Impact of Emerging Technologies on Medication Errors and Adverse Drug Events

Eyal Oren, Ellen R. Shaffer, B. Joseph Guglielmo

Disclosures

Am J Health Syst Pharm. 2003;60(14) 

In This Article

Abstract and Introduction

Published evidence on the effects of computerized physician order entry (CPOE), automated dispensing machines (ADMs), bar coding, and computerized medication administration records (CMARs) on medication errors and adverse drug events (ADEs) were reviewed.

Emerging technologies have been recommended as potential mechanisms for reducing medication errors. Critical evaluations of the impact of these new technologies on medication errors and other adverse outcomes are lacking. PubMed was searched to identify all peer-reviewed publications linking four technologies (CPOE, ADMs, bar coding, and CMARs) with reductions in medication errors and ADEs and secondary endpoints. All controlled studies that assessed the impact of the technologies were evaluated. The appropriateness of the use of these technologies was also examined.

Few studies were identified that evaluated the technologies' impact on these endpoints. Of the evaluated technologies, CPOE was the most studied; however, investigations were limited to selected medical centers. The appropriateness of use of the technologies was evaluated even more infrequently.

A literature review revealed a paucity of controlled, generalizable studies confirming the benefits of technologies intended to reduce medication errors and ADEs. Very little evidence on the appropriateness of the use of these technologies was found.

In 1999 the death rate associated with medication errors was estimated at 7000 per year.[1] Of medication errors considered preventable, over half result in adverse drug events (ADEs).[2] ADEs are defined as "any response to a drug which is noxious, unintended, and which occurs at doses normally used in humans for the prophylaxis, diagnosis, or therapy of disease."[3] A recent meta-analysis found a 6.7% incidence of serious adverse drug reactions in hospitals.[4] In the Medical Practice Study, ADEs accounted for 14.1% of all seriously disabling adverse events.[5] Classen et al.[6] calculated the excess cost of hospitalization attributable to an ADE to be $2013, while others suggest the figure to be even greater, particularly for preventable ADEs.[7]

An estimated 28-56% of ADEs are considered preventable.[6,7,8,9] Medication errors due to illegible handwritten prescriptions, overlooked allergies and drug interactions, and incorrect dosages often result in ADEs. Consequently, technology-based interventions have been recommended as a key mechanism for reducing the likelihood of medication errors and ADEs.[10] Computerized physician order entry (CPOE) has been endorsed as one of three initial methods that should be widely adopted by hospitals to reduce prescribing and transcription errors.[11] Other studies have investigated the impact of technologies on medication errors.[12,13,14] With the exception of a recent publication commissioned by the Agency for Healthcare Research and Quality,[15] critical reviews summarizing the impact of new technologies on medication errors and ADEs are lacking.

Several factors may influence the appropriate use of particular technologies. The complexity of the hospital workplace, limitations in the number of care components that can be automated, and the technologies' interaction with human factors can determine their success or failure. If a technology is not used as intended, increased inefficiency and medical errors may result. Consequently, in addition to demonstrating the value of a new technology with outcomes evidence, it is important to investigate whether the technology is being used appropriately and to identify barriers to its appropriate use.

We critically reviewed four technologies that have been proposed to reduce medication errors: CPOE, automated dispensing machines (ADMs), bar coding, and computerized medication administration records (CMARs). Clinical decision support systems is another commonly used technology; however, it involves multiple individual technologies, and there is considerable heterogeneity among systems, which often include both CPOE and alert systems. Therefore, we did not evaluate clinical decision support systems.

We decided to focus on these four technologies because a review of the contemporary literature indicated that they are commonly used and are most likely to influence patient safety.[13,15,16] The aims of this study were to identify published studies that assessed the effects of the given technology, especially with respect to medication errors and ADEs, and to identify published studies that assessed the appropriateness of use of the technology.

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