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At least 19 recordsLinked to original sources
PubMed1984

Consultant evaluation of a hospital medication system: implementation and evaluation of the new system.

The effects of consultant-recommended modifications in a hospital medication system on medication-error rates and response times were evaluated. Fourteen recommendations for improving the medication system in a large teaching hospital were implemented to varying extents over a period of 1.5 years. The response times and medication-error rates of the newly implemented system were then measured using pharmacist-observers as was done in the old medication system. Medication-error rates were then compared on one medical-nursing unit and two surgical-nursing units both before and after implementation of the new system on the medical unit alone. Response times for routine medication orders decreased by 55% compared with the previous system; for "now" and "stat" orders, response times were reduced by 57% for orders filled from the central pharmacy and by 70% for orders filled from medication carts on the nursing units. No significant differences in medication-error rates were found when the old and new medication systems were compared. This finding was attributed primarily to the hospital's failure to implement recommendations related to computer printing and sorting of orders, use of dispensing envelopes for delivering medications in true unit dose form, and packaging of all medications in unit dose form. This study illustrates how the benefits of a unit dose system can be compromised in implementation and the need for close monitoring to ensure that performance standards are maintained.

Consultants↗
PubMed1984

Consultant evaluation of a hospital medication system: analysis of the existing system.

A consultant team's evaluation of a system for distributing and controlling medications in a large teaching hospital is described. Through interviews with key personnel from administration, pharmacy, nursing, and the medical staff, an interdisciplinary research group identified problems in the reliability and response times of the hospital's existing medication system. After assessing staff expectations regarding acceptable standards for medication errors and response times and their attitudes toward proposed changes in the medication system, medication-error rates were determined using a pharmacist-observer method. Observations during 34 five-hour periods on four nursing units were conducted over a 17-day period. Medication-error rates were calculated as the frequency of medication errors during the observation period divided by the total opportunities for error (OE), which were defined as doses ordered plus unauthorized doses given. Response times for processing "now," "stat," and routine orders were also determined using work-sampling methods. The total medication-error rate for the nursing units studied was 9% excluding wrong-time errors; more than a third of doses were given more than 30 minutes before or after their scheduled administration times. Response times for "now" and "stat" orders averaged about 23 minutes, in conformance with the desired standard of 30 minutes. However, processing of routine orders required an average of two hours and seven minutes, much of which was attributed to delays in the messenger service. The basic design of the existing unit dose medication system contributed to problems in the reliability and efficiency of the system.

Attitude of Health Personnel↗
PubMed1975

A highly automated hospital medication system. Five years' experience and evaluation.

Since 1969, medications have been provided to patients at the Johns Hopkins Hospital using a computer system that controls the entire medication process from entry of physician's order to hourly drug distribution. Special envelopes containing patient and dosage information are computer generated for each dose to be administered. These envelopes, containing individually labelled ready-to-administer doses, are delivered to the nursing units hourly. The system provides daily medication profiles, drug administration histories, discharge summaries, and management and billing reports. Medication errors of commission were 4.6 times more frequent on the traditional nursing units compared to the units with the computer system. Registered nurses spend 56% less time performing medication-related activities on the units served by the computer. For 250 beds, total costs are 7% higher using the computer system. For 450 beds, total costs are 14% lower using the computer system.

Costs and Cost Analysis↗
PubMed1984

Consultant evaluation of a hospital medication system: synthesis of a new system.

Recommendations of consultants for the implementation of a new medication system at a large teaching hospital are described. Based on a previous analysis of the hospital's existing drug distribution and control system that revealed problems in reliability and response time, an interdisciplinary consultant group offered 14 recommendations, which included implementation of a computerized unit dose delivery system and selected clinical pharmacy services. Functions identified for which computerization would produce the greatest benefits included maintenance of patient census data, medication order entry and retrieval, and preparation of a medication administration record for nursing. Recommendations for improving the unit dose system in the hospital consisted of increasing the number of medications packaged in true unit dose form, increasing the frequency of daily deliveries of scheduled medications, sending p.r.n. medications on an on-call basis, decreasing the lead time for preparation of i.v. solutions, and using a pharmacist-manned portable medication cart to reduce workload on the central pharmacy during peak workload periods. Clinical pharmacy services identified as having the greatest cost-benefit ratio were discharge consults, drug therapy monitoring, and drug-use review. Using information from published studies and cost data from the hospital, a net annual savings of over +152,000 was projected with implementation of these services. Improvements in the unit dose system and implementation of clinical pharmacy services were expected to result in substantial cost savings in the study hospital.

Computers↗
PubMed1979

A hospital medication monitoring system.

Hospitals need to process large quantities of scattered information to properly screen medication orders. The data includes complex relationships involving drugs, diseases, and other drugs that determine whether a particular drug is contraindicated for a patient. Hospitals would therefore benefit from a flexible system for storing complex medical data relationships. We have used GPLAN, a CODASYL-like data management system, to construct a functioning model of a hospital pharmacy medication monitoring system. the patients' histories, drug-drug contraindications, disease-drug contraindications, and recommended dosages are stored in the data base in a network structure defined by the Data Description Language. Each drug order is checked for dose, allergies, current diseases, and current medications.

Computers↗
PubMed1992

A study of evaluation methods for hospital medical care systems.

When we seek to evaluate hospital medical care services, we first collect data regarding the existing system in order to gather information and to develop a method of analysis that we can use for evaluation. We took the OPD system as an example, taking into account systematic OPD services based on queuing theory and computer simulation. As a result of the computer simulation model based on experimental conditions, we were able to offer recommendations for modifications of the present system that could improve patient service. The hospital manager can use this information to aid him in the decision making processes concerning the hospital. A study of the methods for the evaluation of hospital medical care services is important. It is necessary to develop a regional medical care information system as well as a hospital medical care information system.

