Computerized Drug Dispensing System

Project and Seminar Material for Computer Science and Computer Engineering

Abstract

The healthcare sectors today are looking for opportunities to improve their daily operations efficiencies, increase pharmacist and pharmacy technician efficiency and improves patient care by promoting medication dispensing accuracy and allowing pharmacists to spend more time on patient care activities. The aim of this work is to design and model an Integrative computerized pharmacy inventory system that would have the capability to improve patient care by promoting medication dispensing accuracy and also allow pharmacists to spend more time on patient care activities, using University of Calabar Teaching Hospital (UCTH) pharmacy as a case study. The specific objective of the system is to provide better security by more securely controlling access to medications in the pharmacy, Saves space – reduces pharmacy storage footprint, aids in Joint Commission compliance by providing complete audit trail of all transactions. In this paper we adopted the structured system analysis and design methodology (SSADM).

HTML (Hypertext Markup Language) is used for the model design. The interface between the front-end and the back-end is through SQL (in WAMPSERVER) and through an application program interface (API) defined in PHP. PHP is used as back-end for managing access structures, query evaluation and optimization, concurrency control and recovery. NetBeans IDE was used as front-end to develop forms, report-trail, and graphical user interface

Chapter One

Introduction

1.1 Background of the Study

Electronic prescribing (EP) is an integral part of e-Health, which is the use of information and communication technology in healthcare systems. EP does not standalone in hospitals and healthcare facilities. In fact, it is more likely to fail if it occurs in isolation from its overall environment. Based on the reports of Institute of Medicine and many other studies, both the United States and the European Union place emphasis on the greater use of health informatics and EP in all healthcare settings throughout the world. There is increasing evidence that EP is associated with reduced medication errors (MEs), especially in terms of dosage form and omission and commission types of errors in ambulatory and inpatient settings in all specialties. Overall, EP is associated with decreased morbidity and mortality, enhanced quality of healthcare services with less costs, better administrative control, improved working efficiency, and enhanced satisfaction both of healthcare providers and consumers [2-5]. Furthermore, in a systematic review involving 47 sources on prescribing, Porterfield and associates suggested that medication errors are substantially reduced (70%) and cost savings attributed to patients’ outcomes and visits are estimated to be between $140 billion and $240 billion over a decade.

Barriers to e-prescribing implementation are cost, lack of provider support, patient privacy, system errors, and legal issues. According to another review, paper-based prescription errors are substantially improved by EPS.
Records are subject to auditing from time to time or when there is information of appropriation indecorous record-keeping or there is case of theft, inferno or flood. Errors on report should be precisely cancelled out and signed for but not wiped out. Records should be completed in the dispensary each day, and not afterward. This will facilitate straightforward compilation of drug utilization and cash receipts. Inventory is a subject in business that is hope can minimize profit. In healthcare industry, inventory management system can handle their inventory particularly in pharmacy department. These consist of all activities such as transaction, order items, item movement tracking, financial management, report generation amongst others [Mustafa NB, 2006].

Drug inventory management can be a frustrating and onerous work. Each day, hospital pharmacist/pharmacists in general must procure and return orders to wholesale suppliers. Pharmacist verifies the drug supply in each pharmacy section in the hospital every now and there. Automation in inventory management as well as procurement control would help enthusiastically [Klibanov OM et all, 2003]. In hospital, pharmacists are inadequate staff principally due to hospital financial plan that is also under pressure to adapt to various changes in health care administration and delivery. Examples of automation used in hospital pharmacy practice include computerization, automation of dispensing and bar coding (automation in drug distribution processes). Many hospitals continue to face the problem of ineffective and inefficient medication distribution systems. Automation in the drug distribution is useful in creating new medical services [Kaushal R, 2002].

1.2 Objectives of the Study

The purpose of this study is to identify how electronic drug prescription (E-Prescription) help achieve excellence in medical field. The study was aiming to find whether E-Prescription was important in medical work and how nurses actively responded and participated in the eHealth program. In addition, the study also provides more information as to why E-Prescription is widely used in the current health care.

This systematic review has the following objectives;

To synthesize international data on Electronic Prescribing and Electronic Health Records
To identify the steps in which computer technology can facilitate dispensing in medicine
To identify strategies for preventing medical errors across all healthcare setting

1.3 Scope of the Study

The WHO Eastern Mediterranean Region (WHO EMR) is far behind when it comes to prescribing and the use of electronic health records. Therefore, we synthesize here the international literature on the use of electronic prescribing across healthcare areas. The scope of this paper is much larger because it reviews electronic prescribing across all ages and healthcare specialties. This study will be conducted at UMTH Calabar

1.4 Significance of the Study

This study intends to design an integrated drug dispensing system in academic pharmacy settings, that will help to improves patient care by promoting medication dispensing accuracy and allowing pharmacists to spend more time on patient care activities.

