REPORT: September 2006

Can technology prevent medication errors?

by Lydia Belardo, MS, RN, Associate Director, NYSNA Nursing Advocacy & Information Program

• Related article: Electronic health records on fast track?

If you work in a direct care setting, odds are that you or a colleague has either made a medication error or prevented one from happening. Registered nurses are the professionals who administer the most medications and, consequently, are the most likely to be cited for making medication errors.

It is important, however, to recognize that administration is the final step in a complex medication process. Errors can occur at various points throughout the process, and may involve the prescriber, pharmacists, pharmacy technicians, and unit clerks. No one will deny that “to err is human,” but the key to minimizing risks and improving patient safety is to understand the root causes of medication errors. It is then possible to develop some solutions.

Error prevention a high priority

In recent years, preventing medication errors has become a priority among various performance improvement initiatives (Poole et al. 2006). The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has made medication management one of their 14 priority focus areas for accredited organizations.

According to JCAHO (2004), medication management is a challenging endeavor, but organizations can reduce errors by instituting strategies such as:

• Error reporting for both actual errors and near misses, which can help provide information that can be used for system changes;
• Effective written and verbal communication;
• Comprehensive orientation and training to new and existing members of the medication management team;
• Standardization of abbreviations, acronyms, symbols and dosage expressions;
• Timely access to critical patient information, such as histories, medications taken, laboratory data, allergies, and adverse reactions;
• Application of evidence-based practices that support medication interventions;
• Review of patient care documentation for consistency and effectiveness; and
• Implementation of technology solutions such as computerized orders, bar coding, computerized medication administration records, automated storage and distribution devices, and high-tech infusion devices.

Technology can help

Medication management has become highly dependent upon technology. Technological advances used by many facilities include bar coding, smart infusion systems, and computerized order-entry (COE).

Nurses use bar-code systems at the bedside to interface via real-time wireless technology with admission-discharge-transfer and the pharmacy. Software allows nurses to cross-check patients with identification badges and medication labels. When the nurse scans a bar code on the patient’s ID badge, the computer identifies the medication order for that patient (Anderson & Wittwer, 2004).

Smart infusion pumps reduce the risk of errors associated with the administration of intravenous (IV) medications. The pumps include computerized programs that recognize when a dose or rate is outside of a hospital’s predefined limits. Many of these systems have comprehensive drug libraries, dosing limits, and best practice guidelines. Hospitals also input facility-specific information into the pumps, such as drug names, concentrations, dosing units, and dose limits (Vanderveen, 2005).

Computerized order entry (COE) has helped many facilities to eliminate confusing and illegible orders, a common source of medication errors. COEs are electronic systems that accept orders in a standard format and also alert prescribers to potential problems. Systems can be customized to include assistance with calculations, drug allergy warnings, and reminders about corollary orders, such as blood glucose monitoring when insulin is administered. This technology has been found to reduce errors and to save time previously spent by nurses and pharmacists calling prescribers with questions (Grissinger & Globus, 2004).

Only part of the solution

While technology provides many new safeguards, technology is only part of the solution in preventing medication errors. A comprehensive strategy extends beyond bar codes, smart pumps, and computerized order-entry systems. It must include people at every level of the process. In order for technology to be effective, facilities must choose comprehensive medication administration systems that meet the needs of the facility, staff, and patients.

The Institute of Medicine estimates that 82% of medication errors are caught by registered nurses. Nurses clearly should have a role in the process of selecting medication administration technology and provide input on the error reporting system. RNs and other workers should receive thorough training on new software and equipment for the system to be effective.

For further information, NYSNA members may call the NYSNA Library (800-724-NYRN, ext. 266) to receive full-text versions of the referenced articles. You may also wish read the “Research News You Can Use” column on page 7 of this issue.

Note: This article was written at the request of the Functional Practice Unit of Direct Care Practitioners during its 2005 Convention business meeting.

References

Anderson, S., & Wittwer, W. (2004). Using bar-code point-of-care technology for patient safety. Journal for Healthcare Quality, 26(6), 5-11.

Grissinger, M., & Globus, N. J. (2004). How technology affects your risk of medication errors. Nursing2004, 34(1), 36-41.

Joint Commission on Accreditation of Healthcare Organizations. (2004). Medication station. Medication management as a priority focus area. Joint Commission Perspectives on Patient Safety, 4(6), 3, 6.

Poole, D. L., Chainakul, J. N., Pearson, M., & Graham, L. (2006). Medication reconciliation: A necessity in promoting a safe hospital discharge. Journal for Healthcare Quality, 28(3), 12-19.

Vanderveen, T. (2005). How IV safety systems have prevented medication errors. American Journal of Nursing, 105(3S), 40-41.

Electronic health records on fast track?

While many hospitals have moved to computerize patient records, prescriber orders, and medication administration, this information usually does not follow patients after they leave the hospital.

Legislation passed by both houses of Congress this summer would remove legal barriers to the creation of a nationwide electronic medical record system. President George Bush has called for all Americans to have electronic medical records by 2014.

Differences between the House and Senate versions of the bill may delay its enactment until after the November election, but both include millions in funding to help hospitals and private practitioners purchase computers and software. The U.S. Department of Health and Human Services recently announced the formation of an Office of National Health Information Technology, which would “carry out programs and activities to develop a nationwide health information technology infrastructure.”

Concerns have been raised by consumer groups that existing privacy laws would not adequately protect patients in a nationwide computerized system. Some state laws are stricter than the national HIPAA guidelines, which also must be addressed before a nationwide system can be established.