Elektronik İlaç Yönetim Sistemleri

Year 2024, Volume: 26 Issue: 2, 469 - 500, 12.08.2024

Selin Kalender , Okan Özkan

https://doi.org/10.26745/ahbvuibfd.1364391

Abstract

İlaç yönetimi; ilacın reçete edilmesi, istemi, dağıtımı, takibi ve hastaya uygulanması gibi çeşitli aşamalardan oluşan karmaşık ve hata yapmaya eğilimli bir süreçtir. İlaç hataları ilaç yönetim sürecinin her aşamasında meydana gelerek olumsuz ilaç olaylarının yaşanmasına neden olabilir. Bu durum ilaç ve hasta güvenliğini açısından ciddi bir tehdit unsuru oluşturur ve önemli bir halk sağlığı sorunu olarak görülür. İlaç yönetim sürecinin her aşamasının otomatikleştirerek kontrol altına alan elektronik ilaç yönetim sistemleri (EİYS) hastanelerde yaygın olarak kullanılmaktadır. Bu sistemlerde ilaç ile ilgili tüm işlemler elektronik ortamda yapılmaktadır. EİYS’ler ilaç hatalarının azaltılması ve ilaç yönetim sürecinin iyileştirilmesinde önemli bir müdahale aracı olarak görülmektedir. Bu çalışmada hastaneler için önemli bir gereklilik haline gelen EİYS konusu ele alınmıştır. EİYS’lerin ilaç hatalarını önleme ve hasta güvenliğini sağlama başta olmak üzere ilaç yönetimindeki etkisi çeşitli bileşenler üzerinden incelenmiştir.

Keywords

Elektronik ilaç yönetimi, EİYS, ilaç hataları, ilaç güvenliği, hasta güvenliği.

Ethical Statement

Etik Kurul Onayı: Bu çalışma derleme niteliğinde bir makale olduğu için etik kurul onayına ihtiyaç bulunmamakta olup Helsinki Bildirgesi kriterleri göz önünde bulundurulmuştur.

ELECTRONIC MEDICATION MANAGEMENT SYSTEMS

Abstract

Medication management is a complex and mistake-prone process consisting of various stages such as prescribing, ordering, dispensing, monitoring, and administering the medication to the patient. Medication errors can occur at every stage of the medication management process, resulting in adverse medication events. This situation poses a serious threat to drug and patient safety and is seen as an important public health problem. Electronic medication management systems (EMMS), which automate and control every stage of the medication management process, are widely used in hospitals. In these systems, all medication-related transactions are carried out electronically. ECMSs are seen as an important intervention tool in reducing medication errors and improving the medication management process. In this study, the EMMS issue, which has become an important requirement for hospitals, is discussed. The effect of EMMS on medication management, especially in preventing medication errors and ensuring patient safety, has been examined through various components.

Keywords

Electronic medication management, EMMS, medication errors, medication safety, patient safety.

