Closed-Loop Medication Management with an Electronic Health Record System in U.S. and Finnish Hospitals

Benefits and challenges associated with implementation and ongoing use of automated dispensing cabinet for medicines: A scoping review

When deciding whether to adopt a digital healthcare technology, there is a need to fully grasp the benefits as well as understand any potential challenges from the outset, to enable appropriate mitigations to be considered as part of implementation plans. Automated dispensing cabinets (ADCs) have been increasingly used in hospitals as a means of streamlining medicines use workflows, facilitating medicine management, saving costs, and improving patient safety. Manufacturers commonly reference the benefits of ADCs but rarely outline the challenges. It is important that senior leaders in healthcare understand both the benefits and challenges of ADCs prior to implementation, to ensure the technology is implemented in areas where the benefits can be most maximally achieved and the challenges mitigated in so far as possible. A scoping review methodology was used to map existing literature focussing on the benefits and challenges of ADC use with medicines. Following a preliminary search to identify key terms, extensive literature searches were conducted in Medline, PubMed, CINAHL, Embase, Global Health, and Web of Science. Among 234 articles identified from the search, 54 articles were included for full data extraction. Extracted information included publication date and origin, study aims & objectives, study setting, medication distribution model, technology infrastructure, overarching category, area of focus, and key findings. The findings were discussed in terms of implications for broad trends and future research directions. Although results indicate that there is an abundance of published literature on benefits and challenges associated with ADC use with medicines, there are only a handful of UK studies. Differences in settings, distribution models, workflows and technology infrastructure limit the overall ability to generalise findings. Further UK-based studies carried out in different settings with varying levels of technological infrastructure is imperative to not only track the impact of ADCs but also to inform practice to ensure the continued delivery of benefits. Further studies focusing particularly on the impact of stock optimisation and the management of CDs (Controlled drugs) would be key areas of focus.

Artificial intelligence in cardiovascular practice

ABSTRACT

Artificial intelligence (AI) is everywhere, but how is this expansive technology being used in cardiovascular care? This article explores common AI models, how they are transforming healthcare delivery, and important roles for clinicians, including advanced practice providers, in the development, adoption, evaluation, and ethical use of AI in cardiovascular care.

Artificial intelligence in cardiovascular practice

ABSTRACT

Artificial intelligence (AI) is everywhere, but how is this expansive technology being used in cardiovascular care? This article explores common AI models, how they are transforming healthcare delivery, and important roles for clinicians, including advanced practice providers, in the development, adoption, evaluation, and ethical use of AI in cardiovascular care.

Introducing Unit Dose Dispensing in a University Hospital - Effects on Medication Safety and Dispensing Time

Purpose

Unit dose (UD) medications reduce manual steps in the medication management and use process and enable electronic documentation by barcode scanning. This study aimed to explore the effects of introduced unit doses on medication safety and time spent on medication dispensing.

Patients and Methods

Direct before-and-after observations were conducted in an inpatient internal medicine ward at Helsinki University Hospital. The prevalence of medication and procedural errors and time nurses spent dispensing medications at patient-specific doses were observed 10 weekdays before and after introducing unit doses of selected medications. To complement the observations, a separate survey was used to investigate nurses' perceptions of medication dispensing. Quantitative analysis was performed.

Results

During the observations, medications were dispensed for 208 patients (n=1359 medications) before and 221 patients (n = 1171) after introducing unit doses. After UD implementation, 45.3% (n=530/1171) of the medications were dispensed as UDs. Medication and procedural errors were reduced (from 3.2% to 1.7% and 37.4% to 13.9%, respectively; p<0.05). Barcode scanning-related problems decreased from 21.4% to 1.8% (p<0.05) after implementation. The unit doses did not change the median time used to dispense medications to the patient, although the time used to dispense a single medication increased. In the survey, nurses reported improvements in barcode scanning but also indicated problems with handling unit doses and were worried about increased plastic waste.

