The impact of a closed-loop electronic prescribing and administration system on prescribing errors, administration errors and staff time: a before-and-after study

Objectives: To assess the impact of a closed-loop electronic prescribing, automated dispensing, barcode patient identification and electronic medication administration record (EMAR) system on prescribing and administration errors, confirmation of patient identity before administration, and staff time. Design, setting and participants: Before-and-after study in a surgical ward of a teaching hospital, involving patients and staff of that ward. Intervention: Closed-loop electronic prescribing, automated dispensing, barcode patient identification and EMAR system. Main outcome measures: Percentage of new medication orders with a prescribing error, percentage of doses with medication administration errors (MAEs) and percentage given without checking patient identity. Time spent prescribing and providing a ward pharmacy service. Nursing time on medication tasks. Results: Prescribing errors were identified in 3.8% of 2450 medication orders pre-intervention and 2.0% of 2353 orders afterwards (p<0.001; χ2 test). MAEs occurred in 7.0% of 1473 non-intravenous doses pre-intervention and 4.3% of 1139 afterwards (p = 0.005; χ2 test). Patient identity was not checked for 82.6% of 1344 doses pre-intervention and 18.9% of 1291 afterwards (p<0.001; χ2 test). Medical staff required 15 s to prescribe a regular inpatient drug pre-intervention and 39 s afterwards (p = 0.03; t test). Time spent providing a ward pharmacy service increased from 68 min to 98 min each weekday (p = 0.001; t test); 22% of drug charts were unavailable pre-intervention. Time per drug administration round decreased from 50 min to 40 min (p = 0.006; t test); nursing time on medication tasks outside of drug rounds increased from 21.1% to 28.7% (p = 0.006; χ2 test). Conclusions: A closed-loop electronic prescribing, dispensing and barcode patient identification system reduced prescribing errors and MAEs, and increased confirmation of patient identity before administration. Time spent on medication-related tasks increased.

An assessment of the benefits and limitations of the shamba agroforestry system in Kenya and of management and policy requirements for its successful and sustainable reintroduction

The shamba system involves farmers tending tree saplings on state-owned forest land in return for being permitted to intercrop perennial food crops until canopy closure. At one time the system was used throughout all state-owned forest lands in Kenya, accounting for a large proportion of some 160,000 ha. The system should theoretically be mutually beneficial to both local people and the government. However the system has had a chequered past in Kenya due to widespread malpractice and associated environmental degradation. It was last banned in 2003 but in early 2008 field trials were initiated for its reintroduction. This study aimed to: assess the benefits and limitations of the shamba system in Kenya; assess the main influences on the extent to which the limitations and benefits are realised and; consider the management and policy requirements for the system's successful and sustainable operation. Information was obtained from 133 questionnaires using mainly open ended questions and six participatory workshops carried out in forest-adjacent communities on the western slopes of Mount Kenya in Nyeri district. In addition interviews were conducted with key informants from communities and organisations. There was strong desire amongst local people for the system's reintroduction given that it had provided significant food, income and employment. Local perceptions of the failings of the system included firstly mismanagement by government or forest authorities and secondly abuse of the system by shamba farmers and outsiders. Improvements local people considered necessary for the shamba system to work included more accountability and transparency in administration and better rules with respect to plot allocation and stewardship. Ninety-seven percent of respondents said they would like to be more involved in management of the forest and 80% that they were willing to pay for the use of a plot. The study concludes that the structural framework laid down by the 2005 Forests Act, which includes provision for the reimplementation of the shamba system under the new plantation establishment and livelihood improvement scheme (PELIS) [It should be noted that whilst the shamba system was re-branded in 2008 under the acronym PELIS, for the sake of simplicity the authors continue to refer to the 'shamba system' and 'shamba farmers' throughout this paper.], is weakened because insufficient power is likely to be devolved to local people, casting them merely as 'forest users' and the shamba system as a 'forest user right'. In so doing the system's potential to both facilitate and embody the participation of local people in forest management is limited and the long-term sustainability of the new system is questionable. Suggested instruments to address this include some degree of sharing of profits from forest timber, performance related guarantees for farmers to gain a new plot and use of joint committees consisting of local people and the forest authorities for long term management of forests.

Data information system to promote the organization data of collections - modeling considerations by the Unified Modelign Language (UML)

Pode-se afirmar que a evolução tecnológica (desenvolvimento de novos instrumentos de medição como, softwares, satélites e computadores, bem como, o barateamento das mídias de armazenamento) permite às Organizações produzirem e adquirirem grande quantidade de dados em curto espaço de tempo. Devido ao volume de dados, Organizações de pesquisa se tornam potencialmente vulneráveis aos impactos da explosão de informações. Uma solução adotada por algumas Organizações é a utilização de ferramentas de sistemas de informação para auxiliar na documentação, recuperação e análise dos dados. No âmbito científico, essas ferramentas são desenvolvidas para armazenar diferentes padrões de metadados (dados sobre dados). Durante o processo de desenvolvimento destas ferramentas, destaca-se a adoção de padrões como a Linguagem Unificada de Modelagem (UML, do Inglês Unified Modeling Language), cujos diagramas auxiliam na modelagem de diferentes aspectos do software. O objetivo deste estudo é apresentar uma ferramenta de sistemas de informação para auxiliar na documentação dos dados das Organizações por meio de metadados e destacar o processo de modelagem de software, por meio da UML. Será abordado o Padrão de Metadados Digitais Geoespaciais, amplamente utilizado na catalogação de dados por Organizações científicas de todo mundo, e os diagramas dinâmicos e estáticos da UML como casos de uso, sequências e classes. O desenvolvimento das ferramentas de sistemas de informação pode ser uma forma de promover a organização e a divulgação de dados científicos. No entanto, o processo de modelagem requer especial atenção para o desenvolvimento de interfaces que estimularão o uso das ferramentas de sistemas de informação.

Draft programme of statistical work of the ECLAC system, 2006-2007

Includes bibliography

Informe de la Reunión de Expertos sobre Diseño de un Sistema Regional de Información sobre Actividades de Información = Report of the Meeting of Experts on Design of a Regional Information System on Information Activities

Incluye Bibliografía