References

• Agrawal, A. (2009). Medication errors: Prevention using information technology systems. British Journal of Clinical Pharmacology, 67(6), 681–686. https://doi.org/10.1111/J.1365-2125.2009.03427.X
• Akıcı, A., & Altun, R. (2013). Elektronik (e) reçete uygulaması ve akılcı ilaç kullanımına katkısı. Türkiye Aile Hekimligi Dergisi, 17(3), 125–133. https://doi.org/10.2399/tahd.13.00003
• Ammenwerth, E., Aly, A. F., Bürkle, T., Christ, P., Dormann, H., Friesdorf, W., … Criegee-Rieck, M. (2014). Memorandum on the use of information technology to improve medication safety. Methods of Information in Medicine, 53(5), 336–343. https://doi.org/10.3414/ME14-01-0040/ID/OR0040-17
• Aslan, Y. (2020). İlaç kaynaklı tıbbi hata/olay bildirimlerin Dünya Sağlık Örgütü “Hasta Güvenliği Uluslararası Sınıflandırması”na göre değerlendirilmesi. Journal of Health Sciences and Medicine, 3(1), 20-25. https://doi.org/10.32322/jhsm.612510
• Austin, J. A., Smith, I. R., & Tariq, A. (2018). The impact of closed-loop electronic medication management on time to first dose: a comparative study between paper and digital hospital environments. International Journal of Pharmacy Practice, 26(6), 526–533. https://doi.org/10.1111/IJPP.12432
• Avaner, T., & Avaner, E. B. (2018). Yazılım Teknolojileri ve Sağlık Yönetimi: HIMSS ya da Dijital Hastane Hizmetleri Üzerine Bir Değerlendirme. Yasama Dergisi, 37(5), 5-28.
• Avcı, K. (2014). Sağlık Kurumlarında İlaç Hatalarının Engellenmesinde Teknoloji Kullanımı. Balıkesir Health Sciences Journal, 3(3), 183–188. https://doi.org/10.5505/bsbd.2014.30602
• Avşar, G., & Çiftçi, B. (2014). Hemşirelerin Oral İlaç Tedavileri ile İlgili Bilgi ve Uygulamalarının Değerlendirilmesi. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 3(10), 710–722.
• Baballe, M. A. (2021). A Study on the Components used in RFID System and its Challenges. Global Journal of Research in Engineering & Computer Science, 1(1), 21–27.
• Ballentine, A. J., Kinnaird, D., & Wilson, J. P. (2003). Prescription errors occur despite computerized prescriber order entry. American Journal of Health-System Pharmacy, 60(7), 708–709. https://doi.org/10.1093/AJHP/60.7.708
• Barfas. (2021). RFID ve Barkod Si̇stemi̇ Arasındaki̇ Fark Nelerdi̇r? Barfas. https://www.barfas.com/blog-detay/rfid-ve-barkod-si-stemi-arasindaki-fark-nelerdi-r/ adresinden 23.01.2023 tarihinde erişilmiştir.
• Bates, D. W., Boyle, D. L., Vander Vliet, M. B., Schneider, J., & Leape, L. (1995). Relationship between Medication Errors and Adverse Drug Events. Journal of General Internal Medicine, 10, 199–205.
• Bates, D. W., Cohen, M., Leape, L. L., Overhage, J. M., Shabot, M. M., & Sheridan, T. (2001). Reducing the frequency of errors in medicine using information technology. Journal of the American Medical Informatics Association : JAMIA, 8(4), 299–308. https://doi.org/10.1136/JAMIA.2001.0080299
• Bates, D. W., Cullen, D. J., Laird, N., Petersen, L. A., Small, S. D., Servi, D., … Hallisey, R. (1995). Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA, 274, 29–34.
• Bobb, A., Gleason, K., Husch, M., Feinglass, J., Yarnold, P. R., & Noskin, G. A. (2004). The Epidemiology of Prescribing Errors: The Potential Impact of Computerized Prescriber Order Entry. Archives of Internal Medicine, 164(7), 785–792. https://doi.org/10.1001/ARCHINTE.164.7.785
• Bozdoğan, C. (2022). Türkiye’deki Özel Hastanelerin Dijitalleşmesi ve Akreditasyon Sürecine İlişkin Hastane Yöneticilerinin Görüşleri. International Journal of Arts & Social Studies, 5(9), 149–166.
• Burkoski, V., Yoon, J., Solomon, S., Hall, T. N. T., Karas, A. B., Jarrett, S. R., & Collins, B. E. (2019). Closed-Loop Medication System: Leveraging Technology to Elevate Safety. Nursing Leadership, 32(Special Issue), 16–28. https://doi.org/10.12927/CJNL.2019.25817