Conclusion

Piloted unit doses decreased medication and procedural errors. Barcode scanning improved, which supported electronic closed-loop medication management in the study hospital. Unit doses in a fully automated process should be further studied for their effects on the dispensing time. In addition, controlling the amount of plastic waste in the unit dose dispensing should be considered.

Evolution of hospital clinical pharmacy services in Finland in the period 2017-2022: the third nationwide follow-up survey

BACKGROUND AND OBJECTIVES

Pharmacists' involvement in patient care became more common in Finnish hospitals during the period of 2011-2016. The first national survey was conducted in 2011 and repeated using the same method in 2016. This development was in accordance with patient safety policy initiatives and European hospital pharmacy statements. This study aimed to conduct the third national follow-up survey on hospital clinical pharmacy services in Finland in 2022 and compare the results with those in 2016.

METHODS

The study was conducted in 2022 as a national online survey targeting hospital pharmacies (n=22) and smaller-scale, independently operating medicine dispensaries (n=23). Descriptive statistics and qualitative content analysis were used for the data analysis.

RESULTS

The response rate was 64% (n=29/45), accounting for 19/22 hospital pharmacies and 10/23 medicine dispensaries. Clinical pharmacy services were provided in 83% (n=24/29) of the responding units. The clinical pharmacy staff increased between 2017 and 2022 and services became more common, particularly at admission units (eg, emergency departments) and outpatient clinics. In some units (25%, n=6/24), services were also available in the evenings and in one unit during weekends. Similar to 2016, system-based medication safety risk management was also highlighted in this survey, and the first medication safety officer positions (n=8/24) were created. The most increased tasks were medication reviews and medication safety audits, while in 2016 the most increased task was medication reconciliation. Pharmacist participation in patient discharge had decreased. Despite the increasing prevalence of automation technology and pharmacy assistants, logistical tasks decreased only slightly.

CONCLUSIONS

Finnish hospital clinical pharmacy services have continued to expand in accordance with national and international guidelines, and have become increasingly concentrated on medication safety risk management. They currently engage in admission and outpatient units, but effort should also be put into discharge.

Off-the-shelf medication transformed: Custom-dosed metoprolol tartrate tablets via semisolid extrusion additive manufacturing and the perception of this technique in a hospital context

Pharmacies are currently unable to stock proper oral dosage forms for pediatric populations. This leads to manipulation of medications or the need to compound specialized medications, which can be a time-consuming process. Using Semisolid Extrusion (SSE) additive manufacturing (AM), specialized medications can be produced in an expedited process from off-the shelf medication in a hospital or outpatient pharmacy setting. In this study, tablets with a desired dose of 5 mg of metoprolol tartrate derived from commercial Seloken™ 50 mg tablets were 3D printed in a hospital setting. Validation testing was done on five batches, highlighting tablets with a high uniformity in mass and dimension, drug content, acceptable microbial assays, and prolonged release during in-vitro analysis. The average drug content found for the tablets was within ±6% of 5 mg for all batches produced. Comparisons were done between the SSE tablets and capsules produced in an external compounding facility, highlighting several positive aspects of SSE-produced tablets beyond simply shortening the production timeline. The SSE tablets printed in this study are characterized by their smaller size, enhanced prolonged release properties, and more uniform drug content across the tested samples. Additionally, interviews with pharmaceutical professionals were conducted to determine the positive aspects of SSE and further improvements to bring this technique as seamlessly as possible into the pharmacy. This study underscores the feasibility of employing SSE in the production of specialized medications within a hospital environment. Furthermore, it highlights the methodological advantages SSE offers over existing production standards, demonstrating its potential to improve pharmaceutical manufacturing in healthcare settings.

Enhanced Pharmacy Service Delivery Through a Pharmacy Information System at a Medical Center: A Case Study

INTRODUCTION

A pharmacy information system (PIS) is a crucial tool for preventing errors and enhancing patient safety. This study aims to assess the influence of a PIS on workflow and medication errors (MEs) within the pharmacy department of a medical city in Saudi Arabia. The analysis encompasses an evaluation of the current workflow within pharmacy modules (in-patient, out-patient, and clinical pharmacy modules) and an exploration of associated challenges and inefficiencies.

