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Title page for ETD etd-07302015-120900

Type of Document Dissertation
Author Bhatia, Haresh Lokumal
Author's Email Address vrbhatias@gmail.com
URN etd-07302015-120900
Title Measuring the health of medication process using an EHR data repository
Degree PhD
Department Biomedical Informatics
Advisory Committee
Advisor Name Title
Dr. Christoph U. Lehmann Committee Chair
Dr. Catherine H. Ivory Committee Member
Dr. Kim M. Unertl Committee Member
Dr. Neal R. Patel Committee Member
Dr. Phillip W. Stewart Committee Member
  • Pediatric Inpatients
  • Missing Doses
  • Medication Compliance
  • Quality Improvement signals from EHR
  • Time to First Dose
Date of Defense 2015-05-14
Availability unrestricted
Dissertation under the direction of Dr. Christoph U. Lehmann

Health care providers prescribe medications to treat disease or maintain health of their patients. In an inpatient environment, once a medication order has been issued a complex medication process must be successfully and error free navigated to assure delivery and administration of the medication. This process involves providers, pharmacists, pharmacy technicians, nurses, and nursing aids and can result in errors in dispensing, delivery, administration, and documentation. This project analyzed the medication process in a children’s hospital to develop new approaches and methodologies to determine the effectiveness of the medication process and to develop measures to monitor its health.

The approach chosen to determine the “health” of the medication process for the pediatric patients at the Vanderbilt University Medical Center (VUMC) was threefold:

1. Assessment of the proportion of medications not administered to patients including truly missed doses (no administration record) and non-administered medications

2. Assessment of intervals from ordering to dispensing, scheduling, and administration of medications

3. Analysis of factors influencing non-administration and delays in administration

Analysis of orders issued between July 1, 2010 and December 31, 2013 revealed a very small proportion (< 3%) of doses that were not administered. However, we observed that the non-administration of the ordered medication is associated with the corresponding Anatomical Therapeutic Chemical (ATC) class.

The analysis of the schedule and administration times of the ordered medications with respect to the order type, required verification, unit, ATC class, and scheduled-hour provided greater insights including understanding of delays associated with peek demands (pharmacy) and shift changes (nurses).

Incidentally, while analyzing the schedule and administration times, we observed noticeably better times for specific antimicrobials in one of the Neonatal ICUs (NICUs). Further inquiry revealed that the effect was due to a quality improvement effort initiated at this NICU.

Conclusion: Ordering, dispensing, scheduling, and administration data are useful in determining the “health” of the medication process in a university children’s hospital. Further, this analysis independently can detect ongoing improvement efforts.

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