Purpose
The purpose of this study was to evaluate the impact of commercial computerized prescriber order entry (CPOE) on efficiency outcomes in an 864-bed community hospital.
Methods
A retrospective ...study was developed to measure medication errors and medication order turnaround time in St. Luke's Episcopal Hospital located in the Texas Medical Center. The study data were collected by stratified random sampling through a review of medication orders submitted to the pharmacy using a paper-based order system and the CPOE system. Descriptive frequencies, chi-square test, Wilcoxon matched-pairs sign rank test, and logistic regression and multiple regression analyses were conducted to examine the relationship among variables.
Results
Of the 1,110 total orders reviewed (563 paper-based and 547 CPOE), a total of 135 medication errors were found, with 10.5% in paper-based versus 1.6% in CPOE. The most prevalent errors in paper-based orders were inappropriate abbreviations (24.4%), incorrect doses (15.6%), occurrences of allergy (13.3%), and wrong administration frequency (9.6%). In CPOE orders, the errors were occurrences of allergy (10.4%), incorrect doses (2.2%), and drug interaction (0.7%). CPOE resulted in a 50% reduction of medication order turnaround time (median = 24 minutes CPOE vs 48 minutes paper orders). A potential medication error, unidentified prescribers within medication orders, urgency of medication order, and implementation of CPOE were the significant (P < .05) determinants of medication order turnaround time.
Conclusion
The implementation of a commercial CPOE system reduced medication errors and improved medication order turnaround times.
Purpose
To evaluate the effect of bedside barcode medication administration (BCMA) on specific tasks performed by nurses during medication administration in an intensive care unit (ICU).
Methods
A ...prospective observational study was conducted on paper-based medication administration (PBMA) and BCMA in an ICU. A prevalidated time and motion observation instrument was used to measure time spent by nurses on tasks associated with PBMA and BCMA. Frequency of each task performed and mean duration of time dedicated to each task were obtained using descriptive statistics. Analysis of covariance was conducted to assess the difference in time spent with various nursing tasks between 2 periods. Factors considered as covariates were age, gender, body weight, length of stay of the patients in the ICU, number of drugs administered, and number of nurses involved.
Results
A total of 101 PBMA and 151 BCMA were analyzed. The mean duration of total medication administration time was found to be significantly higher during BCMA(377.8 ± 232.8 s) than during PBMA(313.3 ± 224.3 s). During BCMA, nurses spent more time on the following medication administration tasks: drug preparation(159.4 vs 27.3 s; P < .05), assisting physician(5.2 vs. 0.4 s; P < .05), universal precautions(3.6 vs 0.0 s; P < .05), and conversing with patients(21.6 vs 15.0 s; P < .05). During BCMA, nurses spent less time on the following medication administration tasks: giving medications(24.7 vs 35.0 s; P < .05), documenting medications(11.3 vs 17.3 s; P < .05), and cross-checking drugs with orders(7.4 vs 7.6 s; P =.04).
Conclusion
During PBMA, nurses spent more time on documenting medications and less time conversing with patients. This changed significantly after implementation of BCMA. BCMA resulted in nurses spending less time on documentation and more time conversing with patients during medication administration process.
Mature male rats (n = 16) were assigned to either 14 days of head-down suspension with one hindlimb supported (HDS) or to control cages (C) of similar dimensions. Hindlimb support during HDS ...preserved the muscle mass-to-body mass ratio (mg/100g) compared with C conditions for the soleus (48.3 +/- 1.0 to 41.7 +/- 1.0), plantaris (98.4 +/- 3.4 to 103.3 +/- 4.1), and gastrocnemius (484.7 +/- 18.5 to 507.2 +/- 13.9). However, the muscle mass-to-body mass ratio was significantly lower for the soleus (28.9 +/- 1.5), plantaris (83.9 +/- 3.6), and gastrocnemius (411.9 +/- 24.2) muscles from the freely hanging hindlimbs compared with the contralateral muscles from the supported hindlimbs or muscles from C animals. Citrate synthase activity (mumol.g-1.min-1) was significantly lower in soleus muscles from HDS rats in both the supported (19.4 +/- 2.3) and freely hanging (20.0 +/- 1.6) hindlimbs compared with C (28.5 +/- 3.1), whereas soleus muscle glycogen concentration (mg/g) was significantly higher in the freely hanging limbs from HDS rats (5.90 +/- 0.31) but not in the supported limbs (3.80 +/- 0.61) compared with C (4.34 +/- 0.50). Doppler flow probes were used to determine that iliac blood flow to freely hanging hindlimbs was significantly decreased after 48 (-19 +/- 5%) and 72 (-20 +/- 6%)h of HDS compared with presuspension values. In addition, iliac vascular resistance was significantly elevated at most time points during the 72 h of HDS in the freely hanging limbs but not the supported hindlimbs.
