PICOT Question

Does using electronic medication compared to education and training of nurses reduce adverse drug events over a three-month period?

Problem being investigated

The existing problem is Adverse Drug Events (ADEs). The problem accounts for significant patient morbidity and mortality and legal, operational, and patient care costs (Mills et al., 2008). Medications that result in most ADEs include narcotics, chemotherapy, and diabetic and cardiovascular medications (Mills et al., 2008). Issues that cause most ADEs include wrong doses, wrong medication, missed medication, prescribing drugs to the wrong patients, and many prescribers for one patient.

The patient population under consideration is elders. The elderly population is at an increased risk of experiencing ADEs after medication. Available data shows that 15% or more of the elderly experience ADEs (Pretorius et al., 2013). The ADEs in the elderly population are manifested in various forms, including falls, orthostatic hypotension, heart failure, and delirium. Some ADEs, mainly gastrointestinal or intracranial bleeding and renal failure, result in mortalities. Effects of ADEs in hospitals include increased costs of operation, reduced effectiveness, and increased LOS. Adverse drug outcomes can be mediated using different strategies such as discontinuing medications, prescribing new medications sparingly, reducing the number of prescribers, and frequently reconciling medications.

Evidence-based Interventions for Reducing ADEs

The PICOT question compares two nursing interventions that can be applied to reduce ADEs among the elderly population. They are electronic medication and educational programs and training for nurses. Electronic medication system supports the improved quality, safety, and effectiveness of medication management within hospitals by enabling digital prescription, ordering, checking, reconciling, dispensing, and recording the medication. On the other hand, education and training involve equipping nurses with the requisite skills to reduce ADEs among elderly patients. The training can involve proper prescription and documentation of the drug.

Different scholars in the nursing field have published ample evidence on the efficacy of these interventions. In particular, (Wu et al., 2007) investigated the cost-effectiveness of introducing an electronic medication ordering and administration system and its potential impact on reducing ADEs. Their findings revealed that an electronic medication order entry and administration system could improve care by reducing adverse events (Wu et al., 2007). Thus, electronic medication is an evidence-based intervention.

Another study to assess the efficacy of electronic medication in reducing ADEs was done by Truitt et al., (2016). The authors analyzed the effects of implementing barcode medication administration (BCMA) and electronic medication administration record (eMAR) technology on ADEs. Data were analyzed using descriptive statistics, and findings showed that eMAR and BCMA technology improved patient safety by decreasing the overall rate of ADEs and the rate of transcription errors (Truitt et al., 2016). The two studies by Truitt et al., (2016) and Wu et al., (2007) agree that electronic medication can lower ADEs’ prevalence among the elderly population.

Scholarly evidence in support of the educational program to reduce ADEs also exists. (Trivalle et al., 2010) analyzed the impact of educational intervention in decreasing ADEs in elderly patients in a hospital setting using a randomized prospective study. Five hundred twenty-six patients included in the study were 65 years and above, while the study period was four weeks. The data collected showed that educational intervention program led to fewer ADEs in the intervention group (n = 38, 22%) than in the control group (n = 63, 36%; p = 0.004) (Trivalle et al., 2010). (Martin et al., 2018) also investigated the effects of a pharmacist-led education intervention on reducing ADEs among patients aged 65 and above. The outcomes indicated that pharmacist-led education reduced ADEs.

Summary

The two interventions for reducing ADEs among the elderly population are electronic medication and educational programs for healthcare providers. Based on the existing evidence, electronic medication is the best intervention because it is more feasible and can have a huge health impact.

References

Martin, P., Tamblyn, R., Benedetti, A., Ahmed, S., & Tannenbaum, C. (2018). Effect of a pharmacist-led educational intervention on inappropriate medication prescriptions in older adults. JAMA, 320(18), 1889. https://doi.org/10.1001/jama.2018.16131

Mills, P. D., Neily, J., Kinney, L. M., Bagian, J., & Weeks, W. B. (2008). Effective interventions and implementation strategies to reduce adverse drug events in the Veterans Affairs (VA) system. Quality and Safety in Health Care, 17(1), 37–46. https://doi.org/10.1136/qshc.2006.021816

Pretorius, R. W., Gataric, G., Swedlund, S. K., & Miller, J. R. (2013). Reducing the Risk of Adverse Drug Events in Older Adults. American Family Physician, 87(5), 331–336. https://www.aafp.org/afp/2013/0301/p331.html

Trivalle, C., Cartier, T., Verny, C., Mathieu, A.-M., Davrinche, P., Agostini, H., Becquemont, L., & Demolis, P. (2010). Identifying and preventing adverse drug events in elderly hospitalised patients: A randomised trial of a program to reduce adverse drug effects. The Journal of Nutrition, Health & Aging, 14(1), 57–61. https://doi.org/10.1007/s12603-010-0010-4

Truitt, E., Thompson, R., Blazey-Martin, D., Nisai, D., & Salem, D. (2016). Effect of the implementation of Barcode Technology and an electronic medication administration record on Adverse Drug Events. Hospital Pharmacy, 51(6), 474–483. https://doi.org/10.1310/hpj5106-474

Wu, R. C., Laporte, A., & Ungar, W. J. (2007). Cost-effectiveness of an electronic medication ordering and administration system in reducing adverse drug events. Journal of Evaluation in Clinical Practice, 13(3), 440–448. https://doi.org/10.1111/j.1365-2753.2006.00738.x