Technology drastically reduces medication errors, but poor history-taking ups mistakes

Hospitals that deploy bar-coding technology with an electronic medication administration record (eMAR) may prevent an estimated 90,000 medication errors per year, according to Dr. Eric G. Poon, director of clinical informatics at Brigham and Women's Hospital in Boston, whose new study appears in today's New England Journal of Medicine.

With bar-code eMAR in place, pharmacists send approved medication orders from physicians to the patients' charts electronically. Nurses then scan the bar code on the medication and the bar code on the patient's wristband before administering the drug. The system warns the nurse if the two bar codes do not match or if it is not the correct time to administer the drug.

For the study, Poon's team compared 6,723 medication administrations before the bar code system was in use with 7,318 medication administrations after the system was introduced, and noted the following improvements with the latter:

  • A 27 percent reduction in timing errors by an hour or more (with no errors or potential drug-related adverse events occurring from this type of error).
  • A 41 percent drop in administration errors not related to timing.
  • A 51 percent drop in potential adverse drug events not related to timing.

Whether preventing errors saves money isn't known, but the study authors plan on doing a cost-benefit analysis of the $10 million system, reports HealthDay News.

Dr. Chris Longhurst, medical director of clinical informatics at Lucile Packard Children's Hospital in Palo Alto, Calif., who recently published his own study indicating that CPOE could cut hospital mortality by 20 percent, said that "this adds evidence to the mounting pile that the last piece guaranteeing or verifying medication safety is bar coding."

However, any technology is only as good as the data that it holds. A separate study conducted at Northwestern Memorial Hospital indicated that as many as 85 percent of medication errors originate in the patient's medical history, more than half of which can be traced back to incomplete or incorrect medication information collected during admission.

Over one-third of the 651 study inpatients experienced medication discrepancies resulting in order changes. If these errors went undetected, 52 percent may have required intervention to preclude harm and 11 percent were rated as potentially harmful.

"Obtaining medication histories from patients is really challenging and errors are all too common. For patients with language barriers, impaired mental function, and severe illness, the process is even harder. Doctors also face time constraints. But, part of the problem is that most doctors were never really taught how to take complete medication histories. If a patient can bring in a list of their usual medications, or if we can access the latest list through the electronic health record, this helps decrease discrepancies," said David Baker, MD, professor of medicine and chief of general internal medicine at Northwestern University Feinberg School of Medicine and Northwestern Memorial and a co-investigator for the study. Researchers also noted that EHRs are not a panacea, as not all systems are integrated.

The authors concluded that clinicians should help patients maintain complete, accurate and understandable medication lists and encourage patients to bring their lists and prescription bottles with them at every healthcare encounter.

To learn more:
- read this HealthDay News article
- read this article in The Medical News
- check out this post on Injuryboard.com
- read this New England Journal of Medicine abstract
- here's another article in The Medical News
- read this abstract in The Journal of General Internal Medicine

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