Medical Design project of Design & Engineering course. Autumn semester 2013/2014

1. MedBook application & MedTray
Medicine distribution project report
2013/2014

2. Contents
1.BACKGROUND 7
1.1 Introduction 7
1.2 Project aim and objectives 7
1.3 General information about hospital 8
1.4 Patient Safety as a subliminal issue in health care policy
1.5 To err is human
10
2. CURRENT SYSTEM
11
3. CONCEPT 14
3.1 Need
14
3.2 General concept
14
3.3 Mapping of information flow. 15
3.4 Different existing concepts 18
4.DESIGN 21
4.1 Interface of the App 21
4.2 Appearance 27
4.3 Making a prototype for a MedTray
4.4 Product value
34
5. SUMMARY 36
6. REFERENCES
36
33
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3. Team
Gina Metssalu
TTU
BSc Mechanical Engineering
Estonia
Karl Annus
Tartu Art College
Furniture Design
Estonia
Jibing Wu
China,Beijing
Afshin Hasani
TTU
BSc Mechanical Engineering
Iran

4. 1.BACKGROUND
1.1 Introduction
This report details a medical design project in cooperation with North Estonia Medical Center (PõhjaEesti Regionaalhaigla) and Design and Engineering Masters program students at Tallinn University
of Technology.
1.2 Project aim and objectives
Our project aim was to find design solutions on the field’s of patients’ safety and/or dignity in hospital.
From the field research that we carried out in the hospital, we found several issues that could be
improved both the patients and caretakers point of view.
Our group concentrated on medication distribution system in hospital departments. We found out
that current system with several handwritten lists and papers is not unequivocal for everyone and
creates diverse base for human errors. We think that mistakes can best be prevented by designing
the system at all levels to make it safer - to make it harder for people to do something wrong and
easier for them to do it right.
By virtue of their direct patient-care activities and administration of medications to patients, nurses—
perhaps more than any other health-care providers—are in an excellent position to prevent, detect
and report medication errors. Nurses play an important role in risk reduction.
Thats why the main objectives of the proposed project are targeted to designing the nurses working
system, although the benefits will rise up at all levels of system.
After analyzing current system and background research we worked out one possible solution what
we are introducing on the following pages of the report.
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5. 1.3 General information about hospital
1.4 Patient Safety as a subliminal issue in health care policy
The North Estonia Medical Centre is Estonia’s foremost hospital. Their mission is to provide top-level
patient-friendly health care and to promote the development of medicine in Estonia. The hospital is a
higher level medical institution.
The main topic of this project is patient safety as an important health care policy aspect. Patient safety
has been internationally well identified as an important health care problem and research issue, but
Estonia lacks a common understanding not only on patient safety, but also on health care main target.
There are also no national policy nor strategy document contains a patient safety perspective.
At the same time road safety, for example, is topic what is several times more dealt with in Estonia.
The patient safety topic is often compared with aviation what is regulated with high level of safety
requirements.
Institute of Medicine report „To Err is Human“ (1) says that according to estimates from two major
studies at least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as
a result of medical errors that could have been prevented.
As an example we can bring the reference to U.S aviation safety report according to which the
average traveler has to fly 438 years in a row to get a partial in a plane crash.
Medical operations are managed through seven clinical divisions – Anesthesiology Clinic, Diagnostics
Division, Surgery Clinic, Psychiatry Clinic, Oncology and Hematology Clinic, Internal Medicine
Clinic and Follow-up Care Clinic. Hospital provides services in almost all medical specialties (excl.
ophthalmology, paediatrics and obstetrics).
Hospital’s main buildings are situated in Tallinn (different locations) and Kose. The hospital is an
employer for 3626 people, including 590 doctors, 1352 nursing staff and 862 caregivers. There are
over 100 resident doctors in the hospital at any given time. Medical staff are supported by approx.
714 workers.
Hospital is legal person governed by private law and its legal form is foundation. Hospital has been
founded by the Republic of Estonia. Hospital’s official name is Sihtasutus Põhja-Eesti Regionaalhaigla.
Beyond their cost in human lives, preventable medical errors exact other significant tolls. They have
been estimated to result in total costs (in­ luding the expense of additional care necessitated by the
c
errors, lost income and household productivity, and disability) of between $17 billion and $29 billion
per year in hospitals nationwide.
