Hospitals in California are going far beyond a state requirement that they put in place one form of technology to help detect and prevent medication errors, an analysis of safety plans suggests.
In a study of strategies that 344 hospitals submitted to state regulators prior to Jan. 1, 2002, the California HealthCare Foundation says that hospitals, on average, plan to implement 2.8 technologies each, with the most popular being computerized physician order entry, chosen by 46% of facilities.
"Hospitals responded expansively to legislative requirements. Many hospitals went far beyond minimum requirements, even when legislation provided specific exemptions," states the report, published Wednesday.
"It was encouraging more than a surprise," says lead author Bruce Sperlock, M.D., president of Convergence Healthcare Consulting, Sacramento, Calif. "It was encouraging that some of my earlier observations were accurate."
Convergence produced the report on behalf of the foundation, an Oakland-based charity that advocates clinical and administrative improvement of the healthcare delivery system.
Most California hospitals were required to submit plans for measuring and reducing medication errors under a 2000 law, the Minimization of Medication-Related Errors Bill, also known as the Medication Safety Bill or Senate Bill 1875. They have until Jan. 1, 2005, to meet their goals or risk losing their state licenses.
The CHCF report says that California will set a high standard for quality improvement if hospitals actually follow through on their plans, but the foundation cautions that few institutions have concrete strategies to measure error detection and reduction other than by self-reporting, which can be unreliable.
"Part of the problem is that we rely on voluntary error reporting," Sperlock says.
According to the report, "Importantly, hospitals rarely describe what level of participation they expect from their physicians. In particular, descriptions of CPOE deployment usually do not address the percentage of physicians expected to use the technology described."
Based on anecdotal evidence, Sperlock says there might be some problems meeting CPOE goals. Order entry systems vary greatly in their functionality and hospitals have different requirements for physician participation, so compliance may be hard to measure, the report says.
Sperlock says he hopes to conduct a follow-up study after the 2005 implementation deadline.