1.5 Justification of the Study

The focus of this study is rested on the design and modeling of drug dispensing system. It is hoped that this article will serve as a reference source for students, professionals’ application developers, and scholars. As a reference material, it could generate other researchers’ interests in the unfinished part of this research, especially in the full implementation and deployment of the system.

1.6 Research Questions

This review has the following questions;

What are the pros and cons of electronic prescribing?
Does Electronic Prescribing really help the hospital in terms of speed?
What are the strategies for preventing medical errors in healthcare systems?
Do automated dispensing systems reduce dispensing and administration errors and improve efficiency?

1.7 Limitation of the Study

Most constraint experienced during the course of writing this project is that of detailed information about the major operations of UCTH, the personnel manager was a little diplomatic in answering my questions in order to reveal information that may indent the company’s image, though that did not stop me from writing and researching for detailed information.

Due to finance and confidentiality of information, program developed covers all aspect of employees’ registration, attendance and salary control. Whatever is left out is as a result of the stated limitations.

1.8 Assumption of the Study

During the process of data collection, information relating to secured Payroll processing system was obtained from UCTH. The information was collected from the admin staff during the course of my research. Hence, it is assumed that all the data collected are correct and contains no false information

1.9 Definition of Terms

DRP Drug Related Problems:

An event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes. … Often such problems are caused by a certain type of error e.g. prescribing errors or drug-use or administration errors. But there might be no error at all involved.

HIT Health Information Technology:

Is information technology applied to health and health care. It supports health information management across computerized systems and the secure exchange of health information between consumers, providers, payers, and quality monitors.

PDMPs Prescription Drug Monitoring Programs:

A prescription drug monitoring program (PDMP) is an electronic database that tracks controlled substance prescriptions in a state. PDMPs can provide health authorities timely information about prescribing and patient behaviors that contribute to the epidemic and facilitate a nimble and targeted response.

E-Prescription Electronic Prescription:

Is a technology framework that allows physicians and other medical practitioners to write and send prescriptions to a participating pharmacy electronically instead of using handwritten or faxed notes or calling in prescriptions.

ADEs Adverse Drug Events:

An adverse drug event (ADE) is an injury resulting from medical intervention related to a drug. This includes medication errors, adverse drug reactions, allergic reactions, and overdoses. ADEs can happen anywhere: in hospitals, long-term care settings, and outpatient settings

EHRs Electronic Health Records:

An electronic health record (EHR), or electronic medical record (EMR), is the systematized collection of patient and population electronically-stored health information in a digital format. These records can be shared across different health care settings

Chapter Five

Discussions and Conclusion

5.1 Discussions

This chapter discusses the findings of the study in relation to the findings of past researchers (i.e. literature review section). It also provides the summary and conclusion gotten from this research.

5.1.1 Methodological Considerations and Limitations

The research was conducted as a literature review. Data was acquired from different databases such as, Science Direct, SAGE publications, Emerald, EBSCO and Pub Med. The search strategy or approach employed in the study, as well as publication bias and the number or quantity of databases explored could be the principal limitations to this study. These factors might have limited articles that were accessible or available for the study’s review.

5.1.2 Ethics

Ethical consideration plays a critical role in research work and can be outlined from various angles. In the research work, breaking the ethical rules must be strictly avoided. All the articles used in the case of study are not under copyright violation. To retrieve information from the academic databases, official access should be carried along in the process (Alfano, 2013). The means and progress of nursing research are very much guided by a research nursing ethic. Quotes are not copied directly from the article and all the used quotes are referenced in the reference page. Noted points in the research were carefully compared before making a conclusion. At this level of study, it is understood that recommendation is not allowed, thus, suggestions were only made in the end. To avoid bias; all the studies that contained relevant information were included appropriately. The sources of the research information were only secured from those databases that offered free access.