METHOD

The study employed both qualitative and quantitative methodologies, incorporating structured interview techniques and the review of system records, such as logs, incident reports, and ME databases.

RESULTS

Respondents recognized the benefits of the PIS, including the management of high-quality real-time data (26%), reduction of MEs (25%), acceleration of healthcare practices (23%), and absence of space-time constraints (14%). The study highlighted the role of PIS in addressing medication stock control and shortage issues, thereby improving overall medication availability. Furthermore, PIS significantly enhanced safety (93.3%), efficiency (80%), reliability, accuracy, ease of use (56.7%, 56.7%), and cost-effectiveness (53.7%). Following the implementation of the PIS, there was an increase in ME reporting, indicating improved error detection and management.

CONCLUSION

The research revealed an increase in ME reporting rates in hospitals after PIS installation, attributed to improved medication management processes resulting in higher detection rates. As healthcare facilities increasingly embrace electronic medical records, the understanding of patient care quality will be significantly impacted. Consequently, further research is warranted to explore the role of PIS in reporting, detecting, analyzing, and mitigating MEs, as well as their influence on the work environment to promote a secure and efficient patient journey.

Harmonizing the definition of medication reviews for their collaborative implementation and documentation in electronic patient records: A Delphi consensus study

BACKGROUND

Medication review practices have evolved internationally in a direction in which not only physicians but also other healthcare professionals conduct medication reviews according to agreed practices. Collaborative practices have increasingly highlighted the need for electronic joint platforms where information on medication regimens and their implementation can be documented, kept updated, and shared.

OBJECTIVE

The aim of this study was to harmonize the definition of medication reviews and create a unified conceptual basis for their collaborative implementation and documentation in electronic patient records (definition appellation: collaborative medication review).

METHODS

The study was conducted using the Delphi consensus survey with three interprofessional expert panel rounds in September-December 2020. The consensus rate was set at 80%. Experts assessed the proposed definition of collaborative medication review based on an international and national inventory of medication review definitions. The expert panel (n = 41) involved 12 physicians, 13 pharmacists, 10 nurses, and six information management professionals. The range of response rates for the rounds was 63-88%.

RESULTS

The experts commented on which of the pre-selected items (n = 75) characterizing medication reviews should be included in the definition of collaborative medication review. The items were divided into the following five themes and 51 of them reached consensus: 1) Actions included in the collaborative medication review (n = 24/24), 2) Settings where the review should be conducted (n = 5/5), 3) Situations where the review should be considered as needed and carried out (n = 10/11), 4) Prioritization of top five benefits to be achieved by the review and 5) Prioritization of top five patient groups to whom the review should be targeted.

CONCLUSIONS

A strong interprofessional consensus was reached on the definition of collaborative medication review. The most challenging was to identify individual patient groups benefiting from the review.

Infusion pump innovation: Embracing change for patients and bottom lines

Within the infusion delivery landscape, significant room exists for an improved experience with more intuitive and interoperable solutions. The majority of smart infusion pumps still rely on technology developed more than a decade ago. Many Canadian healthcare institutions regularly undergo a comprehensive re-evaluation of infusion fleets, to modernize infusion delivery for patients across the country. Amid the availability of new technologies with evidence demonstrating their ability to elevate the current standards of care, this article argues for the need for healthcare systems to prepare for, and embrace, change when it comes to new technologies. Clinical informatics consultant, Helen Edwards, delves into why new technologies are needed now more than ever. She shares her experience with the Ivenix Infusion System, capturing how it can help redefine clinical workflows, reduce costs across the entire healthcare continuum, and better support patient care. She also offers insights on how to effectively introduce new technologies and cultivate an environment that is likely to be open and adaptive to the change. As the Canadian healthcare landscape continues to evolve, the proactive adoption of new technologies will be a step towards advancing the outcomes for patients and the sustainability of Canadian healthcare infrastructures.