The purpose of this research was to compare the design of Dose Error Reduction Software (DERS) between smart pumps to determine which features affect the ability of nurses to safely and efficiently program intravenous medications. A high-fidelity usability experiment was conducted. Twenty-four Registered Nurses completed a series of infusion tasks, in a simulated clinical environment, using three smart pumps (Cardinal Alaris System, BBraun Infusomat, and Hospira Symbiq). Results found significant differences in nursing performance across the smart pumps. Nurses were more likely to override clinically inappropriate soft limit alerts when using BBraun Infusomat, than when using Hospira Symbiq or Cardinal Alaris System. Furthermore, when asked to program an infusion over a specific duration, nurses were found to make significantly more parameter entry errors when using Hospira Symbiq than when using Cardinal Alaris System. Results from this study will help set DERS design principles, and assist hospitals during their procurement processes.

The purpose of this research was to compare the design of Dose Error Reduction Software (DERS) between smart pumps to determine which features affect the ability of nurses to safely and efficiently program intravenous medications. A high-fidelity usability experiment was conducted. Twenty-four Registered Nurses completed a series of infusion tasks, in a simulated clinical environment, using three smart pumps (Cardinal Alaris System, BBraun Infusomat, and Hospira Symbiq). Results found significant differences in nursing performance across the smart pumps. Nurses were more likely to override clinically inappropriate soft limit alerts when using BBraun Infusomat, than when using Hospira Symbiq or Cardinal Alaris System. Furthermore, when asked to program an infusion over a specific duration, nurses were found to make significantly more parameter entry errors when using Hospira Symbiq than when using Cardinal Alaris System. Results from this study will help set DERS design principles, and assist hospitals during their procurement processes.

Class of 2013 Abstract / Specific Aims: The objective of this study was to describe the failure rate of activation of medications that employ the ADD-Vantage medication delivery system in one community hospital, Tucson Medical Center (TMC). Methods: A daily, hospital-wide summary was generated identifying all patients currently receiving ADD-Vantage medications using the TMC electronic medical record system, Epic. Data collection occurred on arbitrary days and times from July 2012 to March 2013. Direct observation of a failure or a success in activation occurred by entering a patient’s room after the ADD-Vantage medication was administered by the nurse. Important data collected included: medication, frequency of administration, nursing unit, time of administration, administering nurse, the shift during which the nurse was working and whether or not the medication was or was not properly activated. Main Results: All medications utilizing the ADD-Vantage medication delivery system at TMC were analyzed. The rate of failure across 347 total samples collected on various days and times was 6.92%. Night shift had a higher rate of failure at 11.43% versus 6.41% for day shift (χ2 = 1.23). The General Surgery and Cardiac units of the hospital had the highest rates of failure with 18.18% and 15.38% respectively. Zosyn was improperly activated with greatest frequency with 12 total failures. Conclusion: No statistically significant difference was found between the rates of activation failure for those samples collected during nursing day shift versus night shift. The overall rates of activation failure suggest a significant opportunity for nursing education to improve outcomes.

Class of 2005 Abstract / Objectives: To determine if delivery of medications to an independent living facility increases patient adherence. Methods: Retrospective review of patient pharmacy refill records was completed using a data extraction form in order to calculate a number of days deviation from a projected refill date based on days supply. Data on the use of express pay, auto fill, and delivery service and payment type was collected as well as age and gender. Residents of The Fountains independent living facility were eligible to be included in this study if they had complete data in the pharmacy refill records for at least one scheduled maintenance medication taken for a continuous, three-month period. Results: There were 21 subjects in the delivery group and 18 in the pick-up group. Both groups were primarily women (76.2 percent and 61.1 percent respectively). Age was also similar (85.8 and 83.8, p=0.285). The delivery group had significantly more maintenance medications than the pick-up group (mean=2.8, SD=1.1 and mean=1.7, SD=1.1 respectively). Seven of the nine time deviations were greater for the pick-up group than for the delivery group (p= 0.09 for sign test). Implications: It appears that a delivery service can increase adherence, particularly in a population of advanced age.

Background: Many patients discharged from the hospital do not appropriately fill their discharge medications. At Boston Medical Center, an urban safety net facility, a bedside discharge medication delivery service was pilot tested in 2012 to ensure pediatric patients with asthma left in possession of their new medications. The service was expanded to all pediatric discharges in 2013. It is unknown whether beside delivery increases the proportion of written prescriptions captured by the hospital-owned pharmacy or if the service achieves a positive return on investment. Whether such a service improves patients’ satisfaction, medication adherence, or clinical outcomes is also unknown. Methods: Two primary methodologies were used to evaluate the impact of this novel service. The first evaluated the relative risk of filling a prescription in the hospital- owned pharmacy after the expansion of delivery eligibility criteria using two years of discharge prescription information, corresponding pharmacy fill data, and a hierarchical model with generalized estimating equations (GEE) to account for non-independent events. Initial patient-level impacts of the delivery service were evaluated through a pilot randomized controlled trial to test logistics and obtain empiric estimates of study parameters. Results: Patients were 1.44 times more likely to fill a medication at the hospital- owned pharmacy providing the delivery service after the intervention (95%CI 1.3-1.59). The increased profit generated by prescriptions captured as a result of offering the delivery service is estimated to be equivalent to 8-15% of a pharmacist full-time- equivalent (FTE), whereas only 3% of an FTE was required to provide the service, indicating a positive return on investment. Pilot study data suggest families did not differ significantly with regards to perceived satisfaction or reported outcomes whether randomized to usual care or delivery. Conclusion: A service to deliver discharge medications can yield a positive return on investment, allowing an institution to offset uncompensated care. To further study the intervention, a trial with randomization at the level of the ward or institution is needed. / 2017-10-02T00:00:00Z