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This might not fit in but I thought it was interesting:


A topic which has been on the top of the list at all of our hospital administration meetings is medication reconciliation and errors. It seems when patients are admitted, nurses aren’t verifying home medications consistently and physicians aren’t verifying the list before the patient leaves. This has been a problem for a very long time. The problem is only made worse by staff shortages. It is time consuming to verify medications if the patient isn’t able to actively help. As medical records move to the electronic format, these problems are made more transparent with the ability to query data in a variety of ways thereby increasing the pressure on a staff already stretched thin. With medication errors being the most common and the most preventable injury, this is an important topic. Technology not only makes the errors more transparent but it can be used to improve the process and positively impact patient safety.

One barrier to the most reliable medication list has been the lack of a central repository for medications. The floor uses one database, the emergency department another and surgery still another. We’ve started a project to centralize the data by using one application throughout the hospital. The hope is to have everyone looking at the same set of data which should increase the likelihood that someone will verify the medications more accurately.

The centralized system also has the ability to eliminate duplicate medications and flag drug interactions. A very visible warning appears when one of these occurs. This system also controls what physicians prescribe so the potential for a reduction in prescriber errors exists. A study published in the Archives of Internal Medicine in 2004 supports the use of computerized prescriber order enty. The study indicates that nearly half of the errors could be eliminated with a computerized system using advanced clinical support systems (Bobb, et. al., 2004). Another study in the Journal of the American Medical Information Association followed the medication error rates before and after the implementation of a computerized system. The rate fell from 142 per 1000 to 26.6 per 1000 in missed dose errors and the number of allergy errors went from 10 in the baseline data to 3 in post implementation data.

This is a critical step toward increasing patient safety. The potential for a decrease in medication errors and over prescription of medications is great. This doesn’t address the need for more staff, however. Perhaps the only real solution to the problem is the implementation of a medication reconciliation team whose sole responsibility is the verification of home medications and discharge medications. The responsibility is not only the nurses but the physicians and there needs to be a joint effort to make these systems work. Time will tell.

References
Bobb, A., Gleason, K., Husch, M., Feinglass, J., Yarnold, P., Noskin, G. (2004). The Epidemiology of Prescribing Errors: The Potential Impact of Computerized Prescriber Order Entry. Archives of Internal Medicine, 164, 785-792.

Bates, D., Teich, J., Lee, J., Seiger, D., Kuperman, G., Ma’Luf, N., Boyle, D., Bates, L.(2004). The impact of computerized physician order entry on medication error prevention. Journal of the American Medicaion Information Association, 6(4), 313-321.