Errors also are costly in terms of loss of trust in the health care system by patients and diminished
satisfaction by both patients and health professionals. There have been done a research
(Eurobarometer research 2009- How people feel patient safety aspects) where Estonia had results :
• 45% of respondents considered it likely to get damaged during the hospital stay (EU average
50%)
• 39% of Estonians answered that he/she or his/her family member has experienced a deviation
(EU average 26%)
• Estonians considered that the most important responsible entity of patient safety are healthcare
professionals and hospitals.
Although the opinion on whether patient safety is a problem in Estonian health care or not polarized,
all experts agreed upon that some kind of further action should be taken. Health care in Estonia is not
as safe as it should be - and can be.
Picture 1. North Estonia Medical Centre main house in Mustamäe, Tallinn.
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6. 2. CURRENT SYSTEM
1.5 To err is human
Medical errors can be defined as the failure of a planned action to be completed as intended or the
use of a wrong plan to achieve an aim.
A number of studies have been done to investigate why deviations occur at all.
More commonly, errors are caused by faulty systems, processes, and conditions that lead people to
make mistakes or fail to prevent them.
Thus, mistakes can best be prevented by designing the health system at all levels to make it safer--to
make it harder for people to do something wrong and easier for them to do it right.
Health care organizations must develop a “culture of safety” such that their workforce and processes
are focused on improving the reliability and safety of care for patients. Safety should be an explicit
organizational goal that is dem­ nstrated by strong leadership on the part of clinicians, executives,
o
and governing bodies. This will mean incorporating a variety of well-understood safety principles,
such as designing jobs and working conditions for safety; standardizing and simplifying equipment,
supplies, and processes; and enabling care providers to avoid reliance on memory.
A large percentage of medical errors are associated with medications. The National Coordinating
Council for Medication Error and Prevention (NCCMERP) has approved the following working
definitions specifically for medication errors:
For the field research we observed the daily
routine of the hospitals workflow.
Workflow in hospital is the set of tasks what
are grouped chronologically into processes and
every task needs the set of people or resources
to accomplish a given goal.
We noticed that one important issue what distract
caretakers daily workflow is the information
technology in hospital practice.
Health IT, what must promise many benefits
for improving quality and efficiency of health
care service, seemed to be poorly functioning.
Including unnecessary pauses and rework,
delays, established workarounds, gaps where
steps are often omitted, and a process that
participants feel is illogical. Huge amount of
time is spent on data entry to computers and
its supposed to be only small detail of the many
tasks that nurses are required to complete.
Medication error: Any preventable event that may cause or lead to inappropriate medication use
or patient harm while the medication is in the control of the healthcare professional, patient, or
consumer. Such events may be related to professional practice, health care products, procedures, or
systems including prescribing; order communication; product labeling, packaging and nomenclature;
compounding; dispensing; distribution; administration; education; monitoring; and use.
Picture 2. Nurse’s notebook, where she writes down doctors
orders during morning wards round
Common causes of medication errors:
Ambiguous strength designation on labels or in packaging Drug product nomenclature (look-alike or
sound-alike names, use of lettered or numbered prefixes and suffixes in drug names)
Equipment failure or malfunction
Illegible handwriting
Improper transcription
Inaccurate dosage calculation
Inadequately trained personnel
Inappropriate abbreviations used in prescribing Labeling errors
Excessive workload
Lapses in individual performance
Medication unavailable
Picture 3. Nursing file
10
Picture 4. Nurses workdesk
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7. Health care is a service industry that relies
heavily on good information. In closely following
and taking care of patients, nurses are guardians
of a rich source of information, but we found
that some of this important information was
documented in the nonofficial/ unrecordable
notes or transferred as a conversations. The
official report information seemed to be more
overall assessments of patient care and includes
only required information.
There are some parts of information what are
obligatory to be inserted digitally (Picture 4), but
not all the information, what is recorded on paper
files. There is reluctant attitude towards inserting
information digitally - it is task that nobody wants
to do it willingly.
Because of searching information for every
single patient from nursing files is inconvenient
and time consuming, there are created so called
“PAPKA” system- the piece of paper for each
patient what is editable with pen and eraser
(Picture 5).
Current system at PERH hospital has both the
paper and electronic records, and due to userhostile interface of both of these, there are used
self created medication management system,
with notebooks, handwritten lists, tables and
notes.
Picture 5. “PAPKA”
There are gathered main information, what
nurses needs more often- the quick and easy
overview of all patients all together.
Left side is for patient general information: name,
ID code, doctors name, ward and place nr.
Middle section is for marking down patients
treatment plan for oral medicaments.
