Assignment: Medication Errors Research Paper
Assignment: Medication Errors Research Paper
Assignment: Medication Errors Research Paper ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Medication Errors Research Paper Paper= 80 points 1. Determine the expected/desired outcome of the project/ new piece of equipment. Describe how you gathered the data to make your decision. Provide an evidence-base for your new piece of equipment.= 10 points Assignment: Medication Errors Research Paper 2. Develop a plan to implement your piece of equipment, provide an evidence-base for your intended project. =15 points 3. Identify the needs, steps, barriers, and champions for the equipment implementation. =10 points 4. Describe the plan to utilize champions and overcome barriers. Identify areas of support and resistance. Include everyone who is affected by the new piece of equipment. Develop appropriate strategies to deal with barriers. =10 points 5. Develop a budget for implementing your plan including possible construction cost, staffing, equipment, staff education, etc.= 10 points 6. Discuss the each step of your plan for implementation.= 10 points 7. Evaluate your experience with the project. What have you learned? How could you have done this differently? =5 points 8. APA Style, writing style, transitions, grammar and spelling = 10 points Deductions for late paper, excessive grammatical and/or spelling errors Total Score for written paper Paper should be between 4 5 pages leadership_project.docx leadership_project.docx _art_interventionnurses___perceptions_of_automat.pdf _art_interventionusp__amp_lt_800_amp_gt_.pdf _art_interventionreducing_medication_errors_in_.pdf _art_interventionproquestdocuments_2020_09_23.pdf The Proposal CODE BLUE! As nurses rush to room 187, Nurse Jane stands there in a frantic. She realized the deadly mistake most nurses make. Minutes before the incident, she stands in the medication room in a great debate because she was late to a lunch date with her husband. She decided to pull all her patients medications at once and was sure to separate and label each. As she entered room 187, she mistakenly administers the patient the wrong medications. At this point, she is in a blur as she watches her patient die swiftly before her eyes. Medication errors are a common mistake made by most nurses, by failure to follow protocol and the five rights of medication administration. To reduce medication errors a nurse must comply by the rules of having the right patient, right drug, right dose, right route, and right time. Using the appropriate method will increase a safe medication administration for each patient. To understand medication errors and to identify preventive strategies, the unit nurse begins to act and plan a way to assist in decreasing the harm to patients. Patients will now have individualized pyxis in each room. The pharmacy will oversee supplying each patient medications as they arrive to the floor. The budget will cost $20,000.00 to build a miniature wall unit that will dispense medications to the nurse that will have a lock/time feature. The nurse will first have to identify the patient by scanning the armband and unlock the pyxis by fingerprint only. The pharmacist will unlock the pyxis by fingerprint and will also have a key for malfunction purposes. Assignment: Medication Errors Research Paper The charge nurse will go to a class to learn techniques to do on the job training for nurses and pharmacists during each shift, this will stabilize funds for the upcoming invention. The Proposal CODE BLUE! As nurses rush to room 187, Nurse Jane stands there in a frantic. She realized the deadly mistake most nurses make. Minutes before the incident, she stands in the medication room in a great debate because she was late to a lunch date with her husband. She decided to pull all her patients medications at once and was sure to separate and label each. As she entered room 187, she mistakenly administers the patient the wrong medications. At this point, she is in a blur as she watches her patient die swiftly before her eyes. Medication errors are a common mistake made by most nurses, by failure to follow protocol and the five rights of medication administration. To reduce medication errors a nurse must comply by the rules of having the right patient, right drug, right dose, right route, and right time. Using the appropriate method will increase a safe medication administration for each patient. To understand medication errors and to identify preventive strategies, the unit nurse begins to act and plan a way to assist in decreasing the harm to patients. Patients will now have individualized pyxis in each room. The pharmacy will oversee supplying each patient medications as they arrive to the floor. The budget will cost $20,000.00 to build a miniature wall unit that will dispense medications to the nurse that will have a lock/time feature. The nurse will first have to identify the patient by scanning the armband and unlock the pyxis by fingerprint only. Assignment: Medication Errors Research Paper The pharmacist will unlock the pyxis by fingerprint and will also have a key for malfunction purposes. The charge nurse will go to a class to learn techniques to do on the