Can quality software put your patients in danger?
Potential pitfalls involving use of quality software may be far more serious than possible loss of quality data, according to a recent study. Researchers found that a particular brand of computerized physician order entry (CPOE) software meant to reduce medication errors actually introduced errors instead at one hospital.1
Researchers observed health care workers over a two-year period and concluded that a widely used CPOE system facilitated 22 types of medication error risks, including fragmented displays that prevented a complete view of patients’ medications and inflexible formats generating inaccurate medication orders.
Still, an increasing number of hospitals are using CPOE, with the assumption that it always reduces errors. "Our study showed that it can also introduce errors," says Brian Strom, MD, one of the study’s authors. "One needs to keep in mind that any intervention can introduce errors. These are not silver bullets but programs that need continual evaluation and adaptation."
"I think there is a tendency to think of the software as providing greater protection than it actually does," says Ross Koppel, PhD, the study’s principal investigator. He points to five key recommendations for quality professionals:
- To reduce errors, focus primarily on the organization of work, not on technology.
- Aggressively examine the technology while it’s being used in clinical areas, looking for underlying problems obscured by workarounds.
- Plan for continuous revisions, recognizing that all changes generate new error risks.
- Fix technology when shown to be counterproductive.
- Identify multiple causes of errors.
Carefully craft a contract that requires the vendor to address quality and safety issues on an ongoing basis, so that inevitable problems are corrected immediately, as opposed to waiting for the next updated version, Koppel advises. "Hospitals should seek more of a partnership with vendors, where vendors are obliged to be responsive to the needs of patient safety issues as they emerge," he says.
In addition to patient safety, security concerns also are on the quality professional’s worry list. "Just watching Headline News should alert any of us that security is an issue — and I don’t believe software companies have been able to keep up with the need and demand," says Angie King, BSN, CPHQ, quality management director at Tift Regional Medical Center in Tifton, GA. "Accuracy and other flaws are not as much a concern for me as security, from a liability and competition viewpoint."
Before implementing any quality software, you must do your homework, which involves contacting beta sites and other users to ask about any problems and how these were addressed, stresses King. "I think it boils down to doing due diligence with whichever software company is used, which involves much more than just hearing from the salesperson," she says.
When researching quality software, the most important thing you can do is check with other hospitals using that product, recommends Kathleen Catalano, RN, JD, director of regulatory compliance services for Dallas-based PHNS Inc. "Ask them what their experience has been. If there is a glitch, what is the normal amount of downtime for the problem to be corrected? How many glitches have occurred within a six-month or one-year period? What were the glitches? How much, if any, data were lost?" she says.
Also find out what the company will do if you do lose quality data — for instance, if they will pay for you to hire people to recreate the data, says Catalano. "Also find out if there are service agreements in place, and if they are monitoring the functionality."
The lesson to be learned is that software is only a tool and cannot replace observation and judgment, emphasizes Faith D. Solkoff, RN, BSN, MPA, director of performance improvement at Baptist Hospital of Miami. "These tools are resources, but they are not the be all and end all," she says. "We must go back to basics in health care. Observation, direct communication, and old-fashioned care techniques have gone to the wayside — and this is a root cause for many of our patient safety issues."
Reference
- Koppel R, Metlay JP, Cohen A, et al. Role of computerized physician order entry systems in facilitating medication errors. JAMA 2005; 293:1,197-1,203.
For more information, contact:
- Kathleen A. Catalano, RN, JD, Director, Regulatory Compliance Services, PHNS Inc., One Lincoln Centre, 5400 LBJ Freeway, Suite 200, Dallas, TX 75240. Phone: (214) 257-7112. Fax: (214) 707-7403. E-mail: [email protected].
- Angie King, BSN, CPHQ, Quality Management Director, Tift Regional Medical Center, 901 E. 18th St., Tifton, GA 31794. Phone: (229) 386-6119. Fax: (229) 556-6390. E-mail: [email protected].
- Ross Koppel, PhD, Sociology Department, McNeil Building, Locust Walk, University of Pennsylvania, Philadelphia, PA 19104. Phone: (215) 576-8221. Fax: (215) 576-8346. E-mail: [email protected].
- Brian L. Strom, MD, MPH, Director, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 824 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021. Phone: (215) 898-2368. Fax: (215) 573-5315. E-mail: [email protected].]
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