title: Integrating technology to improve medication administration.
abstract: OBJECTIVE
  The development, implementation, and evaluation of an i.v. interoperability program to advance medication safety at the bedside are described.
  
  
  CONCLUSIONS
  I.V. interoperability integrates intelligent infusion devices (IIDs), the bar-code-assisted medication administration system, and the electronic medication administration record system into a bar-code-driven workflow that populates provider-ordered, pharmacist-validated infusion parameters on IIDs. The purpose of this project was to improve medication safety through the integration of these technologies and decrease the potential for error during i.v. medication administration. Four key phases were essential to developing and implementing i.v. interoperability: (a) preparation, (b) i.v. interoperability pilot, (c) preliminary validation, and (d) expansion. The establishment of pharmacy involvement in i.v. interoperability resulted in two additional safety checks: pharmacist infusion rate oversight and nurse independent validation of the autoprogrammed rate. After instituting i.v. interoperability, monthly compliance to the telemetry drug library increased to a mean ± S.D. of 72.1% ± 2.1% from 56.5% ± 1.5%, and the medical-surgical nursing unit's drug library monthly compliance rate increased to 58.6% ± 2.9% from 34.1% ± 2.6% (p < 0.001 for both comparisons). The number of manual pump edits decreased with both telemetry and medical-surgical drug libraries, demonstrating a reduction from 56.9 ± 12.8 to 14.2 ± 3.9 and from 61.2 ± 15.4 to 14.7 ± 3.8, respectively (p < 0.001 for both comparisons). Through the integration and incorporation of pharmacist oversight for rate changes, the telemetry and medical-surgical patient care areas demonstrated a 32% reduction in reported monthly errors involving i.v. administration of heparin.
  
  
  CONCLUSIONS
  By integrating two stand-alone technologies, i.v. interoperability was implemented to improve medication administration. Medication errors were reduced, nursing workflow was simplified, and pharmacists became involved in checking infusion rates of i.v. medications.
authors.affiliation: Lancaster General Health, Lancaster, PA 17604, USA.
authors.forename: Amanda E
authors.initials: AE
authors.lastname: Prusch
authors.forename: Tina M
authors.initials: TM
authors.lastname: Suess
authors.forename: Richard D
authors.initials: RD
authors.lastname: Paoletti
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Olin
authors.forename: Starann D
authors.initials: SD
authors.lastname: Watts
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D001330:Electronic Data Processing; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007262:Infusions, Intravenous; D008508:Medication Errors / Q000517:prevention & control*; D008510:Medication Systems, Hospital; D024802:Nurse's Role; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D010595:Pharmacists / Q000458:organization & administration; D010865:Pilot Projects; D024382:Professional Role; D013686:Telemetry / Q000379:methods; D057188:Workflow
chemical_list: D000925:Anticoagulants; D004364:Pharmaceutical Preparations; D006493:Heparin