job training for nurses and pharmacists during each shift, this will stabilize funds for the upcoming invention. Metsämuuronen et al. BMC Nursing (2020) 19:27 https://doi.org/10.1186/s12912-020-00420-2 RESEARCH ARTICLE Open Access Nurses´ perceptions of automated dispensing cabinets an observational study and an online survey Riikka Metsämuuronen1* , Hannu Kokki2, Toivo Naaranlahti3, Minna Kurttila4 and Reeta Heikkilä5 Abstract Background: Thirty-two automated dispensing cabinets (ADCs) were introduced in May 2015 in Kuopio University Hospital, Finland. These medication distribution systems represent relatively new technology in Europe and are aimed at rationalising the medication process and improving patient safety. Nurses are the end-users of ADCs, and it is therefore important to survey their perceptions of ADCs. Our aim was to investigate nurses perceptions of ADCs and the impacts of ADCs on nurses work. Methods: The study was conducted in the Anaesthesia and Surgical Unit (OR) and Intensive Care Unit (ICU), of a tertiary care hospital, in Finland. We used two different research methods: observation and a survey. The observational study consisted of two 5-day observation periods in both units, one before (2014) and the other after (2016) the introduction of ADCs. An online questionnaire was distributed to 346 nurses in April 2017. The data were analysed using descriptive statistics including frequencies and percentages and the Chi-Square test. Results: The majority (n = 68) of the 81 respondents were satisfied with ADCs. Attitudes to ADCs were more positive in the ICU than in the OR. Nearly 80% of the nurses in the ICU and 42% in the OR found that ADCs make their work easier. The observational study revealed that in the OR, time spent on dispensing and preparing medications decreased on average by 32 min per 8-h shift and more time was spent on direct patient care activities. The need to collect medicines from outside the operating theatre during an operation was less after the introduction of ADCs than before that. Some resistance to change was observed in the OR in the form of non-compliance with some instructions; nurses took medicines from ADCs when someone else was logged in and the barcode was not always used. Assignment: Medication Errors Research Paper .3 The results of the survey support these findings. Conclusions: Overall, nurses were satisfied with ADCs and stated that they make their work easier. In the ICU, nurses were more satisfied with ADCs and complied with the instructions better than the nurses in the OR. One reason for that can be the more extensive pilot period in the ICU. Keywords: Automated dispensing cabinet, ADC, Hospital pharmacy, Drug storage and distribution system, Observation, Survey, Nurse, Perception, Work efficiency * Correspondence: [email protected] 1 School of Pharmacy, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the articles Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the articles Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Metsämuuronen et al. BMC Nursing (2020) 19:27 Impact and implications of findings on practice Automated dispensing cabinets (ADCs) can facilitate nurses´ work and improve work efficiency. When hospitals and other health care facilities are planning to develop and reorganise the medication process, the introduction of ADCs is worth considering. The successful introduction of ADCs requires commitment and acceptance from employees, and resistance to change can restrict the system from working optimally. Assignment: Medication Errors Research Paper A pilot phase can reveal opportunities to improve the process and benefit to manage the change. Attitudes to ADCs were mainly positive among nurses in Kuopio University Hospital, and the introduction of the ADC system succeeded rather well. Background Automated dispensing cabinets, ADCs, were introduced in the 1980s in the United States, since which time they have been increasingly used to automate and rationalise the medication process in hospitals and other health care facilities [1]. These medication storage systems decentralise the distribution of drugs near the patient and provide quick access to medicines for the nurse. ADCs have the potential to reduce medication errors and to improve the work efficiency of pharmacy and nursing staff [15]. Barcode scanning, generally combined with ADCs, reduces the risk of errors both when drugs are removed from an ADC and when they are being placed in the cabinet. ADCs can also help to control illegal drug delivery for other than patient use. Furthermore, ADCs can help to account for medicine, billing and inventory management. Kuopio University Hospital (KUH), Kuopio, Finland, a tertiary care hospital, has a catchment of 250,000 people, 90,000 annual patients and 20,000 annual operations. In May 2015, a new part of the hospital was completed and 32 ADCs (eMED ICON, NewIcon, Kuopio, Finland) were introduced there in the Operating Rooms of the Anaesthesia and Surgical Unit (OR), and the Intensive Care Unit (ICU). Most of KUHs ADCs are placed into the wall structures of operating theatres and patient rooms using an innovative pass-through method [6]. This system allows the ADCs to be filled from outside the