ABSTRACT
High-quality care requires precise and timely provider documentation. Hospitals have used technology to document patient care within both the inpatient and outpatient areas and long-term care facilities. Research has demonstrated, by revealing a reduction in medical errors, that there has been a worldwide improvement in our community health and welfare since the implementation and utilization of documenting patient care electronically. Although electronic documentation has proven to be an improvement in patient record keeping, the most efficient location in which this documentation is to occur remains a question. At the location where this project took place, only the ICU had computers within the patient rooms for documentation purposes. This project evaluated bedside nurses' opinions related to the efficiency of documentation practices compounded by the location where documentation took place. The options were at the patient's bedside, on a workstation on wheels, or at the nursing station. Surveys were provided to bedside nursing staff both before and after computers were installed in patients' rooms in surgical and medical/surgical nursing units at a Veteran Affairs Medical Center located in the Northeastern region of the United States. The results of this project inconclusively answer the question posed: "Which mode of entry do nurses feel is more efficient to document patient care, on a computer in the patient room, at the nurses' station, or on a workstation on wheels?" Innovative strategies should be explored to develop a user-friendly design for computers located within the patient rooms for patient documentation.
ABSTRACT
High-quality care during and after a medication process requires complete and accurate medication administration documentation. Veterans Affairs Medical Centers use barcode medication administration technology to document medication administered to Veterans throughout the inpatient and long-term care areas of the hospital. Barcode medication administration has demonstrated a reduction in medication administration errors; however, it is not commonly used in Veterans Affairs Medical Center clinical areas or emergency departments. During this study, only 39% of the recorded 165 Veterans Affairs Medical Centers that use barcode medication administration technology in their inpatient areas stated that barcode medication administration was also used in clinical areas of the hospital. Of these facilities, only 14% had implemented barcode medication administration in their emergency department. This study evaluated medication error rates before and after barcode medication administration technology was implemented in the emergency department of a Veterans Affairs Medical Center located in the Southeastern region of the United States. A total of 258 charts, 129 before and 129 after barcode medication administration technology implementation in the emergency department, were reviewed for Veterans who were evaluated and ordered to receive medication in the emergency department before transferring to an inpatient unit at the Veterans Affairs Medical Center where this study was conducted. A quantitative nonexperimental descriptive comparison demonstrated a 10.8% reduction in medication error rates and 21% reduction in the average number of medications given in error per chart after barcode medication administration technology was implemented in the emergency department. In addition to the study outcome, a potentially unsafe workaround was identified. Stakeholders that use barcode medication administration technology in their emergency departments would benefit from assessing the association between barcode medication administration use and medication administration error rates. However, assessing whether barcode medication administration technology remains useful and continues to provide safe medication administration practices for our Veterans is also recommended.