Right section indicates intravenous medicaments.
There are also remarks about patients menu
preferences, date of operation and other main
issues what are necessary to keep in mind.
In the morning ward rounds nurse makes quick
notes about doctors orders (Picture 2).
Some departments then creates one more
handwritten list with overall information about
medicaments what must be daily prepared and
distributed (Picture 6).
As we concentrated our interest on drug
distribution system, then we examined how
information moves from doctors order in medical
treatment plan until its execution.
Everything has to be put down to the nursing file
(Picture 3). Nursing file is a document what proofs
the provision of nursing care to the patient, which
consists of the following components:
• general information about patient
• medical history
• the plan of nursing
• monitoring the condition of the patient
• the treatment plan
• consultations
All together makes a large number of paper
records, what with opportunities of modern
information technology are inadequate and
poorly managed. Handling of these kind of paper
files are time consuming and involves lot of
workforce.
Also there are need for physical space to storing
them (Picture 7).
Picture 7. All patients files are kept in these covers.
Doctor signs all orders in this document. This is
meant to be as a main working tool for nurses- for
getting and gathering information.
Picture 6. Medicine list and timetable on the wall of medicine
cabinet
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8. 3. CONCEPT
3.3 Mapping of information flow.
3.1 Need
To start with, we mapped out the information flow during the daily routine in one hospital department
(Picture 8).
As a result of observing current medication administration system and taking under consideration
background research what we presented in previous paragraphs, our team recognized a need to
redesign this system at all levels to make it safer - to make it harder for people to do something wrong
and easier for them to do it right.
In health care system there should be a working culture what can prevent possible mistakes, doesn’t
carry along errors what emerged in previous steps throughout all the process and avoid reliance on
memory. In the situation where patients to nurses ratio is enormous, there should be avoided all the
unnecessary working tasks.
Another issue is the under-usage of information technology possibilities in hospital practice.
Key Points for describing need :
• prevent errors
• save time
• storing as much information as possible
• convenient access of information
• user-friendly interface for IT solutions
• common operating environment for all levels of system
• the integration of different working processes
3.2 General concept
We found an opportunity for improvements. Our idea was to use benefits of info technological
solutions, so that they are not inconvenient for users and maintain the benefits of existing system. We
wanted to create a system that is as handy to use as notebook and pen, but is times more efficient.
We took an iPad as a convenient tool with lot of possibilities and features as a base to our new system.
We started creating a interface what is connected to a “smart” medicament distributing tray and at
the same time allows to record digitally any kind of information at all levels of communication line.
As far as we collect all the data in digital way its easy to transform it to all forms what are necessary
in hospital system.
Picture 8. Current information flow map
We marked down all the key factors into a simple and clear order and got a blueprint what shows all
the process and touch points (Pictures 9 and 10).
Picture 9. Key figures
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9. Explanations of error types on map:
Mishearing:
• misunderstanding of speech. Can hear wrong name, dose, type, quantity etc
• can not hear properly because of some kind of disturbing factor
Misinterpretation:
• can interpret the heard information wrongly
Writing error:
• misunderstanding handwriting
• cant write so quickly
• somebody might disturb and then there can be blanks
Timing error:
• cant write so quickly
• some information can be skipped due rush
• to save time, nurse may not write everything down and hope to relay on her memory
Medicine error:
• disturbed when distributing medicines
• open and prepare wrong medicine box
• wrong amount
• medicine mix up
• patient mix up
• mix up different time doses (morning pill amount goes to lunch blug etc)
Picture 10. Processes and touch points blueprint
Memory error:
• don’t remember the order
• dont remember on time
As one of our main targets was to reduce error possibilities, we marked down the type of errors and
the touch-points for them to possible rising up (Picture 11).
Nurse writing everything
down to nursing file
Doctor saying instructions
Nurse writing everything
down to notebook
Controlling error:
• doctor controls (signs) only nursing file, not PAPKA what is the main working document
Doctor signs
Nurse writing everything to
the “PAPKA”
Possible mistakes:
-
mishearing
misinterpretation
writing error
timing error
medicine error
memory error
controlling error
Nurse prepears medicines in
medicine cabinet
Nurse brings medicines
to the patient
Patient takes medicines
Picture 11. Current information flow and error points
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10. Automated Kanban System
3.4 Different existing concepts
There are several existing high tech solutions for automated medicine dispensing systems worked
out. We analyzed the pros and cons for all of them and tried to sort out good features.
