As technology improves, so does medical error reporting

FRAMINGHAM (11/20/2003) - Reported medication errors in hospitals are on the rise, according to a study released Tuesday by U.S. Pharmocopeia (USP), a nonprofit, standard-setting organization promoting safe use of medications. The study found 192,477 reported errors at 482 hospitals and healthcare facilities in 2002, which was an 82 percent increase from the 105,000 reported errors in 2001 (with 31 percent, or 149, more organizations surveyed). Of the 192,477 errors, 1.7 percent, or 3,213, accounted for patient injuries, compared with 2.4 percent, or 2,520, errors in 2001. "The increase in errors can be partially attributed to more hospitals participating in the study, different types of hospitals submitting data, and an upsurge in reporting," said a USP spokesperson.

Medical staffers at participating hospitals anonymously entered errors into MedMarx, a national database with more than 530,000 medication error records.

Many factors were responsible for the increases, but technology gets off easy with a mere 8.2 percent of errors attributed to computer entry. The increase of reported errors is likely to rise, as more provider organizations use technology (to measure errors) in care-giving departments, stated Scott Wallace, president and chief executive of the National Alliance of Health Information Technology (NAHIT).

"There will be more reported errors as more people use certain applications, such as computerized physician order entry (CPOE) and bar-coding systems," Wallace said. "Errors identified as near-misses and non-harmful are not tracked well and tend to cause a panic without actually addressing the severity (of the errors). We are starting to see more errors, because detection systems are improving. This is a good thing, because technology has the ability to improve patient care and safety," Wallace added. CPOE systems are currently deployed at nearly 5 percent of hospitals in the U.S., according to the Leapfrog Group.

Leading types of errors cited were dose omission (25.6 percent), improper dose/quantity (25.6 percent), and prescribing errors (18.5 percent). Errors were also broken up by their impact: non-harmful, 82.7 percent; potentially harmful, 15.6 percent; harmful, 1.66 percent; and fatal, less than 1 percent.

According to Wallace, more work needs to be done in order for technology to make more of a difference for reporting errors and better patient safety.

"The deployment of technology in healthcare is a building-block process," Wallace said. "Getting information into a digital format for electronic medical record (EMR), CPOE, and bar-coding systems is an important first-step building block, but people need to realize that these (applications) are tools for tracking errors rather than solutions."

A low rate of technology adoption, coupled with high implementation, training, and software costs, continues to be a challenge for healthcare organizations.

"A proactive commitment is required (by an entire organization) when deciding what systems to deploy," said Diane Cousins, USP vice president of the Center for the Advancement of Patient Safety. "Technology is not a panacea that solves all problems for medical error reporting. There are a lot of non-technology components involved, and high costs often force providers to find alternative ways to measure errors."

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