Technology takes a role in reducing medication errors
Medication errors occur for a variety of reasons in many different areas. Fortunately, technology is nearly as ubiquitous, and technological tools can be used in many places to help prevent those errors. Already, computerized pharmacies and Pyxis machines are in place to reduce human error, while robots help reduce packaging and labeling errors.
Another tool establishing its place in clinical practice is the electronic prescription record that transfers the written prescription from the physician’s computer directly to the pharmacist’s computer. This eliminates errors due to illegible handwriting, misinterpretation of handwriting, poor translation of a spoken prescription over the phone to the writing pad, and incorrect transfer from prescription or phone pad to pharmacy computer.
ISMP white paper addresses prevention
The nonprofit Institute for Safe Medication Practices (ISMP), long involved in reporting and reducing medication errors, has issued the first in its series of white papers addressing medication error prevention topics. (See www.ismp.org for full text.) In that first paper, ISMP calls for the elimination of handwritten prescriptions within three years.
"The electronic prescription record is a powerful force that is readily available now," ISMP vice president for nursing Hedy Cohen tells Drug Utilization Review.
Such devices are handheld and can be used at the point of care. Many of them have the ability to warn prescribers of potential drug-drug and allergy interactions, based on databases of medications taken by patients and other information contained in patient records. Therefore, errors other than those caused by poor penmanship can be avoided by using these tools.
Still, ISMP estimates that only 5% of U.S. physicians currently use this tool in generating their prescriptions. Some may balk at the cost. However, says Cohen, "In the midst of discussion of huge, sweeping changes to improve medication safety, the electronic prescription record provides a smaller, less expensive tool to help reduce and prevent medication errors. When we look at the cost to society of medication errors — both human and financial costs — the cost incurred for this tool is negligible."
Christy Wiebe, PharmD, managed care pharmacist at St. John’s Regional Health Center in Springfield, MO, agrees that electronic prescription records hold great potential for reducing medication errors, especially those related to handwriting. "Systems that would interface to flag drug-drug interactions could provide yet another safety net to catch potential errors," Wiebe tells DUR. "Pharmacists shouldn’t let down their guard in lieu of the new safety net, though. We need to continue to be vigilant in our responsibilities to review and evaluate prescriptions before they’re dispensed.
"Many of the physicians in our institution rely heavily on PalmPilots for drug information, scheduling, and notes," Wiebe adds. "In fact, they probably use their PalmPilots more than their computers." Those physicians likely would be the most open to changing to an electronic prescription record system, she says.
Plan for the future
Many physicians may not be ready to put down their pens and pick up handheld electronic devices to write their prescriptions. Some pharmacies are not yet equipped to receive electronic transfer of prescriptions; some will prefer to wait for newer generations of the tools, allowing the initial bugs to be worked out before embracing the new technology.
Still, the day will come when it’s time for everyone to jump into this phase of technology in the health care field. For those who wait now and jump later, Cohen advises, "Start investigating the technology now. Get familiar with it. Consider how to best implement it in your specific practice area and start to budget for it now."
A lack of hardware and software applicable for electronic prescribing is not a problem. In April of this year, First DataBank announced the development of a drug content product designed to support prescription writing on handheld devices, starting with development for the PalmPilot. It is not the first to market this, however. Already, several other vendors are trying the market, with Allscripts as the market leader for point-of-care electronic prescribing and medication management solutions. (See www.allscripts.com.)
Not to be omitted from a discussion of technology, the Internet is another tool being used to reduce medication errors. ISMP recently launched "Textbook Errata," a new section on its Web site (www.ismp.org) designed to correct incorrect information found in published medical literature. Book publishers and practitioners alike are encouraged to use the site as a clearinghouse for correction of published errors by e-mailing the information to ISMP at ismp.org. Those who visit the site can avoid errors by making subsequent corrections to their articles, references, and textbooks.
Although ISMP passes to the respective publishers the corrections it receives, textbook publishers typically don’t disseminate the corrected information until the next book edition is published. "Pharmacists could help disseminate the corrections broadly and in a more timely manner if they would take the information provided on the Textbook Errata’ page and publish it in their hospital or drug information newsletters and report it to their P&T committees," says Cohen.
Cohen notes that understanding medication errors is just part of the process. Getting the word out to everyone on the team who can help prevent errors is an important second step, he adds.
"The problem of medication errors is one that affects all disciplines," Cohen says. "As members of multidisciplinary teams, pharmacists can do their teams and patients a favor by taking a leadership role in the safe use of medicine and in reducing medication errors."
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