Cerner’s RxStation
Cerner is innovative health care company that has developed quite unique automated medicine
dispensing cabinet: RxStation. This cabinet allows hospitals to eliminate a source of potential human
error. This cabinet is connected to each patient’s electronic medical record (EMR). When clinicians
go to the cabinet to retrieve medications, they open the patient’s EMR and select the medication to
be administered. A drawer on the RxStation cabinet containing the appropriate medication at the
appropriate dose opens, allowing the clinicians to retrieve the medication. The tray and bin with the
correct medication illuminates and unlocks. All other bins and trays are secured. RxStation consists of
different modules that can be modified, added or removed to tailor it’s use for a given health system
(2).
Southwest Solutions Group have created another solution for better hospital inventory management.
It is called A Two-Bin Automated Kanban System. It uses spacesaver’s Frame WRX and StockBox
products. They say that Kanban helps to balance between not running out of medical supplies and
managing inventory overhead cost.
One main component of this system is StockBox (Picture 13) that uses RFID technology to automate
medicine replenishment process.
All the medical inventory is kept in open trays in Frame WRX (Picture 14).
Picture 13. StockBox with RFID technology
Picture 12. Cerner’s RxStation
Picture 14. Frame WRX
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11. 4.DESIGN
KirbyLester
Based on key-points of need, we decided to approach the problem from several angles and started
to create two mutually complementary solutions:
• MedBook application - easy to use interface for safer, quicker and more effective information
administration
• MedTray- what is connected through the dock to the MedBook app and supports nurses in
medicine distribution, helping prevent errors and save time.
Kirby Lester provides systems that
feature the latest technology like
built-in work-flow software, pharmacy
management system interfacing, onscreen drug imaging, order history
and tracking, reports, and other
features previously only available
on more expensive and complicated
systems. Kirby Lester systems not
only help improve counting accuracy
and reduce labor time, but they
also help to reduce and eliminate
dispensing errors.
4.1 Interface of the App
According to our blueprint we mapped out the App structure (Picture 17).
Picture 15. Kirby Lester’s KL 100 pharmacy robot
HD Medi ATDPS
The Automatic Tablet Dispensing and Packaging
System (ATDPS) is a fully-automatic, drug-specific,
and patient-individual dose packaging system for
strings of transparent sachets. The system can
dispense, pack and print sachets for single or
multiple doses, as well as mixed doses with all
the important dose administration information. A
maximum of 3600 drugs doses can be processed
per hour for automatic dispensing to more than
1800 beds. The Special Tablet System (STS) is
incorporated and allows the inclusion of special
tablets in the production run.
The system is compatible with all standard hospital
information and patient administration systems.
Authorization is conveniently handled using RFID
(a unique radio frequency code) and provided
that a user has appropriate access rights, the
production can be managed. The trays used
for the STS are also labeled with a RIFD chip,
ensuring that only the right STS tray is accepted
by the ATDPS (3).
Picture 16. HD Medi ATDPS
Picture 17. App structure
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12. 03.01.2014 Fri
Top menu
Top menu contains four basic parts:
• “morning tour” section which is later changeable to “patient”
• medicine section
• tests
• food
Additional feature is calendar, quick button to home page and login profile, search bar.
We realize the importance of contact between nurse and doctor so we added contact feature and
date.
Left bar
We use left sidebar structure and expanded menu, because it’s simple and very easy to control your
logical location in the app. The buttons are designed in a way for easy understanding the relationship
between each branch. When each button is pressed the visual map can help nurse avoid mistake.
Right bar
Right bar are quick access to clock reminder, notes taking, printing, save, setting and refresh. It can
be dragged to the right to appear a board for above function.
Content
In the content there are basic information section about patient and their contact member. Notice
section keeps update the recently important issue about patients messages and condition. Current
information section contains medicine and food, it could be adjusted by finger for roll up and down to
view all the information.
In history section there is possible to change from calendar look to graph look, which improves the
understandability and easy edit by clicking. It can show operation time, test time and temperature at
the same time (Picture 18). So the nurse can have better knowledge of the patients condition whether
it’s getting better or not.