5.1.3 Discussion of Findings

The study aimed at exploring the advantages associated with the implementation of the e-prescription system in nursing, in relation to the accuracy and efficacy of medication prescription. The study’s findings indicate that the increasing employment of the e-prescription in nursing has resulted into improved communication among physicians and nurses, limited prescription errors, and reduced prescription costs and time, thereby leading to a more efficient and streamlined process of medication prescription in nursing Currently, the increase in the prescription of medications has open doors for more errors associated with drug prescription. E-prescription has led to the elimination of the possibilities of error and can significantly assist in the prevention of approximately 2 million ADEs every year (Jeffrey & Mary, 2009). E-prescription has also been established to minimize errors associated with medication within the ambulatory setting. E-prescription eliminates errors associated with illegibility and assists providers to make informed decisions concerning the medications that should be prescribed to patients.

To accomplish this goal by focusing on patients’ allergy data and histories, all of which are found within systems that are incorporated with EHRs. Such systems notify prescribers when an interaction or association with other medicines or an allergy occurs or health condition is identified. However, the principal limitations of these alerts or notifications are that, in some situations, they occur when there is limited risk or threat or occur in the absence of true complications. Providers may be overwhelmed with notification, clicking through them, as opposed to reading each of them. As a result, providers may end up missing a significant association/interaction. E-prescription also contributes to the efficiency of patient care by improving communication among or between physicians and nurses.

E-prescription streamlines the process involved in taking the prescription to the pharmacy, obtaining refills, and dispensing the medication (Escobar-Rodriguez et al., 2012). Since the patient is not granted the prescription’s hardcopy, the chances of losing the prescription are reduced (Black, 2013). Cases of pharmacy-triggered clarifications have also been limited, decreasing the time spent by providers and pharmacists on the phone, and therefore shortening the time required to fill prescriptions and get it to patients. Increases in monitoring and compliance also result from the implementation of e-prescription.

E-prescription has also been established to contribute significantly to the reduction of costs. Costs savings are realized through improved efficiency, reduction in ADEs, and improved access to formularies on the part of providers (see the table in the appendix for more details on cost reductions by e-prescription). The time spent in handling clarifications is significantly reduced, enabling prescribers to concentrate on patient care. The aspect of cost savings along with improved efficiency and incentives will increase the employment of e-prescription in the future. These findings match the earlier finding of (Villaseñor & Piscotty, 2016) that, eprescription reduces costs.

5.1.4 Implication of the Study to Nursing

This study highlights the need of nurses to embrace technology in their process of care delivery. Embracing technological advancements such as e-prescription enhances the ability of a nurse to provide quality care that is efficient, cost-saving, and time-saving. As such, the implementation or adoption of E-Prescription in the current health care will ensure that nurses not only eliminate medical errors, but also offer quality care to patients in a timely manner.

Costs that are incurred in the production of books or documents for preserving patients’ medical information will also be eliminated as this information will the stored electronically. It is also vital to note that the process of retrieving or tracking patients’ medical information will be made easier and efficient, thereby enhancing timely provision of care to patients.

5.1.5 Implication of the Study to the Learning Process

This research emphasized the need of the learning process to be tailored to meet the technological requirements of nursing, particularly in relation to the use of services such as e-prescription. As such, the study of technological innovations that enhance the delivery of care should be integrated in the nursing learning process. Such an undertaking will ensure that nursing graduates that come from various learning institutions are equipped with relevant knowledge that will enable them to respond effectively to the needs of patients in the dynamic field of health care. Such an undertaking will also rid medical institutions or hospitals from the expenses of providing E-Prescription training to their staff. Thus, there is a significant need for educators and practitioners to embrace technological innovations and integrate them in the learning process.

5.2 Conclusion

This study’s findings suggested that e-prescription had several benefits when it came to increasing the efficiency of nursing in the delivery of patient care. E-prescription results into a reduction in the prescription cost and time, improvement of communication between nurses and physicians, and reduction in prescription errors.

The goal of nurses today is to provide best-practice care that is efficient, cost-effective, and evidence-based in different health institutions. This objective can be accomplished when adequate care is embraced during the delivery of nursing care to patients. With the presence of electronic prescription, the possibility of connecting a big range of health care services and facilities has widely been opened. Nurses are primary users of e-prescription. In Finland, e-prescribing is widely used.

This study focuses on identifying how electronic drug prescription (e-prescription) helps nurses achieve excellence in nursing field. The study accomplishes this goal by conducting a review of 11 articles. The findings of the study revealed that prescription had several benefits when it comes to increasing the efficiency of nursing in the delivery of patient care. E-prescription results into a reduction in the prescription cost and time, improvement of communication between nurses and physicians, and reduction in prescription errors.