"Are we there yet?" Ten persistent hazards and inefficiencies with the use of medication administration technology from the perspective of practicing nurses.

OBJECTIVES: (1) Characterize persistent hazards and inefficiencies in inpatient medication administration; (2) Explore cognitive attributes of medication administration tasks; and (3) Discuss strategies to reduce medication administration technology-related hazards. MATERIALS AND METHODS: Interviews were conducted with 32 nurses practicing at 2 urban, eastern and western US health systems. Qualitative analysis using inductive and deductive coding included consensus discussion, iterative review, and coding structure revision. We abstracted hazards and inefficiencies through the lens of risks to patient safety and the cognitive perception-action cycle (PAC). RESULTS: Persistent safety hazards and inefficiencies related to MAT organized around the PAC cycle included: (1) Compatibility constraints create information silos; (2) Missing action cues; (3) Intermittent communication flow between safety monitoring systems and nurses; (4) Occlusion of important alerts by other, less helpful alerts; (5) Dispersed information: Information required for tasks is not collocated; (6) Inconsistent data organization: Mismatch of the display and the user's mental model; (7) Hidden medication administration technologies (MAT) limitations: Inaccurate beliefs about MAT functionality contribute to overreliance on the technology; (8) Software rigidity causes workarounds; (9) Cumbersome dependencies between technology and the physical environment; and (10) Technology breakdowns require adaptive actions. DISCUSSION: Errors might persist in medication administration despite successful Bar Code Medication Administration and Electronic Medication Administration Record deployment for reducing errors. Opportunities to improve MAT require a deeper understanding of high-level reasoning in medication administration, including control over the information space, collaboration tools, and decision support. CONCLUSION: Future medication administration technology should consider a deeper understanding of nursing knowledge work for medication administration.

The Available Criteria for Different Sepsis Scoring Systems in the Emergency Department-A Retrospective Assessment.

OBJECTIVE: The goal of the study was to assess the criteria availability of eight sepsis scoring methods within 6 hours of triage in the emergency department (ED). DESIGN: Retrospective data analysis study. SETTING: ED of MedStar Washington Hospital Center (MWHC), a 912-bed urban, tertiary hospital. PATIENTS: Adult (age ≥ 18 years) patients presenting to the MWHC ED between June 1, 2017 and May 31, 2018 and admitted with a diagnosis of severe sepsis with or without shock. MAIN OUTCOMES MEASURED: Availability of sepsis scoring criteria of eight different sepsis scoring methods at three time points-0 Hours (T0), 3 Hours (T1) and 6 Hours (T2) after arrival to the ED. RESULTS: A total of 50 charts were reviewed, which included 23 (46%) males and 27 (54%) females. Forty-eight patients (96%) were Black or African American. Glasgow Coma Scale was available for all 50 patients at T0. Vital signs, except for temperature, were readily available (>90%) at T0. The majority of laboratory values relevant for sepsis scoring criteria were available (>90%) at T1, with exception to bilirubin (66%) and creatinine (80%). NEWS, PRESEP and qSOFA had greater than 90% criteria availability at triage. SOFA and SIRS consistently had the least percent of available criteria at all time points in the ED. CONCLUSION: The availability of patient data at different time points in a patient's ED visit suggests that different scoring methods could be utilized to assess for sepsis as more patient information becomes available.

Score at the Door: A retrospective data analysis of sepsis scoring criteria in the Emergency Department.

The goal of this study was to assess the availability of the criteria of eight sepsis scoring methods (SIRS, NEWS, PRESEP, SOFA, qSOFA, SPEED, MEDS, and PIRO) within six hours of triage in the emergency department (ED). Data was analyzed through a retrospective collection of adult (age >18 years) patients presenting to the MedStar Washington Hospital Center (MWHC) emergency department between June 1, 2017 and May 31, 2018 and admitted with a sepsis or sepsis-related diagnosis that progressed to sepsis before discharge. Vital signs are frequently available upon arrival to the ED, while laboratory values tend to be available within three hours and often are not repeated again within the first six hours after arrival. The availability of patient data at different time points in a patient's ED visit suggests that different scoring methods could be utilized to more effectively diagnose and accurately risk-stratify patients within the sepsis spectrum as more information about the patient becomes available.