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Erdfelder F, Ebach F, Zoller R, Walterscheid V, Weiss C, Kappler J, Görtzen-Patin J, Schmitt J, Freudenthal NJ, Müller A, Ksellmann A, Grigutsch D, Külshammer M, Füssel M, Zenker S. Implementation of 2D Barcode Medication Labels and Smart Pumps in Pediatric Acute Care: Lessons Learned. Appl Clin Inform 2023; 14:503-512. [PMID: 37075805 PMCID: PMC10322227 DOI: 10.1055/a-2077-2457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/19/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND In pediatric intensive care, prescription, administration, and interpretation of drug doses are weight dependent. The use of standardized concentrations simplifies the preparation of drugs and increases safety. For safe administration as well as easy interpretation of intravenous drug dosing regimens with standardized concentrations, the display of weight-related dose rates on the infusion device is of pivotal significance. OBJECTIVES We report on challenges in the implementation of a new information technology-supported medication workflow. The workflow was introduced on eight beds in the pediatric heart surgery intensive care unit as well as in the pediatric anesthesia at the University of Bonn Medical Center. The proposed workflow utilizes medication labels generated from prescription data from the electronic health record. The generated labels include a two-dimensional barcode to transfer data to the infusion devices. METHODS Clinical and technical processes were agilely developed. The reliability of the system under real-life conditions was monitored. User satisfaction and potential for improvement were assessed. In addition, a structured survey among the nursing staff was performed. The questionnaire addressed usability as well as the end-users' perception of the effects on patient safety. RESULTS The workflow has been applied 44,111 times during the pilot phase. A total of 114 known failures in the technical infrastructure were observed. The survey showed good ratings for usability and safety (median "school grade" 2 or B for patient safety, intelligibility, patient identification, and handling). The medical management of the involved acute care facilities rated the process as clearly beneficial regarding patient safety, suggesting a rollout to all pediatric intensive care areas. CONCLUSION A medical information technology-supported medication workflow can increase user satisfaction and patient safety as perceived by the clinical end-users in pediatric acute care. The successful implementation benefits from an interdisciplinary team, active investigation of possible associated risks, and technical redundancy.
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Affiliation(s)
- Felix Erdfelder
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Applied Mathematical Physiology (AMP) Lab, Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Fabian Ebach
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Richard Zoller
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
| | - Verena Walterscheid
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Claudia Weiss
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Jochen Kappler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Jan Görtzen-Patin
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
- Department of Internal Medicine I - Gastroenterology and Hepatology, Nephrology, Infectious Diseases, Endocrinology and Diabetology, University Hospital Bonn, Bonn, Germany
| | - Joachim Schmitt
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Noa J. Freudenthal
- Pediatric Cardiac Surgery at the German Pediatric Heart Centre in Bonn, University Hospital Bonn, Bonn, Germany
| | - A. Müller
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Anne Ksellmann
- Pediatric Cardiac Surgery at the German Pediatric Heart Centre in Bonn, University Hospital Bonn, Bonn, Germany
| | - Daniel Grigutsch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Manuel Külshammer
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Maike Füssel
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
| | - Sven Zenker
- Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Applied Mathematical Physiology (AMP) Lab, Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
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