A 410-bed hospital has been using a homegrown provider order entry system for 5
ID: 122896 • Letter: A
Question
A 410-bed hospital has been using a homegrown provider order entry system for 5 years. It has recently decided to put in bar code administration software to scan medications at the time of delivery in order to decrease medical error. The administration is concerned about medication errors, top-level administration is concerned about meeting The Joint Commission accreditation standards, and the IT department is worried that the scanners may not be reliable and may break, increasing their costs. The plan is to have a scanner in each patient's room: nurses will scan the medication when they get to the room and also scan their own badges and the patient's arm band. The application makes it possible to print out a list of the patients with their scan patterns and the nurses sometimes carry this printout because patient's arm bands can be difficult to locate or nurses do not want to disturb patients while they are sleeping. The bar code software was purchased from a vendor and the facility has spent about a year refining it. The IT department is responsible for implementation and has decided that it will implement each of the four inpatient settings one at a time at 6-month intervals. The hospital administration wants to conduct an eval-uation study. You are assigned to be the lead on the evaluation. Discussion Questions What is the key evaluation question for this project? Who are the stakeholders? What level of theory is most appropriate? What are specific elements to measure by stakeholder group?Explanation / Answer
Q.1 The key evaluation questions for this project includes:
1. Proper functioning of bar code software and scanners,
2. medication safety,
3. Use of guidelines or protocols (Joint commission accreditation standards),
3. costs of care,
4. measures of the effectiveness or quality of care
Q.2 The stakeholders in this study includes physicians,nurses, pharmacy staff, the laboratory, the payer (e.g., the insurer), nursing home residents, and the LTC (long-term care) facility.
Q.3 The properties of a new technology that are important in assessing its rate of adoption are described by the Diffusion of Innovation Theory. A new technology’s relative edge, compatibility, trialability, and observability generally lead to a faster rate of acceptance, while increased complexity leads to a slower rate of acceptance. The decision to adopt Bar code scanners is a two-step process: First, the hospital must decide to accept and adopt, and then the individual physician must decide whether to use it. The different perceptions of health care settings and hospitals and individual doctors toward Bar code scanners are really important, because it is the perceived rather than the actual impute that determines acceptance.
Mandates may exert pressure on potential users to accept the advantages of Bar code scanning systems but proper incentives can increase the relative advantage of this system and may trigger the accepting and implementing decisions.
Q.4 The specific elements to measure by stakeholder group includes:
a) Development of a scalable system that could be implemented across diverse patients and easy to use
b) Customization of the provider order entry system and bar code scanning system to meet health staff needs needs
c) Clinically acceptable
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