room and the medicines obtained inside the room. This is expected to reduce unnecessary movement into and out of the operating theatre during operations. Each ward has also a central ADC in the medication room, in which drugs that are seldom needed are stored. Before collecting a medicine from the ADC, a user logs into the system.Assignment: Medication Errors Research Paper Light guidance helps to find the selected product. Each medicine package taken from a Page 2 of 9 cabinet is documented by scanning its barcode to ensure that the right medicine has been taken. The system manages storage control and provides computer-controlled, real-time monitoring and tracking of medicine use and waste. Since the introduction of ADCs in KUH, the billing system has changed; nowadays wards pay only for the medicines they have used, and the medicines are owned by a pharmacy until they are removed from the ADC. The ADCs are restocked by pharmacy technicians. Before introducing the ADCs in clinical use, the nursing staff could practise their use during several pilot phases. The idea of the pilot phases was to gather user experience, recognise problems and improve the usability of the ADCs. The pilot phase lasted 5 months in the OR and 8 months in the ICU. The most important change of ADCs, made based on the pilot phase, was the pass-through principle that allows nurses to use the ADC without disturbing the patient care activities. Change management has an essential role in introducing ADC systems because the introduction of new systems causes often resistance to change [7]. The major challenges in introducing such systems successfully are usually more behavioural than technical. Individuals have to give up their familiar routines and invest their time and energy in learning the new system. The successful introduction of ADCs requires commitment and acceptance from employees, and resistance to change can restrict the system from working optimally. Nurses are the end-users of ADCs, and their perceptions of ADCs are therefore important to survey. Assignment: Medication Errors Research Paper The aim of our study was to assess nurses´ perceptions of ADCs and the impacts of ADCs on nurses work. Our study hypothesis was that implementation of ADCs would decrease nurses time spent on dispensing and preparing medicines and that ADCs would be accepted smoothly by employees after pilot phases. Methods We conducted the study in KUH using direct observation of nurses both before (2014) and after (2016) the introduction of ADCs together with an online survey for nurses in 2017. Observation The first of the two observation periods was carried out in AprilMay 2014, a year before the introduction of ADCs, in the OR and ICU. The second observation period was conducted in the same units in AprilMay 2016, a year after the introduction of ADCs. The observation periods consisted of five consecutive days (8 hours per day) in both units. The observation data were collected by the same observer (RM) both before and after the introduction of ADCs. She observed a different person on each day Metsämuuronen et al. BMC Nursing (2020) 19:27 during each 8-h shift. The activities of the nurses, the time spent with medication-related and other tasks, and movements into and out of the operating theatre during surgical procedures were recorded. Medication-related activities included searching for medicines, taking medicines from the cabinet and preparing and administering medicines, while other activities included monitoring patients, recording patient data, stock managing and personnel traffic in the unit. The time spent by nurses on different activities was assessed by measuring the duration of each activity. Any signs of resistance to change among nurses were recorded. Assignment: Medication Errors Research Paper A pilot data collection period was used before the actual observation period. All observations were first recorded manually, and at the end of the observation day entered into an electronic database. For the analysis, the observation data from 2014 and 2016 were compared with each other. Firstly, we analysed how much time nurses spent on different tasks and whether the ADCs had any impact on time management and workflow. In the OR, we investigated how many times nurses left the operating theatre during an operation to collect medicines from outside the room. Online survey An online questionnaire was developed for this study and it was distributed in April 2017 to 346 nurses of the OR and ICU (See Appendix 1). A link to the questionnaire on Surveypal (Surveypal Inc., Tampere, Finland) was sent to the nurses through their official work emails with a 4-week deadline for responses. The questionnaire was piloted on five nurses. They checked whether the questions were understandable, appropriate, logical, non-confusing and non-leading. Their answers were included in the final survey. The questionnaire consisted of different parts: the nurses´ sociodemographic and practice characteristics, closed- and open-ended questions about whether the ADCs have had an impact on their work and whether they have had problems with ADCs, questions about the use of the ADCs, 18 statements on the ADCs with a 5point Likert scale (1 = strongly