Medication safety through information technology: a focus on medication prescribing and administration

The delivery of hospital care is changing: the aging population results in more patients being admitted to hospitals, but are discharged sooner. As a result, hospitals invest in information technology to assure safe and effective treatment and facilitate rapid patient turnover. In this thesis we describe the consequences of clinical decision support systems (CDSS) and bar-code technology on the most error prone steps of hospital medication use: medication prescribing and administering. We focus in our research on quality (e.g. quality of antimicrobial dosing, medication administration errors and automated dispensing cabinet refill errors) and efficiency aspects (e.g. cost of excess antimicrobial dosing, return on investment of CDSS assisted drug-drug interaction checking and workflow optimization). We describe and research the shortcomings of our current information systems and the barriers to adoption of effective clinical decision support. As an example of our work, we used a CDSS to augment conventional drug-drug interaction checking. Adding a CDSS decreased the number of alerts by 55%, resulting in a decreased time investment by the pharmacist. We also investigated bar-coded medication administration (BCMA) technology to improve the safety and quality of medication distribution and administration. BCMA implementation decreased medication administration errors on general medicine floors, but not on the Intensive Care Unit. To summarize, increased availability of electronic data in hospitals opens many doors for technologies aimed at increasing medication safety in those areas that are most critical; medication prescribing and administering. This thesis can help in selecting and configuring these technologies and measuring its effects