38% the therapy mistakes occur at the medicine administering, after the prescription (39%), the transcription (12%) and the preparation (11%). How can a smart EMR reduce this risk?
The main risk determining a mistake, more or less dangerous, during a therapy are: to get wrong the patient, the medicine, the dose, the administration mode, the time, the operation registration.
In order to reduce risks, the administration process should be completely computerized (Closed Loop Medication Management) and should be carried out at the patient bed though mobile devices. Those solutions where the nurse operates on a PC, print a report and makes the bed tour marking on the paper his/her work present few advantages in respect to the traditional paper use and do not reduce the above mentioned risks.
At first, the software shall require the patient identification by reading a barcode/RFiD bracelet. After that, it shall list the medicine which the patient has to take, in which time and day when the nurse is operating. For each of them it shall require the medicine identification through barcode/RFiD reader, then show the right dose, the perfusion way and speed (with instructions) and the confirmation for occurred administration. The software shall advise and block any action non-coherent with the prescription (i.e. medicine out of therapy or to be provisioned in other time or day).
In case of a medicine is replaced by another, the software shall check the correctness of the choice (which can be guided by the system on the base of the actual ward stock) and register the operation. It shall also permit to manage medicines on demand, for what a doctor prescription is in any case mandatory.
Through the integration with a CDSS, the software can help the nurse calculate the dose (i.e. on the base of weight or kidney functionality) and advise him/her of possible risks, by evaluating hematic, renal or hepatic values. Once the therapy is administered, the CDSS can evidence to nurse which are the adverse effects which can occur, so he/she can warn the patient or his/her care giver, supplying him/her with the relevant indication or recommendations (i.e. on the constipation, lack of equilibrium, sleepiness, and so on).
Even for what concerns the medicine preparation, the software can play an essential role to prevent mistakes, to document the process and finally to program the packaging machines. To amplify the debate, also the medicine logistics by the employment of smart carts and closets can give additional value to the informatization, so closing the entire clinic-logistic cycle of the medicine.