The Impact of a Bedside Medication Scanning Device on Administration Errors in the Hospital Setting: A Prospective Observational Study

Abstract

Introduction: The medication administration process iscomplex and influenced by interruptions, multi-tasking andresponding to patient's needs and is consequently prone toerrors.1 Over half (54.4%) of the 237 million medicationerrors estimated to have occurred in England each year werefound to have taken place at the administration stage and7.6% were associated with moderate or severe harm. The implementation of a Closed Loop Medication Administrationsolution aims to reduce medication administration errorsand prevent patient harm.Aim: We conducted the first evaluation to assess the impact of a novel optical medication scanning device, MedEye,on the rate of medication administration errors in solid oraldosage forms.Methods: We performed a before and after study on oneward at a tertiary-care teaching hospital that used a commercial electronic prescribing and medication administrationsystem and was implementing MedEye (a bedside tool forstopping and preventing medication administration errors).Pre-MedEye data collection occurred between Aug-Nov2019 and post-MedEye data collection occurred betweenFeb-Mar 2020. We conducted direct observations of nursingdrug administration rounds before and after the MedEyeimplementation. Observers recorded what they observedbeing administered (e.g., drug name, form, strength andquantity) and compared this to what was prescribed. Errorswere classified as either a 'timing' error, 'omission' error or'other' error. We calculated the rate and type of medicationadministration errors (MAEs) before and after the MedEyeimplementation. A sample size calculation suggested thatapproximately 10,000 medication administrations wereneeded. Data collection was reduced due to the COVID 19pandemic and implementation delays.Results: Trained pharmacists or nurses observed a total of1,069 administrations of solid oral dosage forms before and432 after the MedEye intervention was implemented. Thepercentage of MAEs pre-MedEye (69.1%) and post-MedEye(69.9%) remained almost the same. Non-timing errors(combination of 'omission' + 'other' errors) reduced from 51(4.77%) to 11 (2.55%), which had borderline significance(p=0.05) however after adjusting for confounders, significance was lost. We also saw a non-significant reduction in'other' error types (e.g., dose and documentation errors) following the implementation of MedEye from 34 (3.2%) to 7(1.62%). An observer witnessed a nurse dispense the wrongmedication (prednisolone) instead of the intended medication(furosemide) in the post-MedEye period. After receiving a notification from MedEye that an unexpected medication hadbeen dispensed, the nurse corrected the dose thus preventingan error. We also identified one instance where the nurse correctly dispensed a prescribed medication (amlodipine) butthis was mistakenly identified by the MedEye scanner as another prescribed medication (metoclopramide).Conclusions: This is the first evaluation of a novel opticalmedication scanning device, MedEye on the rate of MAEs inone of the largest NHS trusts in England. We found a nonstatistically significant reduction in non-timing error rates.This was notable because incidents within this category e.g.,dose errors, are more likely to be associated with harm compared to timing errors.2 However, further research is neededto investigate the impact of MedEye on a larger sample sizeand range of medications.