The Essentials of Patient Safety - Clinical Human Factors Group

The Essentials of Patient Safety
drug interactions and saved nurse time. Finally, the patients themselves were engaged
in the process. Each patient admitted to the hospital is now given a Medication Safety
Brochure that provides advice for them and a form on which to list their current
medication. Patients are also actively encouraged to check with staff if they have been
patients leaving hospital returned to the medication appropriate to their life at home.
Technological innovations, in the form of automated medication dispensing machines,
formed the next phase of the drive to further reduce errors.
Using information technology to reduce medication error
Information technology can reduce error in a number of different ways: improving
communication, making knowledge more readily accessible, prompting for key pieces
of information (such as the dose of a drug), assisting with calculations, monitoring
and checking in real time, and providing decision support(6). Many medication errors
occur because clinicians do not have the necessary information about either the
patient of the drug or because test results are not available. Hand written
prescriptions, transcribing errors and calculation mistakes are also major problems.
Several medication technology systems have been developed to address these and
other problems operating at various stages of the medication and delivery process.
They show great promise but, as David Bates warns, are not a panacea:
the net effect is not entirely predictable, and it is vital to study the impact of
these technologies. They have their greatest impact in organizing and making
available information, in identifying links between pieces of information, and
in doing boring repetitive tasks, including checks for problems. The best
medication processes will thus not replace people but will harness the
strengths of information technology and allow people to do the things best
done by people, such as making complex decisions and communicating with
(7).
The system that has probably had the largest impact on medication error is
computerized physician order entry (CPOE), in which medication orders are written
online. This improves orders in several ways. First, they are structured, so they must
include a drug, dose and frequency; the computer, unlike a person, can refuse to
accept any order without this information. They are always legible, and the clinician
making the order can always be identified if there is a need to check back. Finally, all
orders can be routinely and automatically checked for allergies, drug interactions,
liver and kidney function. Clinical staff may fear that these advantages may be offset
by the time lost in typing rather than writing orders, but in practice there is minimal
difference (9).
Bates and his colleagues (10) showed that the introduction of a computerised
order entry system resulted in a 55% reduction in medication errors. This system
provided clinicians with information about drugs, including appropriate constraints on
choices (dose, route, frequency) and assistance with calculations and monitoring.
With the addition of higher levels of decision support, in the form of more
comprehensive checking for allergies and drug interactions, there was an 83%
reduction in error. Other studies have shown improvement of prescribing of
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