Computer Simulation↗
PubMed1996

Causation, incidence, and costs of traumatic brain injury in the U.S. military medical system.

Hospital discharge records from military facilities and private facilities reimbursed by Civilian Health and Medical Program of the Uniformed Services for fiscal year 1992 were reviewed to identify head injury admissions. Incidence rates, case fatality rates, causes of head injuries, and direct cost for hospital admissions were computed in this well-defined population. For fiscal year 1992, there were 5,568 hospitalized cases of noncombat head injury in the military medical system. The age-adjusted head injury rates for ages 15-44 years are higher in active-duty individuals compared with other beneficiaries (1.6 times greater for men and 2.5 times greater for women). The total cost for hospitalization in this population was $43 million. Private facility rehabilitation accounted for 26% of all private facility costs but only 6% of head injury cases. Firearms and motor vehicle crashes caused the most severe injuries for cases admitted to military facilities. Motor vehicle crashes, falls, and fighting accounted for 80% of the total military facility cost for head injuries. Military active-duty individuals are at increased risk for noncombat head injury. Prevention of head injury in military settings should focus on motor vehicle crashes, fist fights (assault), and falls.

Accidental Falls↗
PubMed1998

The Veterans Affairs medical care system: hospital and clinic utilization statistics for 1994.

OBJECTIVES: The authors describe the role the Veterans Affairs (VA) medical system plays as a provider of clinic and hospital services by examining utilization levels and users' characteristics. METHODS: The Veterans Affairs hospital discharge database, the Veterans Affairs outpatient clinic files, and the veteran population files were used to estimate the number of persons using the Veterans Affairs medical care system in 1994 and the intensity of their clinic and hospital use. Demographic and clinical characteristics of users were tabulated. RESULTS: In 1994, 2.7 million veterans, 10.3% of all US veterans, and approximately 23% of veterans who would have met the statutory eligibility requirements for Veterans Affairs care, used the hospital and/or clinic components of the Veterans Affairs medical system. Sixty-three percent of the system's users were younger than age 65, and 10.5% were women. These 2.7 million veterans had 901,665 Veterans Affairs hospital stays, 15.5 million bed-days, and 31.2 million outpatient visits in fiscal year 1994. The average number of hospitalizations per hospital user was 1.71; the average number of visits per clinic user was 11.7. Medical, surgical, and psychiatric diagnosis-related groups (DRGs) accounted for 56%, 21%, and 23%, respectively, of hospitalizations, but psychiatric diagnosis-related groups accounted for 43% of all inpatient days. Principal medicine clinic visits and psychiatry clinic visits accounted for 21% and 16% of Veterans Affairs ambulatory care. CONCLUSIONS: Because the patient population served by the Veterans Affairs system is skewed in a number of ways, its contribution as a provider of health services in the United States varies by gender, age, socioeconomic status, and diagnosis.

Adult↗
PubMed1998

Survey of hospital systems and common serious medication errors.

The Institute for Safe Medication Practices and the University of Illinois at Chicago, College of Pharmacy, undertook a hospital survey of medical-surgical hospitals to determine systems-oriented factors that allow the highest level of medication safety. The study incorporated a peer-reviewed and pretested questionnaire, which focused on critical information necessary to yield quality data for comparison. Through analysis, it was shown that over one third of all medication errors reported in the survey involve just six categories--allergies, insulin, heparin, opiates, PCA devices, and potassium concentrates.

Chicago↗
PubMed1992

Alternative payment systems for hospital medical staffs.

This paper examines the implications of using a Medical Staff Payment System (MSPS) for reimbursing physicians for services provided to inpatients. Inpatient episodes are defined to include seven days before admission and 30 days postdischarge. Simulations are performed using Medicare Part A and B data from nine states in 1988. DRGs are strong predictors of expenditures on physician services during the inpatient episode, achieving an R2 of .61. Gains and losses for various types of facilities are simulated, and the characteristics of winning and losing hospitals under an MSPS are identified.

Diagnosis-Related Groups↗
PubMed1996

Use of data from a hospital online medical records system by physicians during preanesthetic evaluation.

OBJECTIVE: There is no data on the use of hospital-wide online medical record (OLMR) systems by anesthesiologists. We measured how often anesthesiologists accessed the OLMR database maintained by the hospital, how often data was copied from this database into the clinic's computer system, and how much data was copied. METHODS: In a preanesthetic evaluation clinic that has a computerized evaluation system designed for physician-entered data, a graphical user-interface prototype link provided access to the hospital OLMR database for users and was studied over a 37-day period. The software allowed the user to search the OLMR system by patient name, retrieve a text listing of the patient's record, and then copy and paste desired information into the forms of the preanesthetic system. Using embedded routines, we recorded how many times physicians searched for and retrieved medical records from the hospital OLMR database, as well as how many times they copied data to the preoperative database. As a measure of how much data was copied, the number of characters was also recorded. RESULTS: Of 1,080 patients evaluated in the clinic during the study period, electronic searches of the hospital OLMR database for 221 patients (20.5%) were noted. Of these searches, 208 (94.1%, or 19.3% of 1,080 patients) successfully retrieved data from the patient's record. Data was copied for 170 patients - 81.7% of the successful searches. Of 7,525,153 characters retrieved, 262,269 were copied-an average of 1,543 characters per instance of copying. CONCLUSION: We conclude that anesthesiologists, given even crude graphical access to a hospital OLMR data-base, will retrieve and copy data, potentially increasing the accuracy of the medical records and saving time.

Anesthesiology↗