Point of View: Patient Safety and Quality
By Tejal Gandhi, MD, MPH, Chief Quality and Safety Officer at Partners HealthCare
While it is critically important to deploy technology designed to improve medical safety, it is equally important to measure the effects of such technology and to be especially alert to any unintended results such as new errors. Clinicians, researchers, and staff at Partners HealthCare seek to continuously improve on the technology used in our hospitals and outpatient facilities by closely monitoring the impact of safety related applications.
Implementation of medication safety technology has been a longstanding priority at Partners Healthcare. Two examples of technologies that have been proven to reduce errors are computerized physician order entry (CPOE) and medication barcoding. Computerized prescribing in the outpatient setting (where prescriptions are typed on the computer and not handwritten) has also been promoted as a way to reduce outpatient medication errors. Computerized prescribing eliminates handwriting errors and also prompts and alerts the prescriber to make sure he or she is prescribing correct medications and dosages; at the same time the system automatically checks for allergies and drug interactions. Some small published studies have shown significant reductions in prescribing errors after implementation of these kinds of systems.
However, it is important to realize that every technology can also create new forms of unintended errors. We have seen this with CPOE and barcoding, and a recent study1 conducted by researchers at Brigham and Women’s Hospital and CVS Pharmacy found that about 1 in 10 computer-generated prescriptions included at least one error, of which a third had potential for harm. Errors included omissions of information such as dose or frequency, or unclear/conflicting information in the prescription. Researchers also found that some computerized prescription systems were better than others in preventing these kinds of errors.
This study was important because it highlighted some common errors and also made targeted recommendations for how such errors could be prevented. These recommendations were reviewed internally by Partners’ Information Systems experts, and they made changes to the medications module in the Partners electronic medical record based on the study findings and feedback from staff.
In addition, we hope this research will influence the way vendors will design these systems moving forward. We also encourage clinicians to report problems with technology to their managers and via the electronic safety reporting system so leadership can review these problems and make improvements to try to reduce future errors. In this way, we can continuously work to improve the care we are delivering.
1 Computerized provider-order entry: challenges, achievements, and opportunities J Am Med Inform Assoc 2011;18:730-731
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