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CC BY-NC-ND 4.0 · Appl Clin Inform 2023; 14(03): 503-512
DOI: 10.1055/a-2077-2457
Research Article

Implementation of 2D Barcode Medication Labels and Smart Pumps in Pediatric Acute Care: Lessons Learned

Felix Erdfelder
1   Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
2   Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
3   Applied Mathematical Physiology (AMP) Lab, Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
4   Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
,
Fabian Ebach
5   Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
,
Richard Zoller
1   Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
,
Verena Walterscheid
1   Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
5   Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
,
Claudia Weiss
2   Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
,
Jochen Kappler
2   Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
,
Jan Görtzen-Patin
1   Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
4   Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
6   Department of Internal Medicine I - Gastroenterology and Hepatology, Nephrology, Infectious Diseases, Endocrinology and Diabetology, University Hospital Bonn, Bonn, Germany
,
Joachim Schmitt
5   Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
,
Noa J. Freudenthal
7   Pediatric Cardiac Surgery at the German Pediatric Heart Centre in Bonn, University Hospital Bonn, Bonn, Germany
,
A. Müller
5   Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
,
Anne Ksellmann
7   Pediatric Cardiac Surgery at the German Pediatric Heart Centre in Bonn, University Hospital Bonn, Bonn, Germany
,
Daniel Grigutsch
2   Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
4   Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
,
Manuel Külshammer
1   Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
5   Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
,
Maike Füssel
1   Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
5   Department of Neonatology and Pediatric Critical Care, University Hospital Bonn, Bonn, Germany
,
Sven Zenker
1   Staff Unit for Medical and Scientific Technology Development and Coordination, University Hospital Bonn, Bonn, Germany
2   Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
3   Applied Mathematical Physiology (AMP) Lab, Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
4   Applied Medical Informatics (AMI) Lab, Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
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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.

Keywords

medication process - pediatrics - barcoding - medication administration systems - infusion - smart pump

Note

The staff council of the University Hospital Bonn was informed in detail about the questionnaire and provided approval.


Protection of Human and Animal Subjects

No ethics vote is required.


