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Senior Citizen Health & Medicine
Skyrocketing Hospital Medication Errors Can Be
Reduced 66%, Says New Study
Senior citizens most at risk as largest medication
consumers
 June 27, 2007 – The rate of medication errors
experienced by hospitals has skyrocketed from only 5 percent in 1992 to
nearly 25 percent today – a deadly consequence for many senior citizens,
who are most likely to fall victims to medication mistakes. A study from
the University of Minnesota has found a rather easy way to decrease
these errors by as much as 66 percent.
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Doctors are famous for sloppy scribbling — and
handwritten prescriptions lead to thousands of medication errors each
year. Electronics to the rescue: U.S. hospitals that switched to
computerized physician order entry systems saw a 66 percent drop in
prescription errors, according to the new review of studies.
Illegible handwriting and transcription errors are
responsible for as much as 61 percent of medication errors in hospitals.
A simple mistake such as putting the decimal point in the wrong place
can have serious consequences because a patient’s dosage could be 10
times the recommended amount.
Drugs with similar names are another common source
of error, such as the pain medication Celebrex and the antidepressant
Celexa, or the tranquilizer Zyprexa and the antihistamine Zyrtec.
“These medication errors are very painful for
doctors, as well as the patients. Nobody wants to make a mistake,” said
Tatyana Shamliyan, lead review author and a research associate at the
University of Minnesota School of Public Health.
The incidence of medication errors can be reduced
by implementing a computerized physician order entry (CPOE) system,
according to a review of several studies conducted by the researchers.
The review, recently published in the online
journal Health Services Research, analyzed 12 studies conducted between
1990 and 2005 that compared the number of handwritten and computerized
medication errors made by hospital physicians.
Medication errors include prescribing the wrong
drug, ordering an inaccurate dosage, or administering a drug at the
wrong time. These mistakes dropped by as much as 66 percent in United
States hospitals that switched to a CPOE system.
Illegible handwriting and transcription errors
account for more than 60 percent of medication errors.
“Most errors typically go undetected unless they
led to an adverse event,” said review co-author Robert Kane.
In addition to improving patient safety,
computerized systems make life easier for pharmacists. “They don’t have
to decipher the chicken scratch,” said Karl Gumpper, director of the
pharmacy informatics and technology section of the American Society of
Health-System Pharmacists, based in Bethesda, Md. Pharmacists frequently
have to call the prescribing doctor or interview the patient because of
problems in deciphering handwriting.
Currently, only about 9 percent of hospitals have
computerized prescription systems. Some hospitals have stand-alone
systems, while others have computerized prescriptions as part of an
electronic medical record system.
Each year, more health systems implement
computerized order entry systems and more will do so as electronic
medical records become more common. “It’s a growth industry,” Kane said.
A small handful of institutions, including Brigham
and Women’s Hospital in Boston and Vanderbilt University Medical Center
in Nashville, have been leaders in integrating computerized
prescriptions, experts say.
It takes 12 to 36 months to implement computerized
prescribing system, Gumpper said. Currently, no industry standard system
exists. Some hospitals use systems created in-house, while others use
commercial products created by companies such as Epic Systems, based in
Verona, Wis. or McKesson Corp., based in San Francisco.
Some systems guide doctors through the prescription
process, asking questions that might help avoid errors. Some even use
voice recognition.
“Patient safety is our final goal,” said
Shamliyan.
“Evidence from these studies show
that computerized systems can reduce mistakes, but unfortunately less
than 50 percent of hospitals have implemented these systems. There is a
lot of work to be done in the future.”
The rate of medication errors by hospitals has
climbed from only 5 percent in 1992 to nearly 25 percent today. The
review found that of these hospitals, CPOE systems were most beneficial
when the rate of medication errors was more than 12 percent.
There are two reasons why more hospitals have not
switched to electronic prescription systems, says Arthur Levin, director
of the Center for Medical Consumers in New York. First, “Physicians,
like most of us, don’t like change,” he said. In addition, electronic
prescription systems are costly and difficult to integrate into the
complex, sometimes-chaotic hospital structure.
Regardless, in hospitals with a computerized
prescription system, the number of medication errors dropped, especially
among adult patients. However, the rate of one type of error
—prescribing the wrong drug — did not decrease, and in five studies, the
number of adverse events from drug errors did not decrease.
Each year, more than one-half million patients
sustain injuries or die in hospitals from adverse events, according to
the study.
Medical schools in the United States rarely address
penmanship. It is the same in Russia, says Shamilyan, who studied there.
However, at least one medical school in the United States, Indiana
University in Indianapolis, teaches penmanship to students in hopes of
avoiding errors.
As nearly every industry becomes more computerized,
Levin says the doctor’s prescription pad should go the way of
scarification used in the 19th century for bloodletting. “Written and
verbal orders should be a no-no,” he said.
The Institute of Medicine has already identified
medication errors as a major threat to patient safety and has endorsed
electronic prescribing of medication as an effective method in
correcting the problem.
Medication errors are among the most common medical
errors, harming at least 1.5 million people every year, according to the
report last year from the Institute of Medicine of the National
Academies that was funded by the Centers for Medicare and Medicaid
Services.
Senior citizens, because they are the largest
consumers of medication, are at the highest risk from these errors.
“Medication errors are a central aspect of
improving hospital safety. CPOE can help that process,” says Robert
Kane, M.D., review co-author.
“Hospitals would be short-sighted not to use it.”
Kane also notes that CPOE systems can be combined with existing
computerized medical records, creating a central location for physicians
to efficiently enter and view past and present patient prescriptions and
medical history.
While the review found that the number of
medication errors dropped as a whole, the incidence of one type of
error, prescribing the wrong drug, did not decrease.
In five of the
twelve studies, the number of adverse events from drugs errors did not
decrease. More than one-half million patients suffer injuries or death
from adverse events, causing up to $5.6 million annually per hospital,
according to the review.
Editor's Notes:
Health Services Research is the official journal of
AcademyHealth and is published by Blackwell Publishing on behalf of the
Health Research and Educational Trust. Contact Jennifer Shaw, HSR
Business Manager, at (312) 422-2646 or
jshaw@aha.org. HSR is available online at
http://www.blackwell-synergy.com/loi/hesr.
The Academic Health Center is home to the
University of Minnesota’s six health professional schools and colleges
as well as several health-related centers and institutes. Founded in
1851, the University is one of the oldest and largest land grant
institutions in the country. The AHC prepares the new health
professionals who improve the health of communities, discover and
deliver new treatments and cures, and strengthen the health economy.
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