disagree, 5 = strongly agree), questions about the impacts of ADCs on patient safety, a question about overall satisfaction and two open-ended questions about suggestions for improvements and free comments. Assignment: Medication Errors Research Paper Nurses working in the OR were also asked whether the ADCs increased or decreased the need to collect medicines from outside the operating theatre during an operation. The online survey data were exported direct from the Surveypal program to IBM SPSS Statistics for Windows, Version 23.0. (International Business Machines Corporation, Armonk, NY, USA). The data were analysed using descriptive statistics including frequencies and percentages Page 3 of 9 and the Chi-Square test. We combined the strongly disagree and disagree, and the strongly agree and agree, answers to present the data concisely. Ethics approval Ethics approval for the study protocol was obtained from the Research Ethics Committee of the Hospital District of Northern Savo, Kuopio, Finland (152/2016, April 5, 2016). The study had institutional approval. Informed verbal consent was obtained from each nurse prior to the observations. Participation in the survey was voluntary and responses were gathered anonymously. Results Observation study Observations in the Anaesthesia and surgical unit Nurses use of time The time spent on dispensing and preparing medications, including searching for medicines, taking medicines from the cabinet, preparing the medicines and marking them, in the operating theatre for elective surgery decreased on average by 32 min per 8-h shift after the introduction of ADCs; in 2014 nurses spent on average 55 min, and in 2016 on average 23 min, on these activities per 8-h shift. The time saved, 32 min, was spent on patient management and monitoring in the operating theatre; in 2014 nurses spent on average 243 min, and in 2016 on average 272 min, per 8-h shift on patient care in the operating theatre during an operation, an increase of 29 min per 8-h shift. Assignment: Medication Errors Research Paper Time spent on other duties was the same between 2014 and 2016. Movement of nurses during an operation The need to collect medicines from outside the operating theatre during an operation was less in 2016 than in 2014. In 2014, the nurses under observation collected the medicines or solutions from outside the operating theatre during the operation in seven out of eleven (64%) operations observed, whereas in 2016 the figure was in only one operation out of eight (13%). In 2014, there were altogether 15 collections compared to three in 2016. In 2014, there were up to six collections during a single operation. Resistance to change Some resistance to change was observed in the OR, where a few deficiencies were noted in documenting the drugs removed from the ADC and the use of barcodes. Some nurses took medicines from the ADC without recording the fact, which caused errors in the stock balance. Neither did all nurses use the barcode identification. In some cases, nurses also took medicines from the ADC when someone else was logged in. Metsämuuronen et al. BMC Nursing (2020) 19:27 Page 4 of 9 Observations in the Intensive care unit Table 1 Nurses´ sociodemographic and practice characteristics (n = 81) Nurses use of time In the ICU, nurses´ time spent on different tasks was similar between 2014 and 2016. In 2014, nurses spent on average 78%, and in 2016 80% of their working time in a patient room treating and monitoring patients. Characteristics Resistance to change Nurses´ perceptions of ADCs were more positive in the ICU than in the OR. Assignment: Medication Errors Research Paper Nurses logged in and out correctly and, with only a few exceptions, did not use the ADC when someone else was logged in. They also documented the removal of a medicine in the data system by scanning the barcode. Number (%) Title Staff nurse 79 (98) Head nurse 2 (2) Nursing unit Anaesthesia and Surgical Unit 52 (64) Intensive Care Unit 29 (36) Sex Female 67 (83) Male 14 (17) Age (years) Online survey 2029 10 (12) The response rate of the survey was 23% (81/346). The nurses´ sociodemographic and practice characteristics are presented in Table 1. 3039 21 (26) 4049 23 (28) 5059 26 (32) 60 or over 1 (1) Nurses´ perceptions A high proportion of the nurses (84%, 68/81) were satisfied with the ADCs (Table 2). Most nurses (81%, 66/81) found ADCs easy to use and 85% (69/81) agreed that the concept of ADCs is good (Table 3). The majority of the respondents (75%, 61/81) disagreed with the statement that they would rather return to the old stock system, while most of the nurses (74%, 60/81) also disagreed that the process of patient medication had become more difficult. In the ICU, a higher proportion of the nurses (79%, 23/ 29) said that the ADCs have made their work easier compared to the nurses in the OR (42%, 22/52) (Table 2). Over half (59%, 17/29) of the nurses in the ICU and 48% (25/ 52) in the OR found that with the ADCs they spend less time ordering and preparing medications than before the ADC system was installed. In the open-ended answers, nurses mentioned most frequently that the fact Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10
Assignment: Medication Errors Research Paper
