Informatics at work. Nice results!

rninformatics, DNP, RN · Apr 1, 2011

Doesnt work for me. I'll try later.

Angela

Hopefully this link works. From my 2 favorite fields, psych and informatics.
https://readingnurse.mednewsplus.com/html/topicdetails.asp?topic_id=25519&section_id=146

PsychRN98, ASN · Apr 1, 2011

here's the content...computerized system slashes psych drug errorsby charles bankhead, senior writer, medpagetoday

reviewed by robert jasmer, md; associate clinical professor of medicine, university of california, san francisco

march 24, 2011

use of a web-based computerized system accessible to all caregivers has cut psychiatric medication errors by 75% over five years, according to the team overseeing the system.

the number of errors declined from 369 in 2004, the first year of the program at a large urban inner-city hospital, to 89 during 2007. the overall error rate decreased by 80% to 90%, whether defined in terms of patient days or billed doses of medication.

the improved performance occurred during a period when annual admissions to the psychiatry unit doubled, as reported in the march issue of the journal of psychiatric practice.

"the process of studying one's own system and the teaching of a culture of safety have broad applicability," geetha jayaram, md, of johns hopkins, and coauthors wrote in conclusion. "the [approach] can be easily adapted to many systems, including paper-driven ones.

"it should also be noted that we did not encounter much resistance to the system launch and application. we continue to refine the options offered by the [prescribing system] to exploit the full scope of an electronic system in error prevention."

in report released in 2009, the joint commission identified medication errors as one of the five leading causes of sentinel events, defined as an unanticipated event that results in serious injury or death unrelated to the natural course of a patient's illness.

many other events that do not meet the definition of a sentinel event often go unreported, the authors wrote in the introduction to their paper. as a consequence, hospitals and other healthcare institutions might not learn the true cause of the errors and determine how to prevent them.

psychiatric medication errors have also received scant attention in the medical literature, the authors continued. in particular, no long-term prospective efforts to reduce medication errors in psychiatric care have been reported.

in an effort to generate needed data, jayaram and colleagues conducted a prospective evaluation of psychiatric medication errors before and after implementation of new medication error reporting and medication ordering systems.

prior to 2004, medication errors were reported by means of a pharmacy-driven electronic reporting system. in 2004 the medical center introduced the patient safety net (psn) error reporting system, and all healthcare personnel received training in use of the system.

the switch to the psn marked the transition from non-standardized reporting of medication errors to standardized documentation. the pharmacy-driven electronic reporting system required less than 30 seconds to file a report, the authors wrote. in contrast, each psn report requires three to five minutes to complete.

though available to all healthcare personnel, the psn is used primarily by the nursing staff. the system allows healthcare personnel to enter events at the point of care and categorizes the degree of harm caused by the error, following criteria developed by the national coordinating council for medication error reporting and prevention.

jayaram and colleagues documented psychiatric medication errors that occurred in 2003, the year before the switch to the psn. then they compared results from that year with those from 2005 and 2007.

the five-year study period encompassed 65,466 patient-days and 617,524 billed doses of medication. during that time, the number of admissions increased from 13,226 in 2003 to 26,894 in 2005 before declining slightly to 25,946 in 2007.

comparison of 2003 with 2005 and 2007 and comparison of 2005 with 2007 revealed significant reductions in medication errors for all comparisons (p

the reported error rate per 1,000 patient-days declined from 27.89 in 2003 to 5.50 in 2005 to 3.43 in 2007. the reported error rate per 1,000 billed doses declined from 2.07 in 2003 to 0.69 in 2005 to 0.39 in 2007 (p

the number of errors declined in all categories of the medication process, including prescribing, transcription, preparation, administration, and monitoring.

three errors met criteria for causing harm to patients. all three occurred during 2005 and all of them met the minimum threshold definition of harm.

although applicable to a wide range of psychiatric-care environments, the reporting process works best with access to computer and related resources.

"this in-hospital study demonstrated that the highest rate of prescribing success is achieved with computerized systems that have integrated decision support for drug selection, dosing, drug allergy alerts, drug interactions, patient identifiers, and monitoring, as compared with manual systems with minimal decision support," the authors wrote.

limitations to this in-patient study included its single-institution design, which restricts its applicability to another facility and to an outpatient setting, the researchers noted.

additionally, jayaram and co-authors wrote that the scope of the review of the actual error rate was limited by sampling only 120 randomly selected charts and many errors may not be self-reported or detected by provider order entry.

thirdly, they acknowledged that although there was a reduction of manual errors, computer-generated errors were encountered and "such errors highlight the need for constant retooling of the system."

they added that a doubleblind design would have been superior, "since it would have yielded clearer results concerning benefits and outcomes of interventions."