Patient
Medicine
Tests
Food
Patient Info
Photo
Contact
Notice
Name
Sex
Age
Tele
Adress
Changing operation room
Cloth washing is done
Reminder
5min ago
1hour ago
Building X in construction
yesterday
Name
Relasion
Tele
Adress
08:00
10:00
Current Info
-Medicine
-Food
Taking blood test
12:00
14:00 Taking medicine
History
16:00
Recording
Operation
Test
Temperature
Get test result
18:00
20:00
22:00
Picture 19. Automated reminder
03.01.2014 Fri
Patient
Medicine
Tests
03.01.2014 Fri
Food
Patient
Medicine
Building/Floor
Building/Floor
Patient Info
Department/Unit
Ward1
Name
Photo
Name
Name
Contact
Ward2
Name
Sex
Age
Tele
Adress
Changing operation room
Cloth washing is done
5min ago
1hour ago
Building X in construction
yesterday
Contact
Ward2
Name
-Food
Name
Relasion
Tele
Adress
Changing operation room
Cloth washing is done
yesterday
Food
Breakfast
A: Pulled Pork Sandwich,Steamed Carrots
B: Cream Style Corn,Biscuit
-Medicine
Lunch
A: Rosemary Roasted Potatoes,Sauteed Cabbage
B: Sauteed Zucchini & Tomatoes Dressing
A: Chicken Breast Tampico
B: Shrimp & Sausage Jambalaya
Name
Name
5min ago
1hour ago
Building X in construction
Current Info
Ward4
-Medicine
Notice
Name
Sex
Age
Tele
Adress
Dinner
Ward3
Current Info
Name
Photo
Name
Name
Name
Relasion
Tele
Adress
Ward3
Ward4
Ward1
Name
Food
Patient Info
Department/Unit
Notice
Tests
-Food
Ward5
Ward5
Name
Name
Ward6
Ward6
History
Ward7
Ward8
Edit
Recording
Operation
Test
Temperature
Save
History
Ward7
Ward8
Edit
Recording
Operation
Test
Temperature
Visual map
Visual map
Picture 18. MedBook app’s patient page
Picture 20. Food choosing window
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13. We also add automated reminder (Picture 19) as backup during morning tour rush hour to reduce
mistake as well as nurse’s stress of recording everything correctly in such a short time.
03.01.2014 Fri
Patient
Medicine
Tests
Food
Patient
Medicine
Tests
Food
Friday 3.01
By clicking pencil button it will pop up a small window where the information is editable. For example
if you want to edit food, it brings up a check list (Picture 20). Its very easy and timesaving to do just
a few click and save. It automatically goes to the general system so kitchen gets all the information
at the same time.
Under food page (Picture 21), left bar gives the basic information about a day. Notice will show if
there’s patient left who hasn’t chosen the food yet or any problem occur. When all is correct then
“send” button will highlight so nurse can send all the list to the kitchen.
Food list is arranged by ward, when a patient is not allowed to eat (for example in case of scheduled
operation), it will automatically appears cross and it is not active for choices.
Because there are other organizations involved in the food distribution, then it’s possible to create
food lists also as a order for all the units and all patients, dinner, supper, etc (Picture 22).
By clicking the triangle it is possible to arrange all the information in a way as it needs to be - date,
building, department etc. It’s automatically calculates the total amount of certain types of food for a
certain time.
In the Medicine page (Picture 23) we use intelligent searching function at the top. If you insert “a”
,
then the database automatically provides the most possible choices. It turns to blue when it’s been
chosen.
Also there is possibility to search by category. By clicking on the second bar, the drop list will show
all the general categories, and further it changes to the sublists. When item is chosen then it will turn
to blue and the left column appears with its content.
The list gives a warning when the medicine runs out of stock. By quick clicking there is possible to
place an order for them from center pharmacy. Also you can add “favorites” to the search list. When
patient list is chosen it will give all the information about certain medicine.
03.01.2014 Fri
Patient
Medicine
Tests
Breakfast
Lunch
Dinner
Food A
Chicken Breast
tampico
Food B
Shrimp & Sausage
Jambalaya
Notice
Picture 22. Food page
03.01.2014 Fri
Food
Friday 3.01
W ard 1
Patient
Food A
Food B
Remark
W ard 5
Patient
Breakfast
******
******
Remark
******
Medicine List
a
******
******
Food B
******
Lunch
Food A
Dinner
Food A
W ard 2
Patient
Food A
Food B
Remark
W ard 6
Patient
Food B
Food B
Remark
W ard 7
Patient
Fluoroquinolones
Aminoglycosides
Tuberculosis
Food A
Food B
Fungal infections
Remark
******
******
******
Malaria
******
******
Otheranti-infectives
******
W ard 4
Drug Detail
Viral infection
******
Notice
dicloxacillin
Tetracyclines
******
Food A
penicillin v potassium
Macrolides
******
Patient
ampilicin susp
Cephalosporins
Remark
******
******
Food A
******
******
W ard 3
ampicillin caps
Penicillines
******
Food B
amoxil drops
All
Distribution
******
Chicken Breast
tampico
Shrimp & Sausage
Jambalaya
Patient List
amoxicillin
amoxicillin
Patient
Food A
Food B
Remark
W ard 8
Patient
******
******
******
Remark
******
******
Food B
******
******
Short cut
Food A
******
Picture 21. Food page
+
Add shortcut
Picture 23. Medicine page
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Order

14. 4.2 Appearance
Step 1. Dock stays in medicine storage room. It also has a charging function.