Supplementary Material



Publication History

Received: 11 November 2022

Accepted: 19 March 2023

Accepted Manuscript online:
19 April 2023

Article published online:
05 July 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Tariq RA, Vashisht R, Scherbak Y. . Medication Errors. In: StatPearls. StatPearls Publishing; 2020. Accessed July 24, 2020. NBK519065
    PubMed
  • 2 Alghamdi AA, Keers RN, Sutherland A, Ashcroft DM. Prevalence and nature of medication errors and preventable adverse drug events in paediatric and neonatal intensive care settings: a systematic review. Drug Saf 2019; 42 (12) 1423-1436
    CrossrefPubMedGoogle Scholar
  • 3 Kaushal R, Bates DW, Landrigan C. et al. Medication errors and adverse drug events in pediatric inpatients. JAMA 2001; 285 (16) 2114-2120
    CrossrefPubMedGoogle Scholar
  • 4 Ghaleb MA, Barber N, Franklin BD, Wong ICK. The incidence and nature of prescribing and medication administration errors in paediatric inpatients. Arch Dis Child 2010; 95 (02) 113-118
    CrossrefPubMedGoogle Scholar
  • 5 Conn RL, Tully MP, Shields MD, Carrington A, Dornan T. Characteristics of reported pediatric medication errors in Northern Ireland and use in quality improvement. Paediatr Drugs 2020; 22 (05) 551-560
    CrossrefPubMedGoogle Scholar
  • 6 Larsen GY, Parker HB, Cash J, O'Connell M, Grant MC. Standard drug concentrations and smart-pump technology reduce continuous-medication-infusion errors in pediatric patients. Pediatrics 2005; 116 (01) e21-e25
    CrossrefPubMedGoogle Scholar
  • 7 Aguado-Lorenzo V, Weeks K, Tunstell P, Turnock K, Watts T, Arenas-Lopez S. Accuracy of the concentration of morphine infusions prepared for patients in a neonatal intensive care unit. Arch Dis Child 2013; 98 (12) 975-979
    CrossrefPubMedGoogle Scholar
  • 8 Advancing Medication Safety in Paediatrics. . Accessed July 24, 2020 at: https://www.ismp-canada.org/CurrentProjects/Paediatrics/
    PubMed
  • 9 Avoid Preparing Infusions Using the Rule of 6 or Broselow Tape. Accessed July 24, 2020 at: https://www.medscape.com/viewarticle/501053
    PubMed
  • 10 Cree ML, Stocker CF, Tu QM, Scaini LF. Adherence to standard medication infusion concentrations and its impact on paediatric intensive care patient outcomes. Aust Crit Care 2018; 31 (04) 213-217
    CrossrefPubMedGoogle Scholar
  • 11 Lesar TS. Tenfold medication dose prescribing errors. Ann Pharmacother 2002; 36 (12) 1833-1839
    CrossrefPubMedGoogle Scholar
  • 12 Avidan A, Levin PD, Weissman C, Gozal Y. Anesthesiologists' ability in calculating weight-based concentrations for pediatric drug infusions: an observational study. J Clin Anesth 2014; 26 (04) 276-280
    CrossrefPubMedGoogle Scholar
  • 13 Skog J, Rafie S, Schnock KO, Yoon C, Lipsitz S, Lew P. The impact of smart pump interoperability on errors in intravenous infusion administrations: a multihospital before and after study. J Patient Saf 2022; 18 (03) e666-e671
    CrossrefPubMedGoogle Scholar
  • 14 Khammarnia M, Kassani A, Eslahi M. The efficacy of patients' wristband bar-code on prevention of medical errors: a meta-analysis study. Appl Clin Inform 2015; 6 (04) 716-727
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Berdot S, Boussadi A, Vilfaillot A. et al. Integration of a commercial barcode-assisted medication dispensing system in a teaching hospital. Appl Clin Inform 2019; 10 (04) 615-624
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Manrique-Rodríguez S, Sánchez-Galindo AC, López-Herce J. et al. Risks in the implementation and use of smart pumps in a pediatric intensive care unit: application of the failure mode and effects analysis. Int J Technol Assess Health Care 2014; 30 (02) 210-217
    CrossrefPubMedGoogle Scholar
  • 17 Borycki E, Dexheimer JW, Hullin Lucay Cossio C. et al. Methods for addressing technology-induced errors: the current state. Yearb Med Inform 2016; (01) 30-40
    PubMedGoogle Scholar
  • 18 Koppel R, Wetterneck T, Telles JL, Karsh BT. Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety. J Am Med Inform Assoc 2008; 15 (04) 408-423
    CrossrefPubMedGoogle Scholar
  • 19 Institute for Safe Medication Practices Independent Double Checks. . Worth the Effort if Used Judiciously and Properly. 2019 Jun 6. Accessed February 17 2023 at: https://www.ismp.org/resources/independent-double-checks-worth-effort-if-used-judiciously-and-properly
    PubMed
  • 20 Kasparick M, Schmitz M, Andersen B. et al. OR.NET: a service-oriented architecture for safe and dynamic medical device interoperability. Biomed Tech (Berl) 2018; 63 (01) 11-30
    CrossrefPubMedGoogle Scholar
  • 21 Reece KM, Lozano MA, Roux R, Spivey SM. Implementation and evaluation of a gravimetric i.v. workflow software system in an oncology ambulatory care pharmacy. Am J Health Syst Pharm 2016; 73 (03) 165-173
    CrossrefPubMedGoogle Scholar
  • 22 Fan M, Yang D, Ng B. et al. Impact of technology-assisted versus manual sterile compounding on safety and efficiency in a Canadian community hospital. Am J Health Syst Pharm 2022; 79 (19) 1685-1696
    CrossrefPubMedGoogle Scholar