Case study 3: Reduce medication errors with a closed-loop medication administration syste

Read the case thoroughly and provide an analysis of the IT and Health Informatics Systems issues presented in the case. To give you an idea what information should be included in the paper, these questions (and possibly others, depending on specific topic chosen) should be addressed (when applicable):

Explain the issue using information from the readings in the book and other sources (e.g., websites, articles, etc). Cite your sources using APA. (Required)
What are the healthcare considerations that to apply this case and why?
What are the information systems considerations that apply to this case?
Who are the stakeholders (parties interested in the outcome)? (Required)
What possible courses of action are available? (if applicable)
What are the predictable effects of each action? (if applicable)
Any additional questions identified in the case study (Required)
Other formal questions included with the cases, such as your final decision. Your decision will not be evaluated as “right or wrong.” It must be supported though, by answering the questions above.
Include your own thoughts/opinions as well as materials to support these. (Required)
Do NOT write your answer in bullet point form – it MUST be in narrative (paragraph) form.

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Case studies are to be 3 – 5 pages long (not including references or title page). Follow these assignment protocols:

Microsoft Word document with 1” margins all around, 12 pt. Times New Roman font, and double-spaced work. Failure to follow assignment protocols will result in a 10% loss in possible points. Additionally, cases should be free from grammatical errors.

This is an individual assignment, so work must be done independently. Late assignments will not be accepted

Contributors: Kareen Hall-Clarke, MPH, FACHE, CPHIMS, Seneca College, ON & Alstair Forsyth, MHSc, North York General Hospital, ON, Canada

North York General Hospital (NYGH) serves the culturally diverse communities of North

Toronto and provides acute, ambulatory and long-term care services across three sites serving 400,000 people. In 2007, it embarked on a multi-year clinical transformation project to bring its EHR into the future, from HIMSS Stage 2 to a goal of HIMSS Stage 7. In 2010, NYGH implemented the eCare Project with a primary focus of improving the quality and safety of care.

In 2004, the Canadian Adverse Events Study (CAES) 1 reviewed acute care hospitals across the country and found that 7.5% of those had an adverse event and 45% were related to medication services. One of NYGH first eCare initiatives was to redesign its medication administration process. Prior to eCare, the medication process consisted of handwritten physician orders, duplicative manual transcription and shared med carts. This system left a lot of room for error, with 39 percent of errors occurring with medication prescribing and 38 percent occurring with medication administration.

After examining the local problem and designing a new workflow to solve that problem, NYGH implemented closed-loop medication administration (CLMA), (See Figure 1). By leveraging information technology CLMA eliminates manual entry and sends an alert if a medication about to be administered does not match the drug, dose, route, timing and/or intended patient indicated in the active orders in the electronic chart. From 2010-2015, NYGH has prevented more than 11,000 medication errors using CLMA.

Figure 1: NYGH Closed Loop Medication Administration Process

Physician enters orders online using CPOE and evidence-based order sets
Medications populate in the eMAR in real-time
Orders are routed to automated dispensing cabinets for cart fill and first dose dispensing
Nurse views medications on eMAR and obtains medications that are due for the patient
Nurse signs into CareMobile™ using his/her barcoded ID badge
Nurse uses CareMobile™ to scan pre-packaged unit-dosed medication(s)
Nurse scans patient armband
Nurse reviews and resolves any alerts, administers medications to the patient and signs off the administration on CareMobile™

1 Baker, G. R., P. G. Norton, V. Flintoft, R. Blais, A. Brown, J. Cox, E. Etchells, W. A. Ghali, P. Hebert, S. R. Majumdar, M. O’Beirne, L. Palacios-Derflingher, R. J. Reid, S. Sheps and R. Tamblyn (2004). “The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada.” CMAJ Canadian Medical Association Journal 170 (11): 1678-1686

Case Study Discussion Questions:

1. How should medication errors be addressed at each step of the eMAR process? Prescribing, Transcribing, Dispensing and Administration?

2. Why should closed-loop medication administration (CLMA) technologies be the last defense to medication errors in the delivery of optimum patient care and safety?

Case Study Rubric
Case Study Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeAssignment Content – Questions
25.0 pts
Student answers all questions posed; thorough detail is provided with examples when applicable
13.0 pts
Student answers parts of questions posed; lacking detail and/or examples provided
0.0 pts
Content completely missing
25.0 pts
This criterion is linked to a Learning OutcomeCase Study Disucssion Questions
15.0 pts
Student answers all case study specific questions posed; thorough detail is provided with examples when applicable
8.0 pts
Student answers parts of case study specific questions posed; lacking detail and/or examples provided
0.0 pts
Content completely missing
15.0 pts
This criterion is linked to a Learning OutcomePersonal Opinions
15.0 pts
Shows great insight on topic with the depth of knowledge and learning integrated into personal thoughts, abstract ideas
8.0 pts
Inclusion of personal opinion in some detail and/or the opinion is not supported by the rest of the paper
0.0 pts
Content completely missing
15.0 pts
This criterion is linked to a Learning OutcomeWriting Mechanics
6.0 pts
Student has no spelling/grammatical/sentence structure errors. Fewer than 3 errors
3.0 pts
Student has spelling, grammatical, or sentence structure errors – 3 – 5 errors
0.0 pts
More than 5 spelling, grammatical, or sentence structure errors
6.0 pts
This criterion is linked to a Learning OutcomeFormatting & Style
6.5 pts
All formatting requirements followed
3.0 pts
Some formatting requirements addressed.
0.0 pts
Most or all formatting requirements were not followed.
6.5 pts
This criterion is linked to a Learning OutcomeAPA citation
7.5 pts
APA style followed with for references and citations. Fewer than 3 errors.
4.0 pts
In text citation issues, multiple errors
0.0 pts
No reference or citation; or significant number of errors
7.5 pts
Total Points: 75.0

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