• Cash, J. J. (2009). Alert fatigue. American Journal of Health-System Pharmacy, 66(23), 2098–2101. https://doi.org/10.2146/AJHP090181
• Chandak, A. (2016). Adoption of Medication Management Technologies by U. S. Acute Care Hospitals after the HITECH Act. [Doctorate Thesis, p. 173]. University of Nebraska Medical Center, Health Services Research, Administration and Policy Graduate Program: Nebraska.
• Eraydın, C., Tezcan, B., & Koç, Z. (2019). İlaç yönetiminde bir sistem: Pyxis otomasyon sisteminin hemşirelerin ilaç uygulamalarına etkisi. Sağlık Akademisyenleri Dergisi, 6(2), 100–104.
• Fracica, P. J., & Fracica, E. A. (2020). Patient Safety. In A. P. Gİardinao, L. A. Riesenberg, & P. Varkey (Ed.), Medical Quality Management (3. Edition, pp. 53–90). Cham: Springer.
• Franklin, D. B., O’Grady, K., Donyai, P., Jacklin, A., & Barber, N. (2007). The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study. Quality & Safety Health Care, 16, 279–284. https://doi.org/10.1136/qshc.2006.019497
• Gall, W., Aly, A. F., Sojer, R., Spahni, S., & Ammenwerth, E. (2016). The national e-medication approaches in Germany, Switzerland and Austria: A structured comparison. International Journal of Medical Informatics, 93, 14–25. https://doi.org/10.1016/J.IJMEDINF.2016.05.009
• Gallagher, R. M., & Gallagher, H. C. (2012). Improving the working relationship between doctors and pharmacists: is inter-professional education the answer? Advances in Health Sciences Education: Theory and Practice, 17(2), 247–257. https://doi.org/10.1007/S10459-010-9260-5
• Garg, A. X., Adhikari, N. K. J., McDonald, H., Rosas-Arellano, M. P., Devereaux, P. J., Beyene, J., … Haynes, R. B. (2005). Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes: A Systematic Review. JAMA, 293(10), 1223–1238. https://doi.org/10.1001/JAMA.293.10.1223
• Gider, Ö., Ocak, S., & Top, M. (2015). Evaluation of Electronic Prescription Implications in Turkey: An Investigation of the Perceptions of Physicians. Worldviews on Evidence-Based Nursing, 12(2), 88–97. https://doi.org/10.1111/WVN.12082
• Hellström, L. M., Bondesson, Å., Höglund, P., & Eriksson, T. (2012). Errors in medication history at hospital admission: prevalence and predicting factors. BMC Clinical Pharmacology, 12(9), 1-9 https://doi.org/10.1186/1472-6904-12-9
• HIMSS Eurasia. (2021, Kasım 17-19). HIMSS Eurasia Sonuç Raporu 2021. HIMSS. https://himsseurasia.com/wp-content/uploads/2022/04/HIMSS2021_RAPOR_TR-1.pdf adresinden 23.01.2023 tarihinde erişildi.
• HIMSS Legacy Workgroup. (2013, Ocak). History of the Healthcare Information and Management Systems SocietyHistory of the Healthcare Information and Management Systems Society. HIMSS. http://www.himss.org/files/HIMSSorg/content/files/HistoryHIMSS_January2013.pdf adresinden 23.01.2023 tarihinde erişildi.
• Institute of Medicine. (2000). To Err Is Human: Building a Safer Health System. Washington DC: National Academies Press. https://doi.org/10.17226/9728
• Institute of Medicine. (2012). Health IT and Patient Safety: Building Safer Systems for Better Care. Washington DC: National Academies Press. https://doi.org/10.17226/13269
• ISMP (2024, January). High-alert medications in acute care settings. Institute for Safe Medication Practices. https://www.ismp.org/recommendations/high-alert-medications-acute-list adresinden 20.01.2024 tarihinde erişildi.
• QUALIFACTS. (2021). Electronic Medicine Administration Record. Insync Healthcare Solutions. https://www.insynchcs.com/emar?hsCtaTracking=152b29ab-f0ff-46fc-8d5e-63c8e9d8b4eb%7Cb032852a-3480-4f98-ac7a-d11523ad8106 adresinden 01.03.2023 tarihinde erişildi.
• Johnson, K. F. (2016). U. S. Nursing Students’ Perceptions of Safe Medication Administration [Doctorate Thesis, p. 192]. Walden University, Colloge of Education: Minnesota.
