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

Methods

The first objective of this review was to identify all published studies evaluating patient outcomes associated with the use of the four technologies. We selected studies with medication errors and ADEs as primary endpoints. These studies also had secondary endpoints, including costs, work efficiencies, and other measures. Medication errors were defined as "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer."[17] ADEs were 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] Studies were assessed for concordance with these definitions. Appropriateness of use of technologies was defined as any analysis that assessed the degree to which a technology was used as intended (e.g., overrides with ADMs[18]).

Previously published studies of CPOE, bar coding, and CMARs were identified through a PubMed search for the period from 1982 (when CPOE was first integrated into hospital information systems) through March 2002. ADMs were searched from the inception of PubMed in 1966, since the first publications associated with ADMs appeared shortly thereafter (1969).

A set of relevant publications was selected for inclusion on the basis of a specific search strategy using medical subject heading (MeSH) terms. Our search strategy included the following MeSH termsa:

  • CPOE: Clinical pharmacy information systems, decision support systems, clinical drug therapy, computerassisted/*methods, hospital information systems, information systems, medication errors/prevention and control, medical records systems/computerized, medication systems, hospital, user computer interface, and pharmaceutical preparations/*adverse effects. Keywords: CPOE, computerized physician order entry.

  • ADMs: Automation, clinical pharmacy information systems, medication errors/statistics and numerical data, medication systems–hospital, computer-assisted/*methods, medication errors/prevention and control. Keywords: ADM, automated dispensing machine*.

  • Bar coding: Clinical pharmacy information systems, clinical drug therapy, computer-assisted/*methods, hospital information systems, information systems, medication errors/ prevention and control, medical records systems/computerized, hospital and user computer interface, automatic data processing/*methods. Keyword: Bar-cod*.

  • CMARs: Clinical pharmacy information systems, clinical drug therapy, computer-assisted/*methods, hospital information systems, information systems, medication errors/prevention and control, medical records systems/ computerized, hospital and user computer interface. Keywords: medication administration record, MAR.

We reviewed all references from the recovered articles, as well as from previously identified review articles. Studies were evaluated and included only if they were based in the United States and published in a peer-reviewed journal. Only controlled studies were included. Implementation guidelines, reviews, user-satisfaction surveys, opinions, and letters were excluded. Studies in which the full text was unobtainable were also excluded.

Five articles among the identified citations could not be located for review (Appendices A-D). However, the titles and lengths of these articles suggest that they probably do not describe controlled studies.

"/*" refers to major MeSH subheadings, "*" in middle or end of word refers to a truncated search term (i.e., a wildcard that allows searches for any combination that begins with those characters), and "/" refers to a MeSH subheading.

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