Preventing misdosing with automated workflows
Being a nurse who administers chemotherapy to cancer patients is an inherently challenging job. Every dose delivered must fulfil the five rights of medication administration:
Being a nurse who administers chemotherapy to cancer patients is an inherently challenging job. Every dose delivered must fulfil the five rights of medication administration:
Right patient
Right medication
Right dose
Right time
Right documentation
However, the administration process within oncology is often long and complex, and presents numerous opportunities for dosing errors.
Errors that occur due to the incorrect administration of chemotherapy can have serious consequences, not only in regards to having a detrimental effect on the health of a patient, but also by having a negative psychological impact on the staff member involved. Additionally, errors can be costly to an organisation, both due to the financial cost of resolving the error, and the potential damaging effect of it on the hospital’s reputation. Therefore, taking steps to prevent misdosing is key.
We are going to discuss how manual medication workflow processes have the potential for misdosing, and how automating these processes can help reduce the risk.
Some healthcare organisations still use paper files for the recording and transfer of patient data between departments, which are at risk of being misplaced or misinterpreted, whilst information relayed during phone calls can be easily forgotten. The delivery of a chemotherapy treatment regimen at any one administration session can take several hours and can involve more than one nurse, which presents an opportunity for miscommunication if patient data hasn’t been transferred effectively. All these issues can result in a nurse not having the most up-to-date information about the patient and their treatment at the point of administration, which could potentially lead to an error.
Another potential source of error at the point of administration is handwritten prescriptions, resulting in legibility issues. For example, a nurse could administer a medication by an incorrect infusion rate due to misreading a poorly written or illegible prescription.
Stressful working environments for nurses and other staff within oncology can have an influence on human factors related to medication errors. Sutherland’s paper on the subject of human factors in prescribing errors states that “mitigating fatigue and standardising procedures may minimise slips and lapses”.2 Manual workflows that are timeconsuming and rely on visual checking of processes contribute to potential stress and fatigue of healthcare staff.
Misdosing by a nurse can also be a result on an error earlier on in the treatment pathway, such as the medication being incorrectly prescribed by an oncologist, or incorrectly compounded by pharmacy. Following manual workflows for prescribing and compounding have a lot of opportunities for human error. For example, when the oncologist is required to perform dose calculations themselves, or have knowledge and awareness of dose limits and cumulative dose limits of drugs that they must not exceed. Or when, during the compounding process, the pharmacy technician has to visually check that the vial of drug they select is correct, or that the volume of drug drawn up is accurate.
Automating workflows represents an opportunity to address all these potential causes of errors associated with manual workflows.
Workflow automation can play a huge part in preventing misdosing within oncology. For a nurse, workflow automation can bring clarity and confidence that they are administering medication correctly. Automation can also help streamline processes by eliminating many resource-intensive tasks. This can help reduce the workload on staff, and free up nurse time for direct patient care or other value-added tasks.
BD offers solutions to automate workflows, addressing the challenges that come with paper-based systems and manual verification processes. These solutions include:
The step-by-step summary below shows the oncology workflow from prescription through to administration, and how the use of automation within this workflow can help prevent misdosing. Points 1-2 relate to oncologist and pharmacy processes, as prevention of errors at this stage offers reassurance to nurses that they are administrating the correct treatment, whilst points 3-4 demonstrate how automation helps to prevent direct administration errors for nurses:
Studies have shown the impact of automation using BD solutions on reducing misdosing:
Preventing misdoing within oncology is a top priority as it benefits patients, staff, and the organisation. Many dosing errors could be prevented by introducing technology and systems that embed error prevention, rather than relying on manual workflows and checking procedures that have multiple opportunities for human error.
BD’s solutions can help implement automation into the oncology workflow and provide confidence to nurses that they are administering their patients the right medication, at the right dose, at the right time, and by the right route.
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