Closing the Loop on Medication Errors - Technology Information

Health Management Technology, Dec, 1999 by Billie Waldo

By now, most healthcare professionals are well aware of the staggering consequences of adverse drug events (ADEs) for patients and healthcare organizations. A sampling of recent findings represents the price of ADEs in terms of deaths, disability and dollars:

* Nearly 200,000 patients die each year from ADEs;

* More than 700,000 patients are injured each year by ADEs;

* One hospital alone spent $5.6 million in one year on ADE-related problems.

Perhaps most significant--and chastening--among the recent findings is the Journal of the American Medical Association's (JAMA) conclusion that medication errors are largely preventable.

Given such sobering facts, the driving concern among healthcare providers is how to best address the serious ADE problem. As providers begin to search for potential solutions, the roles of information technology and pharmaceutical supply management invariably become more important. And they should.

Prevention Across the Medication Spectrum

By combining information technology and automated supply management, providers can drastically reduce medication errors--and their steep, sometimes fatal, cost. Automated systems provide check-points across the medication spectrum, from prescription to administering, and help ensure the "five rights" of medication management: right medication, right patient, right time, right dose and right route.

Imagine this: During rounds, a doctor enters an order at the point of care via a wireless or mobile computer, alerting the clinician about drug interactions. A correct order automatically triggers a pharmacist requisition. At the pharmacy, the order receives a unique bar code, and a robot, quickly and with perfect accuracy, matches the order's bar code to the corresponding bar code on the correct medication. It fills the order--and nearly 100 others--within the hour. Back at the point of care, a nurse scans the bar code on the medication and the patient's bar-code wristband. A match indicates it is safe to administer. A mismatch would create an alert, providing a potentially life-saving opportunity to doublecheck before proceeding.

This scenario is possible today using automated supply management and information technology products that significantly reduce medication errors at each phase of the medication process, increasing efficiency and effectiveness.

Prevention at Each Stage

The key to success in combating ADEs is first understanding when and how errors occur, and then implementing appropriate solutions to reduce potential for error at each stage. A recent study published in JAMA indicates that 90 percent of medication errors occur at the ordering and administration stages; the remaining 10 percent occur during transcription and dispensing.

Working together, automated supply management and information technology provide the most comprehensive protection against medication error because they incorporate checks at every stage of the process, dramatically curtailing the potential for error across the medication spectrum.

Prescription/Ordering

Online order entry at the point of care gives providers the full advantages of having the patient's complete electronic medical record at their fingertips, increasing efficiency and also eliminating errors caused by faulty manual transcription. Built-in alerts, interfaced with a comprehensive database of drug interactions, provide additional protection, warning clinicians of contraindications before the order is accepted. By taking advantage of information technology at this stage, providers can address 60 percent of the errors most likely to occur.

Dispensing

Automated drug distribution systems dramatically reduce errors that occur at the dispensing stage of the medication process. They also free pharmacists to consult with clinicians, which is proven to lessen the incidence of medication error. Using bar codes, automated drug distribution systems ensure a match between the clinician's order and the corresponding medication, filling orders more quickly and accurately than traditional methods.

Administering

Bar codes play a crucial role in reducing error during administration as well. Using a wireless device, caregivers can scan the bar codes on their own ID badge, the patient's wristband and the medication for a three-way crosscheck of key patient, medication and administration information. A built-in alert warns of discrepancies before administration, eliminating potential errors.

Going Forward

These days, few need convincing that an ADE problem exists, and most are aware of the enormous costs to healthcare providers and the patients they treat. But many are still unsure how to proceed. Three top professional organizations, American Medical Association, the American Nursing Association and the American Society of Health-System Pharmacists, endorse the use of computers to decrease errors by:

* Identifying drugs through proper labeling (bar coding);

* Documenting administration information;

* Tracking ADEs;

* Transmitting orders;

* Freeing pharmacists for direct clinical consultation.