Assignment: Medication Errors Research Paper ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Medication Errors Research Paper Paper= 80 points 1. Determine the expected/desired outcome of the project/ new piece of equipment. Describe how you gathered the data to make your decision. Provide an evidence-base for your new piece of equipment.= 10 points Assignment: Medication Errors Research Paper 2. Develop a plan to implement your piece of equipment, provide an evidence-base for your intended project. =15 points 3. Identify the needs, steps, barriers, and champions for the equipment implementation. =10 points 4. Describe the plan to utilize champions and overcome barriers. Identify areas of support and resistance. Include everyone who is affected by the new piece of equipment. Develop appropriate strategies to deal with barriers. =10 points 5. Develop a budget for implementing your plan including possible construction cost, staffing, equipment, staff education, etc.= 10 points 6. Discuss the each step of your plan for implementation.= 10 points 7. Evaluate your experience with the project. What have you learned? How could you have done this differently? =5 points 8. APA Style, writing style, transitions, grammar and spelling = 10 points Deductions for late paper, excessive grammatical and/or spelling errors Total Score for written paper Paper should be between 4 5 pages leadership_project.docx leadership_project.docx _art_interventionnurses___perceptions_of_automat.pdf _art_interventionusp__amp_lt_800_amp_gt_.pdf _art_interventionreducing_medication_errors_in_.pdf _art_interventionproquestdocuments_2020_09_23.pdf The Proposal CODE BLUE! As nurses rush to room 187, Nurse Jane stands there in a frantic. She realized the deadly mistake most nurses make. Minutes before the incident, she stands in the medication room in a great debate because she was late to a lunch date with her husband. She decided to pull all her patients medications at once and was sure to separate and label each. As she entered room 187, she mistakenly administers the patient the wrong medications. At this point, she is in a blur as she watches her patient die swiftly before her eyes. Medication errors are a common mistake made by most nurses, by failure to follow protocol and the five rights of medication administration. To reduce medication errors a nurse must comply by the rules of having the right patient, right drug, right dose, right route, and right time. Using the appropriate method will increase a safe medication administration for each patient. To understand medication errors and to identify preventive strategies, the unit nurse begins to act and plan a way to assist in decreasing the harm to patients. Patients will now have individualized pyxis in each room. The pharmacy will oversee supplying each patient medications as they arrive to the floor. The budget will cost $20,000.00 to build a miniature wall unit that will dispense medications to the nurse that will have a lock/time feature. The nurse will first have to identify the patient by scanning the armband and unlock the pyxis by fingerprint only. The pharmacist will unlock the pyxis by fingerprint and will also have a key for malfunction purposes. Assignment: Medication Errors Research Paper The charge nurse will go to a class to learn techniques to do on the job training for nurses and pharmacists during each shift, this will stabilize funds for the upcoming invention. The Proposal CODE BLUE! As nurses rush to room 187, Nurse Jane stands there in a frantic. She realized the deadly mistake most nurses make. Minutes before the incident, she stands in the medication room in a great debate because she was late to a lunch date with her husband. She decided to pull all her patients medications at once and was sure to separate and label each. As she entered room 187, she mistakenly administers the patient the wrong medications. At this point, she is in a blur as she watches her patient die swiftly before her eyes. Medication errors are a common mistake made by most nurses, by failure to follow protocol and the five rights of medication administration. To reduce medication errors a nurse must comply by the rules of having the right patient, right drug, right dose, right route, and right time. Using the appropriate method will increase a safe medication administration for each patient. To understand medication errors and to identify preventive strategies, the unit nurse begins to act and plan a way to assist in decreasing the harm to patients. Patients will now have individualized pyxis in each room. The pharmacy will oversee supplying each patient medications as they arrive to the floor. The budget will cost $20,000.00 to build a miniature wall unit that will dispense medications to the nurse that will have a lock/time feature. The nurse will first have to identify the patient by scanning the armband and unlock the pyxis by fingerprint only. Assignment: Medication Errors Research Paper The pharmacist will unlock the pyxis by fingerprint and will also have a key for malfunction purposes. The charge nurse will go to a class to learn techniques to do on the job training for nurses and pharmacists during each shift, this will stabilize funds