Closed Loop Medication Administration: Electronic Verification of “the Five Rights”

“The five rights”: This is how many things should go right in order to be able to ascertain proper medication treatment. If you wish to put closed loop medication administration (CLMA) in order, electronic verification should be used to ascertain “the five rights”. These include the right patient, the right medicine, the right dosage, the right time and the right means of administration. Electronic verification can be achieved through data systems and technology.

Only one of the central hospitals in Finland has been granted stage 6 of the Electronic Medical Record Adoption Model (EMRAM), which entails the CLMA, by the Healthcare and Information and Management Systems Society (HIMSS). Close loop medication means that the whole medication administration chain should be electronic and that at no point in the chain is the data transferred via printed matter. Medication data is thus in real time at every stage and immediately available to the people participating in the patient’s care.

The purpose of the electronic medication care process is to eliminate information breaks and minimise errors. In practice, an error can occur at any one of four different stages of the medication process, namely while prescribing, processing, dispensing or administering medication. As a consequence of a medication error, a patient may receive inappropriate medicine, the wrong dose or medicine intended for another patient. Medication may also be administered, for example, at the wrong time. In the worst case, erroneous medication can lead to the patient’s death.

Nowadays however, data systems and technology can be utilised at the various stages of the medication care process, thereby eliminating many of the most common medication errors.

1.)   Prescribing medication via mobile device or computer

As the prescription of medication shifts to an electronic and, above all, a structured format, handwritten prescriptions go out of use and the number of common errors caused by misreading illegible handwriting is reduced. When the prescription tool is integrated into the Electronic Health Record, the clinician receives information on any allergies the patient may have and other safety factors immediately while prescribing the medication.

2.)   Receiving and checking electronic prescriptions

The safety factors, contraindications and appropriate dosages of electronic prescriptions received by the pharmacy are checked automatically. In addition, the alternative medication dispensed by hospital pharmacies (depending on the stock situation) are saved in the Electronic Health Record. At the administration stage, precisely the correct trade name of the medication is shown.

3.)   An automated administration system

The bar-coded packs of medicines are stored in a smart medicine cabinet, which electronically directs the nurse to take the right medication for the patient. The medicine is then documented with the help of the bar-code and machine sealed into a sachet. The sachet is not opened until the patient takes the medicine.

4.)   Electronic verification and documentation

Before administering a medication, the electronically identified nurse checks the medicine, the dose and patient compatibility by reading the patient wristband and the sachet containing the medication dose. The tool accessed should be easy for the nurse to take along and it should be integrated with the Electronic Health Care so that the updated patient and medication data is unambiguously available to the care staff. The entry for each administered medication is made by electronic means, whereby the information about this is saved into the Electronic Health Record at once.

In order to achieve the EMRAM stage 6, the medication care process should be without gaps and automated as far as possible. The solutions to reaching this stage exist already, so the next step is to introduce them within the organisation and put them into practice. No transformation happens overnight, however, and it is likely to be met with opposition as well. By understanding the transformation, however, the situation is easier to appropriate and implement within the organisation.

Learn more about how to do away with papers in the health care sector, how the public IT projects of the health care sector can be successful ja how the Hospital District of Southwest Finland utilises mobile medication feature.