for the medication, which is faxed to the pharmacist and transcribed by the unit secretary onto the medication administration record sheet, which the nurse then uses to obtain the medication and administer to the patient.

5. Unfreezing The flaws identified with the current system of medication administration are Spelling errors during the transcribing stage, Allergy and drug interactions omitted by the pharmacist, Increased likelihood of bedside verification errors such as administering medication to the wrong patient

6. Unfreezing The solution offered by management and nursing staff is a system that eliminates spelling and dosage errors, provides automated allergy and drug interaction alerts, and decreases bedside verification errors.

7. Moving Through review of literature and data collection on medication errors, electronic medication administration is selected due to multiple studies that suggest a decrease in the number of medication administration errors. A detailed plan for the new system is made and a pilot unit is selected.

8. Moving Using the new system, Spelling mistakes will be eliminated by having physicians enter their medication orders in the computer which will be sent directly to the pharmacist. Through the Computerized Physician Order Entry System (CPOE). This step is essential in avoiding transcription errors. Automated Allergy and drug to drug interaction alerts are preloaded in electronic medication record. Barcode scanning at the bedside to prevent Bedside Administration errors.

9. Moving A unit is selected to pilot the program. Preferably a small unit. At this time, coverage from superusers and technical support are available on the unit around the clock. Feed back is obtained from end users on improvements

10. Refreezing During this stage, the program is fully integrated in all units. Quarterly reviews on end user competency using the program are performed. Facilitators and barriers to change are identified.

11. Facilitators to Change A need for accuracy to ensure patient safety in medication administration Millennial generation nurses accustomed to cutting edge technology

12. Barriers to Change Financial costs of new system Lack of computer skills by staff Time required to learn new system Privacy and security concerns

13. Risks Cyber security threats Privacy concerns System/software malfunctions could delay care due to dependence on technology

14. Benefits Decrease in bedside medication errors such as wrong time administration and wrong patient administration. Drug to drug interactions automatically programmed Increased accuracy and pharmacy compliance Spelling errors during transcription eliminated Long-term financial savings For example, Between 1993 and 2002, the Brigham young Women’s Hospital spent $11.8 million to develop, implement, and operate CPOE. Over ten years, the system saved BWH $28.5 million for cumulative net savings of $16.7 million and net operating budget savings of $9.5 million

15. Conclusion Making the Switch to electronic medication administration and Computerized Physician order entry will Improved patient safety Increased employee satisfaction due to ease of use Positive patient outcomes Financial Savings

16. References Hunter, K. (2011). Implementation of an electronic medication administration record and bedside verification system. Online Journal Of Nursing Informatics, 15(2), Kaushal, R., Jha, A., Franz, C., Glaser, J., Shetty, K., Jaggi, T., &... Bates, D. (2006). Return on investment for a computerized physician order entry system. Journal Of The American Medical Informatics Association, 13(3), 261-266.