for the upcoming invention. Metsämuuronen et al. BMC Nursing (2020) 19:27 https://doi.org/10.1186/s12912-020-00420-2 RESEARCH ARTICLE Open Access Nurses´ perceptions of automated dispensing cabinets an observational study and an online survey Riikka Metsämuuronen1* , Hannu Kokki2, Toivo Naaranlahti3, Minna Kurttila4 and Reeta Heikkilä5 Abstract Background: Thirty-two automated dispensing cabinets (ADCs) were introduced in May 2015 in Kuopio University Hospital, Finland. These medication distribution systems represent relatively new technology in Europe and are aimed at rationalising the medication process and improving patient safety. Nurses are the end-users of ADCs, and it is therefore important to survey their perceptions of ADCs. Our aim was to investigate nurses perceptions of ADCs and the impacts of ADCs on nurses work. Methods: The study was conducted in the Anaesthesia and Surgical Unit (OR) and Intensive Care Unit (ICU), of a tertiary care hospital, in Finland. We used two different research methods: observation and a survey. The observational study consisted of two 5-day observation periods in both units, one before (2014) and the other after (2016) the introduction of ADCs. An online questionnaire was distributed to 346 nurses in April 2017. The data were analysed using descriptive statistics including frequencies and percentages and the Chi-Square test. Results: The majority (n = 68) of the 81 respondents were satisfied with ADCs. Attitudes to ADCs were more positive in the ICU than in the OR. Nearly 80% of the nurses in the ICU and 42% in the OR found that ADCs make their work easier. The observational study revealed that in the OR, time spent on dispensing and preparing medications decreased on average by 32 min per 8-h shift and more time was spent on direct patient care activities. The need to collect medicines from outside the operating theatre during an operation was less after the introduction of ADCs than before that. Some resistance to change was observed in the OR in the form of non-compliance with some instructions; nurses took medicines from ADCs when someone else was logged in and the barcode was not always used. Assignment: Medication Errors Research Paper .3 The results of the survey support these findings. Conclusions: Overall, nurses were satisfied with ADCs and stated that they make their work easier. In the ICU, nurses were more satisfied with ADCs and complied with the instructions better than the nurses in the OR. One reason for that can be the more extensive pilot period in the ICU. Keywords: Automated dispensing cabinet, ADC, Hospital pharmacy, Drug storage and distribution system, Observation, Survey, Nurse, Perception, Work efficiency * Correspondence: [email protected] 1 School of Pharmacy, University of Eastern Finland, PO Box 1627, FI-70211 Kuopio, Finland Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the articles Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the articles Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Metsämuuronen et al. BMC Nursing (2020) 19:27 Impact and implications of findings on practice Automated dispensing cabinets (ADCs) can facilitate nurses´ work and improve work efficiency. When hospitals and other health care facilities are planning to develop and reorganise the medication process, the introduction of ADCs is worth considering. The successful introduction of ADCs requires commitment and acceptance from employees, and resistance to change can restrict the system from working optimally. Assignment: Medication Errors Research Paper A pilot phase can reveal opportunities to improve the process and benefit to manage the change. Attitudes to ADCs were mainly positive among nurses in Kuopio University Hospital, and the introduction of the ADC system succeeded rather well. Background Automated dispensing cabinets, ADCs, were introduced in the 1980s in the United States, since which time they have been increasingly used to automate and rationalise the medication process in hospitals and other health care facilities [1]. These medication storage systems decentralise the distribution of drugs near the patient and provide quick access to medicines for the nurse. ADCs have the potential to reduce medication errors and to improve the work efficiency of pharmacy and nursing staff [15]. Barcode scanning, generally combined with ADCs, reduces the risk of errors both when drugs are removed from an ADC and when they are being placed in the cabinet. ADCs can also help to control illegal drug delivery for other than patient use. Furthermore, ADCs can help to account for medicine, billing and inventory management. Kuopio University Hospital (KUH), Kuopio, Finland, a tertiary care hospital, has a catchment of 250,000 people, 90,000 annual patients and 20,000 annual operations. In May 2015, a new part of the hospital was completed and 32 ADCs (eMED ICON, NewIcon, Kuopio, Finland) were introduced there in the Operating Rooms of the Anaesthesia and Surgical Unit (OR), and the Intensive Care Unit (ICU). Most of KUHs ADCs are placed into the wall structures of operating theatres and patient rooms using an innovative pass-through method [6]. This system allows the ADCs to be filled from outside the room and the