- It works everywhere within your healthcare environment.
- It works offline (natural and man-made disasters, military, transport, remote situations).
- It has basic documentation functionalities (inserts time-stamped text logs) that work with your existing electronic systems.
- It is supplemented with barcode access points that eliminate the need for math or memorization at the critical areas of acute ordering, drug preparation and delivery.
- Whenever possible, it is in the native language of your healthcare providers and patients.
- It is integrated into your systemic response to acute drug shortages.
The Performance Gap
Medical errors are a greater threat to children than adults because there is no standardized dose for different patient sizes and age. Approximately 35% of pediatric patients receive the wrong dose from emergency care providers \cite{frank2016}. Pediatric emergency care is especially prone to error due to the chaotic nature and stress associated with the emergency setting. Tenfold mathematical errors due to incorrect calculations are a much greater threat to children than adults. Due to the high level of incorrect calculation errors and the real world potential for downtime miscalculation in the absence of the EHR, the availability of a standardized system to reduce the potential for these occurrences would greatly reduce the potential for error.
2.Jump up ^ Park, Kyung S. (1997). "Human error". In Salvendy, Gavriel. Handbook of human factors and ergonomics (2nd ed.). New York: Wiley. pp. 150–73. ISBN 978-0-471-11690-5.
Leadership Plan
National and international governments, hospital leadership, and emergency response leadership must close their performance gaps by implementing a comprehensive approach that is applicable at all levels of medical sophistication.
The process must include those outlined in the National Quality Forum (NQF) safe practices (Meyer 2010) and an understanding of applicable practices internationally.
Demonstrate evidence-based effectiveness and reduction in preventable morbidity and mortality;
Are generalizable to national and international venues, in first and third world settings;
Reduce preventable death and disability if implemented;
Provide both information where the EHR is not implemented or in situations where it is not available providing information that can be used to assist healthcare professionals in the most extreme situations;
Establish measurable quality indicators, benchmarks, and implementation goals;
Provide budget allocations that are matched to available resources;
Obtain broad implementation across all providers and systems in target implementation areas;
Establish a feedback mechanism to assure continuous improvement.
Practice Plan
- Create a multidisciplinary team which includes physicians, nurses, pharmacists, respiratory therapists, laboratory personnel, and information technology (IT) personnel (if available).
- Develop education and training about mobile app, its capabilities, and how to use it in various healthcare settings.
- Collaborate with IT to implement a synchronous communication pathway for recording the medication administration (medication, dose, date, time, ROA, and patient).
- Create a backup documentation system for when electronic systems are down/offline from the mobile app and related software.
- Collaborate with IT and pharmacy to sync the drug shortages with alternative medications that have similar MOA, compatibilities, and FDA-approved indications in a real-time manner for local, regional, national, and international synchronization.
- For resource-limited communities and healthcare centers, collaborate with IT to create a copy of the medication administration log book from the mobile app (drug, dose, time of administration, ROA, and patient). The log book could be transferred into the patient's medical chart as a hardcopy.
- Collaborate with ASHP, University of Utah medication teams, and applicable international organizations about drug shortages and alternatives.
- Eliminate information silos regarding drug shortage information.
Technology Plan
- This is a mobile safety system designed to address drug and knowledge shortages in acute situations and resource-limited communities and settings (e.g., disaster or remote, third-world triaging clinical circumstances).
- To be successful in implementing this Actionable Patient Safety Solutions, one should rely on implanting an universally available technology plan using technology available at local healthcare settings.
- The system will be designed to be optimized for sharing of open data, in alignment with the Patient Safety Movement's goals.
- The system will be designed to work with all applicable technology.
- It will be manufacturer and EHR agnostic.
- This mobile app will provide the safety net in APSS 3D (Pediatric Adverse Drug Events).
- Other specific strategies will be developed or become apparent as the above are implemented.
- Careful observation of the consequences of each new strategy will, in turn, lead to additional novel ideas for further improvement in medication administration safety and coordination with key stakeholders in the face of drug shortages.
- Suggested practices and technologies are limited to those proven to show benefit or are the only known technologies with a particular capability.
- The only known technology to accommodate these goals is a dose through downtime (DTD) platform.
- It situations where the technology is available, the mobile app will synchronize the downtime data back to the EHR.
Patient & Family Engagement
- The mobile app information could be transferred to caregivers and family members.
- As per the WHO vision, these transferable data and information could be viewed and verified by caregivers and family members of the patient.