Improving Process through Technology
Doctors are famous for sloppy scribbling -- and handwritten prescriptions lead to thousands of medication errors each year. Electronics to the rescue: most hospitals that switched to computerized physician order entry systems saw a 66 percent drop in prescription errors. Illegible handwriting and transcription errors are responsible for as much as 61 percent of medication errors in hospitals. A simple mistake such as putting the decimal point in the wrong place can have serious consequences because a patient's dosage could be 10 times the recommended amount. Drugs with similar names are another common source of error, such as the pain medication Celebrex and the antidepressant Celexa, or the tranquilizer Zyprexa and the antihistamine Zyrtec. These medication errors are very painful for doctors, as well as the patients. Nobody wants to make a mistake. Medication errors include prescribing the wrong drug or incorrect dosage or administering a drug at the wrong time or not at all. Most errors typically go undetected unless they led to an adverse event. In addition to improving patient safety, computerized systems make life easier for pharmacists. "They don't have to decipher the chicken scratch. Pharmacists frequently have to call the prescribing doctor or interview the patient because of problems in deciphering handwriting. Currently, only about 9 percent of hospitals have computerized prescription systems. Some hospitals have stand-alone systems, while others have computerized prescriptions as part of an electronic medical record system. Each year, more health systems implement computerized order entry systems and more will do so as electronic medical records become more common. "It's a growth industry," It takes 12 to 36 months to implement computerized prescribing system, currently, no industry standard system exists. Some hospitals use systems created in-house, while others use commercial products created by companies. Some systems guide doctors through the prescription process, asking questions that might help avoid errors. Some even use voice recognition. There are two reasons why more hospitals have not switched to electronic prescription systems. First, "Physicians, like most of us, don't like change. In addition, electronic prescription systems are costly and difficult to integrate into the complex, sometimes-chaotic hospital structure. Regardless, in hospitals with a computerized prescription system, the number of medication errors dropped. However, the rate of one type of error --prescribing the wrong drug -- did not decrease, and in five studies, the number of adverse events from drug errors did not decrease. Each year, more than one-half million patients sustain injuries or die in hospitals from adverse events, according to the study. In hospitals with a higher number of medication errors -- more than 12 percent -- computerized systems made the biggest improvement, the researchers found. As nearly every industry becomes more computerized, the doctor's prescription pad should go the way of scarification used in the 20th century for bloodletting. "Written and verbal orders should be a no-no"
MEDICATION ERRORS TARGETED
The delivery of medication typically involves 5 distinct steps which include the following: prescribing, transcription, dispensing, administration, and monitoring. Table 1 illustrates the results of a study which indicate that most of the errors occur at prescribing or administration stage.
Table 1: Medication Errors
Medication ErrorsTypes of Errors
Prescribing 39%Wrong Dose 28%Drug-drug Interaction 3%
Transcription 12%Wrong Choice 9%Wrong route 2%
Dispensing 11%Wrong Drug 9%Extra Dose 1%
Administration 38%Known Allergy 8%Failure to act on a test 1% Monitoring 1%Missed Dose 7%Equipment Failure 1%
Wrong Time 7%Inadequate monitoring 1%
Wrong Frequency 6%...