medicines obtained inside the room. This is expected to reduce unnecessary movement into and out of the operating theatre during operations. Each ward has also a central ADC in the medication room, in which drugs that are seldom needed are stored. Before collecting a medicine from the ADC, a user logs into the system.Assignment: Medication Errors Research Paper Light guidance helps to find the selected product. Each medicine package taken from a Page 2 of 9 cabinet is documented by scanning its barcode to ensure that the right medicine has been taken. The system manages storage control and provides computer-controlled, real-time monitoring and tracking of medicine use and waste. Since the introduction of ADCs in KUH, the billing system has changed; nowadays wards pay only for the medicines they have used, and the medicines are owned by a pharmacy until they are removed from the ADC. The ADCs are restocked by pharmacy technicians. Before introducing the ADCs in clinical use, the nursing staff could practise their use during several pilot phases. The idea of the pilot phases was to gather user experience, recognise problems and improve the usability of the ADCs. The pilot phase lasted 5 months in the OR and 8 months in the ICU. The most important change of ADCs, made based on the pilot phase, was the pass-through principle that allows nurses to use the ADC without disturbing the patient care activities. Change management has an essential role in introducing ADC systems because the introduction of new systems causes often resistance to change [7]. The major challenges in introducing such systems successfully are usually more behavioural than technical. Individuals have to give up their familiar routines and invest their time and energy in learning the new system. The successful introduction of ADCs requires commitment and acceptance from employees, and resistance to change can restrict the system from working optimally. Nurses are the end-users of ADCs, and their perceptions of ADCs are therefore important to survey. Assignment: Medication Errors Research Paper The aim of our study was to assess nurses´ perceptions of ADCs and the impacts of ADCs on nurses work. Our study hypothesis was that implementation of ADCs would decrease nurses time spent on dispensing and preparing medicines and that ADCs would be accepted smoothly by employees after pilot phases. Methods We conducted the study in KUH using direct observation of nurses both before (2014) and after (2016) the introduction of ADCs together with an online survey for nurses in 2017. Observation The first of the two observation periods was carried out in AprilMay 2014, a year before the introduction of ADCs, in the OR and ICU. The second observation period was conducted in the same units in AprilMay 2016, a year after the introduction of ADCs. The observation periods consisted of five consecutive days (8 hours per day) in both units. The observation data were collected by the same observer (RM) both before and after the introduction of ADCs. She observed a different person on each day Metsämuuronen et al. BMC Nursing (2020) 19:27 during each 8-h shift. The activities of the nurses, the time spent with medication-related and other tasks, and movements into and out of the operating theatre during surgical procedures were recorded. Medication-related activities included searching for medicines, taking medicines from the cabinet and preparing and administering medicines, while other activities included monitoring patients, recording patient data, stock managing and personnel traffic in the unit. The time spent by nurses on different activities was assessed by measuring the duration of each activity. Any signs of resistance to change among nurses were recorded. Assignment: Medication Errors Research Paper A pilot data collection period was used before the actual observation period. All observations were first recorded manually, and at the end of the observation day entered into an electronic database. For the analysis, the observation data from 2014 and 2016 were compared with each other. Firstly, we analysed how much time nurses spent on different tasks and whether the ADCs had any impact on time management and workflow. In the OR, we investigated how many times nurses left the operating theatre during an operation to collect medicines from outside the room. Online survey An online questionnaire was developed for this study and it was distributed in April 2017 to 346 nurses of the OR and ICU (See Appendix 1). A link to the questionnaire on Surveypal (Surveypal Inc., Tampere, Finland) was sent to the nurses through their official work emails with a 4-week deadline for responses. The questionnaire was piloted on five nurses. They checked whether the questions were understandable, appropriate, logical, non-confusing and non-leading. Their answers were included in the final survey. The questionnaire consisted of different parts: the nurses´ sociodemographic and practice characteristics, closed- and open-ended questions about whether the ADCs have had an impact on their work and whether they have had problems with ADCs, questions about the use of the ADCs, 18 statements on the ADCs with a 5point Likert scale (1 = strongly disagree, 5 = strongly agree), questions about the impacts of ADCs on patient safety, a question about overall satisfaction and two open-ended questions about suggestions for improvements and free comments. Assignment: Medication Errors Research Paper Nurses working in the OR were also asked whether the ADCs increased or decreased the need to collect medicines from outside the operating theatre during an operation. The online survey data were exported direct from the Surveypal program to IBM SPSS Statistics for Windows, Version 23.0. (International Business Machines Corporation, Armonk, NY, USA). The data were analysed using descriptive statistics including frequencies and percentages Page 3 of 9 and the Chi-Square test. We combined the strongly disagree and disagree, and the strongly agree and agree, answers to present the data concisely. Ethics approval Ethics approval for the study protocol was obtained from the Research Ethics Committee of the Hospital District of Northern Savo, Kuopio, Finland (152/2016, April 5, 2016). The study had institutional approval. Informed verbal consent was obtained from each nurse prior to the observations. Participation in the survey was voluntary and responses were gathered anonymously. Results Observation study Observations in the Anaesthesia and surgical unit Nurses use of time The time spent on dispensing and preparing medications, including searching for medicines, taking medicines from the cabinet, preparing the medicines and marking them, in the operating theatre for elective surgery decreased on average by 32 min per 8-h shift after the introduction of ADCs; in 2014 nurses spent on average 55 min, and in 2016 on average 23 min, on these activities per 8-h shift. The time saved, 32 min, was spent on patient management and monitoring in the operating theatre; in 2014 nurses spent on average 243 min, and in 2016 on average 272 min, per 8-h shift on patient care in the operating theatre during an operation, an increase of 29 min per 8-h shift. Assignment: Medication Errors Research Paper Time spent on other duties was the same between 2014 and 2016. Movement of nurses during an operation The need to collect medicines from outside the operating theatre during an operation was less in 2016 than in 2014. In 2014, the nurses under observation collected the medicines or solutions from outside the operating theatre during the operation in seven out of eleven (64%) operations observed, whereas in 2016 the figure was in only one operation out of eight (13%). In 2014, there were altogether 15 collections compared to three in 2016. In 2014, there were up to six collections during a single operation. Resistance to change Some resistance to change was observed in the OR, where a few deficiencies were noted in documenting the drugs removed from the ADC and the use of barcodes. Some nurses took medicines from the ADC without recording the fact, which caused errors in the stock balance. Neither did all nurses use the barcode identification. In some cases, nurses also took medicines from the ADC when someone else was logged in. Metsämuuronen et al. BMC Nursing (2020) 19:27 Page 4 of 9 Observations in the Intensive care unit Table 1 Nurses´ sociodemographic and practice characteristics (n = 81) Nurses use of time In the ICU, nurses´ time spent on different tasks was similar between 2014 and 2016. In 2014, nurses spent on average 78%, and in 2016 80% of their working time in a patient room treating and monitoring patients. Characteristics Resistance to change Nurses´ perceptions of ADCs were more positive in the ICU than in the OR. Assignment: Medication Errors Research Paper Nurses logged in and out correctly and, with only a few exceptions, did not use the ADC when someone else was logged in. They also documented the removal of a medicine in the data system by scanning the barcode. Number (%) Title Staff nurse 79 (98) Head nurse 2 (2) Nursing unit Anaesthesia and Surgical Unit 52 (64) Intensive Care Unit 29 (36) Sex Female 67 (83) Male 14 (17) Age (years) Online survey 2029 10 (12) The response rate of the survey was 23% (81/346). The nurses´ sociodemographic and practice characteristics are presented in Table 1. 3039 21 (26) 4049 23 (28) 5059 26 (32) 60 or over 1 (1) Nurses´ perceptions A high proportion of the nurses (84%, 68/81) were satisfied with the ADCs (Table 2). Most nurses (81%, 66/81) found ADCs easy to use and 85% (69/81) agreed that the concept of ADCs is good (Table 3). The majority of the respondents (75%, 61/81) disagreed with the statement that they would rather return to the old stock system, while most of the nurses (74%, 60/81) also disagreed that the process of patient medication had become more difficult. In the ICU, a higher proportion of the nurses (79%, 23/ 29) said that the ADCs have made their work easier compared to the nurses in the OR (42%, 22/52) (Table 2). Over half (59%, 17/29) of the nurses in the ICU and 48% (25/ 52) in the OR found that with the ADCs they spend less time ordering and preparing medications than before the ADC system was installed. In the open-ended answers, nurses mentioned most frequently that the fact Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10
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