Maximum oxygen consumption (VO2max) has been shown to be reduced after periods of simulated weightlessness. To assess the role of the sympathetic nervous system in these reductions, Sprague-Dawley ...rats were either chemically sympathectomized (SYMX) or injected with saline (SHAM) and assigned to head-down suspension (HDS), horizontal restraint with the hindlimbs weight bearing (HWB), or cage-control (CC) conditions. VO2max, run time (RT), and mechanical efficiency (ME) were measured before suspension and on days 7 and 14. Male and female SHAM HDS groups exhibited reduced measures of VO2max (12-13%) after 7 and 14 days, and this decrease was attenuated in the SYMX and HWB rats. HDS resulted in a significant reduction in RT (9-15%) in both the male and female rats, and ME was significantly reduced after HDS in male and female SYMX and male SHAM rats (23-33%) but not in the female SHAM rats. Lesser reductions in ME were observed in the HWB rats. HDS and HWB were associated with lower body, fat-free, and fat masses, which were similar in male and female rats as well as for the SHAM and SYMX conditions. In a related HDS experiment with normal rats, plasma norepinephrine and epinephrine were increased by 53 and 42% after 7 days, but only epinephrine returned to baseline after 14 days. It was concluded that chemical sympathectomy and/or a weight-bearing stimulus will attenuate the loss in VO2max associated with simulated weightlessness in rats despite similar changes in body mass and composition. The mechanism(s) remains unclear at this time.
This study was designed to examine insulin- and exercise-stimulated glucose uptake and metabolism in the hindlimb muscles of rats after conditions of simulated microgravity. To simulate microgravity, ...male Sprague-Dawley rats were suspended in a head-down (45 degrees) position with their hindlimbs non-weight bearing (SUS) for 14 days. In addition, rats were assigned to suspension followed by exercise (SUS-E), to cage control (CC), or to exercising control (CC-E) groups. Exercise consisted of five 10-min bouts of treadmill running at the same relative intensity for the CC-E and SUS-E rats (80-90% of maximum O2 consumption). Hindlimb perfusion results indicated that glucose uptake for the entire hindquarter at 24,000 microU/ml insulin (maximum stimulation) was significantly higher in the SUS (8.9 +/- 0.5 mumol.g-1.h-1) than in the CC (7.6 +/- 0.4 mumol.g-1.h-1) rats, signifying an increased insulin responsiveness. Glucose uptake at 90 microU/ml insulin was also significantly higher in the SUS (48 +/- 4; % of maximum stimulation over basal) than in the CC (21 +/- 4%) rats. In addition, exercise-induced increases in glucose uptake for the hindlimbs (133%) and glucose incorporation into glycogen for the plantaris (8.4-fold), extensor digitorum longus (5.4-fold), and white gastrocnemius (4.8-fold) muscles were greater for the SUS-E rats than for the CC-E rats (39% and 1.9-, 1.9-, and 3.0-fold, respectively). Therefore, suspension of the rat with hindlimbs non-weight bearing leads to enhanced muscle responses to insulin and exercise when they were applied separately. However, insulin action appeared to be impaired after exercise for the SUS-E rats, especially for the soleus muscle.
This study was designed to examine the effect of non-weight-bearing conditions and the systemic influences of simulated microgravity on rat hindlimb muscles. For this purpose, rats were suspended ...(SUS) in a head-down position (45 degrees) with the left hindlimb non-weight bearing (NWB) and the right hindlimb bearing 20% of presuspension body mass (WB). Weight bearing by the SUS-WB limb was accomplished by using a platform connected to a rod in sleeve, cable, and pulley apparatus to which weight could be added. Rats (250-325 g) were assigned to SUS or cage control (CC) conditions for 14 days. The angle between the foot and leg for SUS-WB and CC remained similar (20-30 degrees) throughout the experiment while the SUS-NWB hindlimbs extended to approximately 140 degrees by day 12. On day 14, the soleus, plantaris, and gastrocnemius muscles from the SUS-NWB limbs exhibited significantly lower (P < or = 0.05) masses than presuspension mass values (29, 11, and 21%, respectively). Weight bearing by the SUS-WB limbs prevented the loss of mass by these muscles. In separate groups of SUS and CC rats, 2-deoxyglucose uptake during hindlimb perfusion was significantly higher in both SUS-NWB and SUS-WB hindlimbs at 24,000 microU/ml of insulin compared with CC for all the muscles examined (21-80%). In addition, extracellular space (ml/g) was significantly greater in the soleus muscles from both the SUS-NWB and SUS-WB hindlimbs (64%) compared with CC muscles.
To determine the time course of changes in maximal oxygen consumption (VO2max) and its relationships with body composition, a 29-d simulated microgravity study was initiated with 30 adult female rats ...(230-280 g) randomly assigned to one of three experimental groups; namely, head-down suspension (HDS) at 45 degrees, horizontal suspension (HS) at 0 degree, or cage control (CC). Five separate exercise performance tests with measurements related to VO2max, treadmill run time, and mechanical efficiency were conducted before suspension and on days 7, 14, 21, and 28. The animals were sacrificed and chemically analyzed for fat and fat-free free mass (FFM) between days 22 and 29. When oxygen consumption results were expressed on an absolute basis (ml.min-1), both suspension groups had significant decreases at day 7. Thereafter, the HDS rats remained significantly decreased, while the HS rats returned to values not significantly different than the presuspension values by day 28. When oxygen consumption was expressed on a relative basis (ml.kg-1.min-1), all groups exhibited significant reductions between 6-8%. Both suspended groups had significantly less fat than the CC rats but had similar values for FFM (p greater than 0.05). When VO2max was evaluated on a FFM basis, the HDS rats had a group mean that was 6% lower than the other two groups, but the difference was not statistically significant. Treadmill run time was significantly reduced in all groups after 28 d with the reduction from pre-suspension values being more pronounced with HDS animals.
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