Picture 24. “MedTray” iPad dock
Step 2. If placed to the dock, overall medicine distribution list opens. As there are need for distribution
several times a day, then system automatically recognize a right time and shows a list for medicines
what needs to be prepared.
Picture 25. “MedTray” dock with iPad
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15. Step 3. Placing the tray ontop of the lightpanel (Picture 26).
Step 5. Holes are filled with paper cups (Picture 28).
Picture 26.
Picture 28.
Step 4. System lights up holes for these patients who needs medications in this distribution time
(Picture 27).
Extra feature: we are using different colored cups for marking patients in ward (Picture 29)- we
would like to suggest that in ward there are different places marked with different colors - bedsheets,
cupboards, pijamas of patients or something else. Then its another proof that right medicine cup goes
to right patient.
Picture 27.
Picture 29.
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16. Step 6. Barcode reader window opens (Picture 30).
Step 8. According to prescriptions right holes lights up. Amount of light dots indicates how many bills
are needed to this cup (Picture 32).
Picture 30.
Picture 32.
Step 7. Front camera reads barcode and detailed drug information appears (Picture 31).
Step 9. After all necessary cups are filled, all lights are closed. Next step is inactive if there are some
missing bills (Picture 33).
Picture 31.
Picture 33.
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17. Step 10. The same procedure repeats with next medicaments from list until all needed are distributed
(Picture 34).
Picture 34.
4.3 Making a prototype for a MedTray
Picture 36.
Picture 37.
Picture 38.
Picture 39.
Step 11. Medicaments are ready for distribution (Picture 35).
Picture 35.
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18. 4.4 Product value
Med Book application would be working-tool for nurses that would be easy to use
and due to this inserting and editing information would be easy and convenient. They would not need
to do unnecessary tasks.
If we compare “before” and “after” information flow maps, then it shows that most of the errors would
be eliminated from the system after using MedBook together with MedTray. Not to mention the time
what it would save and digitally recorded material what would be available for all levels of health care
system.
Benefits:
• preventing errors
• saves time
• information is quickly editable and controllable
• device is handy to use and portable
• information is recorded digitally- allows easy transfers to other systems
• information is in one common environment- available for all levels of system
• all the records are quickly available and creates possibilities to quick analyses
Nurse writing everything
down to nursing file
Doctor saying instructions
Nurse writing everything
down to notebook
Doctor signs
Doctor signs
Nurse writing everything to
the “PAPKA”
Doctor saying instructions
mishearing
misinterpretation
writing error
timing error
medicine error
memory error
controlling error
Nurse prepears medicines in
medicine cabinet
Possible mistakes:
Possible mistakes:
-
Nurse writing everything
down to iPad
Nurse prepears medicines in
medicine cabinet
Picture 40. Previous information flow map
Nurse brings medicines
to the patient
Patient takes medicines
-
mishearing
misinterpretation
writing error
timing error
medicine error
memory error
controlling error
Picture 41. New information flow map
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35
Nurse brings medicines
to the patient
Patient takes medicines

19. 5. SUMMARY
The implementation of modern information technology affects health care system heavily. The use
of information technology in health and medical treatment improves the quality of service, as well as
giving it the opportunity to significantly reduce the cost, which is related to the medical service.
At the moment most health care institutions use different information systems, which are not able to
exchange information with each other smoothly yet, but it is improving every day.
As long as the use of a computer for everyday work is troublesome additional commitment for nurses
there is amount of information what remains unsaved.
We are sure that if the interface of device is convenient, then users will soon see it rather than the
helping tool then a tedious extra duty.
6. REFERENCES
1. http://www.iom.edu
2. http://www.cernerrxstation.com/
3. http://www.hdmedi.eu/en/products/packaging
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