• Kaushal, R., Shojania, K. G., & Bates, D. W. (2003). Effects of Computerized Physician Order Entry and Clinical Decision Support Systems on Medication Safety A Systematic Review. Archives of Internal Medicine, 163, 1409–1406.
• Kemer, S., & Ergün, H. (2021). İlaç sınıflandırmaları ve yüksek riskli ilaç kavramının sağlık çalışanları tarafından bilinirliği ve meslek içi uygulamalarındaki yeri. Turkiye Klinikleri Journal of Medical Sciences, 41(1), 51-62. https://doi.org/10.5336/medsci.2020-78629
• Kinlay, M., Ho, L. M. R., Zheng, W. Y., Burke, R., Juraskova, I., Moles, R., & Baysari, M. (2021). Electronic Medication Management Systems: Analysis of Enhancements to Reduce Errors and Improve Workflow. Applied Clinical Informatics, 12(5), 1049–1060. https://doi.org/10.1055/S-0041-1739196/ID/JR210156RA-53
• Lenderink, B. W. (2004). Closing the loop of the medication use process using electronic medication administration registration. Pharmacy World and Science, 26, 185–190.
• Lisby, M., Nielsen, L. P., & Mainz, J. (2005). Errors in the medication process: frequency, type, and potential. International Journal for Quality in Health Care, 17(1), 15–22. https://doi.org/10.1093/intqhc/mzi015
• Lo, C., Burke, R., & Westbrook, J. I. (2010). Electronic Medication Management Systems’ Influence on Hospital Pharmacists’ Work Patterns. Journal of Pharmacy Practice and Research, 40(2), 106–110. https://doi.org/10.1002/J.2055-2335.2010.TB00516.X
• Mac’spharmacy. (2022, December 2). What is eMar? Mac's LTC. https://www.macspharmacy.com/blog/what-is-emar/ adresinden 07.03.2023 tarihinde erişilmiştir.
• Munzner, E. E., Welch, A. S., & Richardson, K. L. (2015). Measuring and Describing Dose Omissions using an Electronic Medication Management System. Pharmacy Practice and Research, 42(4), 264–267. 10.1002/j.2055-2335.2012.tb00185.x
• Naidu, M., Lee, Y., Alicia, Y., Naidu, M., & Alicia, Y. L. Y. (2019). Impact of Bar-Code Medication Administration and Electronic Medication Administration Record System in Clinical Practice for an Effective Medication Administration Process. Health, 11(5), 511–526. https://doi.org/10.4236/HEALTH.2019.115044
• NWS Government. (2019, October 10). Electronic Medication Management System Governance and Standards. Politicy Directive. https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2019_050.pdf adresinden 22.01.2023 tarihinde erişilmiştir.
• Office of the National Coordinator for Health Information Technology. (2017, September 15). Health IT Terms: Glossary of Selected Terms Related to Health IT. ONC. https://www.healthit.gov/topic/health-it-and-health-information-exchange-basics/glossary adresinden 23.01.2023 tarihinde erişilmiştir.
• Öztürk, E. (2019). Hastanelerde yatışlı servi̇slerde kapalı döngü i̇laç uygulamasının i̇laç i̇ade oranlarına etki̇si̇ni̇n araştırılması. [Yüksek Lisans Tezi, s. 75]. İstanbul Medipol Üniversitesi Sağlık Bilimleri Ensititüsü Sağlık Yönetimi Anabilim Dalı: İstanbul.
• Pearce, R., & Whyte, I. (2018). Electronic medication management: is it a silver bullet? Australian Prescriber, 41(2), 32–33. https://doi.org/10.18773/AUSTPRESCR.2018.012
• Perras, C., Jacobs, P., Boucher, M., Murphy, G., Hope, J., Lefebvre, P., … Morrison, A. (2010). Technologies to Reduce Errors in Dispensing and Administration of Medication in Hospitals: Clinical and Economic Analyses. CADTH Technology Overviews, 1(3), 1–6.
• ProHealth. (2017, Ağustos 11). Sağlık Bilgi Teknolojisi (Sağlık BT). Pro Health Ware. https://prohealthware.com/tr/health-information-technology-health-it/ adresinden 20.01.2023 tarihinde erişilmiştir.
• ProHealth. (2022, Haziran 11). Elektronik Tıbbi Kayıtlar (EHR) ve Elektronik Sağlık Kayıtları (EMR) Arasındaki Farklar. Pro Health Ware. https://prohealthware.com/tr/differences-between-electronic-medical-records-emr-and-electronic-health-records-ehr/ adresinden 20.01.2023 tarihinde erişilmiştir.
