When it comes to medication safety, healthcare information technology can create opportunities for errors, but error severity under these systems is significantly lower than in healthcare settings without IT, according to a study by U.S. Pharmacopeia.
The study by the private, not-for-profit drug standards organization based in Rockville, Md., looked at more than 580,000 medication errors reported by 570 hospitals and healthcare facilities to its Medmarx medication error program between 1999 and 2003. In that last year, one in five errors involved some form of computerization or automated dispensing system.
"USP is not trying to make a point that people should not implement IT or that IT is dangerous," said Diane Cousins, vice president of the organization's Center for the Advancement of Patient Safety. "Having this database is a way for people to learn from the errors of others and not repeat them."
Overall, Cousins said, the data shows that 1.5% of errors reported to USP caused patient harm, but just 0.7% of those errors involving computer entry resulted in harm. Computer entry, or CE, systems include the lab, nurses and the pharmacy as well as the prescriber. And in a subset of CE systems -- computerized prescriber order entry, or CPOE, systems -- only 0.1% of errors reported resulted in harm, Cousins said.
Still, as the systems come into wider use, the total number of errors attributable to them has increased, according to USP. In 1999, with 56 hospitals reporting, 458 errors, or around 7% of the 6,224 errors reported, were attributed to CE systems, Cousins said. By 2003, with 570 hospitals reporting, 27,711 errors, or 13% of 212,754 errors were attributed to CE systems, she said.
CPOE was the fourth leading source of medication errors in 2003, according to the study.
What has been described as "performance deficit," where the practitioner has the required skills and knowledge to complete the task but makes a mistake anyway, was the leading cause of these computerized entry errors. Distractions were the leading contributing factor, figuring in nearly 57% of the CE errors, according to U.S. Pharmacopeia.
Facilities using CPOE had slightly above average incidences of errors due to wrong dose or wrong dosage form -- for example, tablet instead of injection -- than those without the systems. The total number of errors per 100,000 doses dispensed was nearly the same.
Dosing errors -- either prescribing the wrong dose, an extra does or omitting the dosage -- accounted for almost 29% of CPOE errors, with "knowledge deficit," described as unfamiliarity with the system, as the most frequently reported additional cause of error.
Automated dispensing devices, in use in more than half the hospitals in the U.S., were implicated in nearly 9,000 medication error events last year, 1.3% of which resulted in harm to a patient. They were the 10th leading cause of medication errors, and nearly 70% of them were either a wrong dose or a wrong drug error.
Errors with computerized systems occurred at all phases of the order entry and drug delivery process, from prescription, to transcribing and documenting, to dispensing, to administering, to monitoring, according to U.S. Pharmacopeia, but errors in transcribing/documenting and dispensing were most common.
"We need to be careful in interpreting this data," said Eric Poon, M.D., a physician scientist with the clinical informatics research and development group at Partners Information Systems, part of the Partners Healthcare system in Boston. For one thing, the data is entirely self-reported and the numbers of errors reported recently is far more than those a few years ago, so its relevance over time is affected, according to Poon.
"What they are reporting is the numerator, not the denominator," he added, so the rate of errors as a function of the number of transactions processed through computer systems cannot be calculated. He warned that strong evidence shows that computerized systems significantly reduce medication errors.
Still, he said, "Errors are being made and the database can help inform us about what errors are being made. They obviously have done a great job of getting people to share their near misses and errors across systems.
"My hope is they can take it one step forward. They need to feed this back to the software developers to inform them on how to design the next generation of systems."