Study: Computerized systems reduce psychiatric drug errors
Coupling an electronic prescription drug ordering system with a computerized method for reporting adverse events can dramatically reduce the number of medication errors in a hospital's psychiatric unit, according to research published in the March edition of The Journal of Psychiatric Practice.
"Medication errors are a leading cause of adverse events in hospitals," wrote Geetha Jayaram, MD, MBA, an associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine in Baltimore, and colleagues. "With the use of electronic ordering, training of personnel and standardized IT systems, it is possible to eliminate dangerous medication errors."
Jayaram and colleagues reported a medication error rate of 27.89 per 1,000 patient days in 2003 to 3.43 per 1,000 patient days in 2007 in the 88-bed psychiatric unit at The Johns Hopkins Hospital in Baltimore.
During the study period, there were no medication errors that caused death or serious, permanent harm, according to the researchers.
The computer program used in the psychiatric department, and hospital-wide at Johns Hopkins, also includes integrated decision support for drug dosage selection, drug allergy alerts, drug interactions, patient identifiers and monitoring.
At the same time that the drug ordering system was put in place, Hopkins instituted the use of the Patient Safety Net error reporting system. The hospital-wide Patient Safety Net (PSN) is an online, web-based reporting tool that is accessible to all caregivers, regardless of discipline. Whenever a mistake is made, big or small, it is to be reported on the PSN.
This system allows for follow up, corrective action and the ability to learn from common mistakes. It also categorizes unsafe conditions and near-miss events, and this can aid in future improvements. Near misses are more likely to be readily reported by frontline staff.
One advantage in a psychiatric department, she wrote, is that medication mistakes involving psychotropic drugs are rarely deadly. “But psychiatric patients also take other kinds of medication — insulin, blood thinners and others that can be lethal if given in the wrong doses or in the wrong combination. In a psychiatric department, some nonpsychotropic medications are considered high-risk and, as a precaution, two nurses must check them off before they are administered.”
Jayaram and colleagues concluded that even with computerized backstops, complacency is the enemy of safe care. "You have to be vigilant for new problems that might come up," she concluded.
"Medication errors are a leading cause of adverse events in hospitals," wrote Geetha Jayaram, MD, MBA, an associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine in Baltimore, and colleagues. "With the use of electronic ordering, training of personnel and standardized IT systems, it is possible to eliminate dangerous medication errors."
Jayaram and colleagues reported a medication error rate of 27.89 per 1,000 patient days in 2003 to 3.43 per 1,000 patient days in 2007 in the 88-bed psychiatric unit at The Johns Hopkins Hospital in Baltimore.
During the study period, there were no medication errors that caused death or serious, permanent harm, according to the researchers.
The computer program used in the psychiatric department, and hospital-wide at Johns Hopkins, also includes integrated decision support for drug dosage selection, drug allergy alerts, drug interactions, patient identifiers and monitoring.
At the same time that the drug ordering system was put in place, Hopkins instituted the use of the Patient Safety Net error reporting system. The hospital-wide Patient Safety Net (PSN) is an online, web-based reporting tool that is accessible to all caregivers, regardless of discipline. Whenever a mistake is made, big or small, it is to be reported on the PSN.
This system allows for follow up, corrective action and the ability to learn from common mistakes. It also categorizes unsafe conditions and near-miss events, and this can aid in future improvements. Near misses are more likely to be readily reported by frontline staff.
One advantage in a psychiatric department, she wrote, is that medication mistakes involving psychotropic drugs are rarely deadly. “But psychiatric patients also take other kinds of medication — insulin, blood thinners and others that can be lethal if given in the wrong doses or in the wrong combination. In a psychiatric department, some nonpsychotropic medications are considered high-risk and, as a precaution, two nurses must check them off before they are administered.”
Jayaram and colleagues concluded that even with computerized backstops, complacency is the enemy of safe care. "You have to be vigilant for new problems that might come up," she concluded.