• Pruitt, Z. M., Kazi, S., Weir, C., Taft, T., Busog, D. N., Ratwani, R., & Hettinger, A. Z. (2023). A systematic review of quantitative methods for evaluating electronic medication administration record and bar-coded medication administration usability. Applied Clinical Informatics, 14(01), 185-198. https://doi.org/10.1055/s-0043-1761435
• Ryan, M. J. (2007). Australian electronic medication management policy and systems. Journal of Pharmacy Practice and Research, 37(1), 49–55. https://doi.org/10.1002/J.2055-2335.2007.TB00660.X
• Sağlık Bakanlığı. (2014, Kasım 20). Dijital-Kağıtsız Hastane Nedir? Dijital Hastane. https://dijitalhastane.saglik.gov.tr/TR,5007/dijital-kagitsiz-hastane-nedir.html adresinden 19.01.2023 tarihinde erişilmiştir.
• Sağlık Bakanlığı. (2020, Haziran 17). EMRAM Hakkında. Dijital Hastane. https://dijitalhastane.saglik.gov.tr/TR,4858/emram-hakkinda.html adresinden 19.01.2023 tarihinde erişilmiştir.
• Sağlık Bilgi Sistemleri Genel Müdürlüğü. (2022, Eylül 28). HIMSS22 Sağlık Bilişimi Genelgesi. HIMSS Eurasia. https://himsseurasia.com/wp-content/uploads/2022/10/HIMSS22-Saglik-Bilisim-Genelgesi.pdf adresinden 22.01.2023 tarihinde erişilmiştir.
• Saspam. (2018). Emram Seviyeleri Nelerdir? İstanbul Medipol Üniversitesi Bilgi Teknolojileri Daire Başkanlığı. https://saspam.medipol.edu.tr/emram-seviyeleri-nelerdir/ 21.01.2023 tarihinde erişilmiştir.
• Seidling, H. M., Kaltschmidt, J., Ammenwerth, E., & Haefeli, W. E. (2013). Medication safety through e-health technology: can we close the gaps? British Journal of Clinical Pharmacology, 76(S1), i–iv. https://doi.org/10.1111/BCP.12217
• Sosyal Güvenlik Kurumu. (2012, Haziran 26). E-reçete Sık Sorulan Sorular. Medeczane. https://medeczane.sgk.gov.tr/doktor/erecetesss.pdf
• Szeinbach, S. L., Hayman-Taylor, T., & Gillenwater, E. L. (1995). Automated Dispensing Technologies: Effect on Managed Care. Journal of Managed Care Pharmacy, 1(2), 121–127. https://doi.org/10.18553/JMCP.1995.1.2.121
• Tüfekci, N., Yorulmaz, R., & Cansever, İ. H. (2017). Dijital Hastane. Journal of Current Researches on Health Sector, 7(2), 143–156. https://doi.org/10.26579/jocrehes_7.2.12
• Ulutaş, E., Şahne, S. B., & Yeğenoğlu, S. (2015). Eczacılıkta İletişimin Rolü. Marmara Pharmaceutical Journal, 19, 200–207. https://doi.org/10.12991/mpj.20151916765
• Uzun, Ş., & Arslan, F. (2008). İlaç Uygulama Hataları. Türkiye Klinikleri Tıp Bilimleri Dergisi, 28(2), 217–222.
• Vaghasiya, M. R., Penm, J., Kuan, K. K. Y., Gunja, N., Liu, Y., Kim, E. D., … Poon, S. (2021). Implementation of an Electronic Medication Management System in a large tertiary hospital: a case of qualitative inquiry. BMC Medical Informatics and Decision Making, 21(1), 1–11. https://doi.org/10.1186/S12911-021-01584-W/TABLES/2
• Von Eiff, M. C., Von Eiff, W., & Ghanem, M. (2023). Patient-centred medication management: How to enhance patient safety and reduce the work burden for medical staff by digitalised closed-loop cabinets. Management in Healthcare, 7(2), 167-178.
• Westbrook, J. I., Reckmann, M., Li, L., Runciman, W. B., Burke, R., Lo, C., Baysari, M. T., … Day, R. O. (2012). Effects of Two Commercial Electronic Prescribing Systems on Prescribing Error Rates in Hospital In-Patients: A Before and After Study. PLOS Medicine, 9(1), e1001164/1-11. https://doi.org/10.1371/JOURNAL.PMED.1001164
• Wolfgarten, J. (2022, Aralık 21). Das E-Rezept im Entlassmanagement. EHEALTH. https://www.shop-apotheke.com/magazin/e-health/e-rezept/e-rezept-in-krankenhaeuser/ 23.02.2023 tarihinde erişilmiştir.
• Yiğit, A., & Oral-Kara, N. (2019). Hastanelerde Otomatik İlaç Dağıtım Sistemi Kullanımı Üzerine Bir Araştırma. Selçuk Üniversitesi Sosyal Bilimler Enstitüsü Dergisi, 42, 66–74.