Executive Summary
Research suggests advanced clinical decision support software can prevent most medication errors in the operating room. The high success rate may indicate a need for wider adoption.
- The study found the software prevented 95% of potential medication errors.
- Wrong medication and wrong dose errors were most likely to be prevented.
- Clinicians still must watch for errors that are difficult for software to detect.
Researchers at Massachusetts General Hospital (MGH) say advanced clinical decision support software (ACDSS) can prevent up to 95% of medication errors in the operating room.
The study findings suggest that whenever possible, clinical decision support software should be used in operating rooms (ORs) to improve patient safety.
ACDSS involves comprehensive software algorithms that provide evidence-based information to clinicians at the point-of-care to enhance decision-making and prevent errors, explains senior author Karen C. Nanji, MD, MPH, a physician investigator in the Department of Anesthesia, Critical Care, and Pain Medicine at MGH and associate professor at Harvard Medical School in Boston.
Despite the potential, clinical decision support technology still is in its early stages of adoption within ORs, she says. (The study is available online at https://bit.ly/4cFsDeM.)
Clinical decision support consists of software algorithms that provide real time, evidence-based information or alerts to clinicians to enhance their decision-making and prevent errors, she says. MGH built a clinical decision support software platform that is fully integrated with clinical systems. It pulls data from electronic health records, such as details on the patient’s medical history, laboratory values and operations, as well as data from other sources, like vital sign monitors and ventilators.
The barcode on any medication syringe label is scanned immediately prior to medication administration, which triggers software to display a dosing window with pertinent information or alerts when necessary to prevent a medication error prior to the medication being administered, Nanji explains. After the medication passes through the clinical decision support algorithms, all the medication data are then sent to the patient’s electronic health records for documentation.
Clinical decision support has been available on hospital wards and other areas in the hospital for more than 15 years now, but it is only now becoming available for the OR, Nanji says.
“The reason why it’s taken this long is the way that we give medications in the operating room is very different from the rest of the hospital. Due to the fast-paced nature and high acuity of surgical patients, we don’t have access to many of the safety checks that exist throughout the rest of the hospital when we’re in the OR,” she says. “For example, on hospital wards, there are many checks and balances that medications go through before they’re administered to a patient. There is electronic clinical decision support to provide important information as medications are ordered. Pharmacists then double-check orders before medications are dispensed, and nurses check again prior to administering that medication to a patient and even scan the medication along with the patient’s wristband to make sure it’s the right medications, right patient, the right timing and all of those other factors.”
The OR is the only location in the entire hospital where these tools typically are not available and a single provider is responsible for all of those steps without double-checks, Nanji says. When a medication is given in the OR, the anesthesia clinician makes the decision to give the medication, opens a cabinet, and selects the appropriate file from hundreds of medication vials, draws it into a syringe, administers the medication to the patient, and then documents it all within seconds, she explains.
“There are no prospective orders in the operating room, and the only electronic step is documentation after the medication is administered. With this workflow, there is usually no natural time for clinical decision support to function,” Nanji says. “But this problem has now been solved, and we have clinical decision software that’s fully integrated with clinical systems in the operating room. Warnings are available prior to medication administration, and the first electronic interaction can now be prior to medication administration and not after medication administration.”
Wrong medication and wrong dose errors are the most common medication errors likely to be preventable by clinical decision support, along with inadvertent boluses and certain types of omitted medications that are caused by equipment problems, Nanji says.
“It’s difficult for current clinical decision support systems to recognize and prevent loose connections on intravenous (IV) tubing, for example, that may result in a medication leaking out of the IV instead of reaching the patient,” she says. “Therefore, the onus of surveilling physical equipment and tubing connections remains on the clinician, but the most common error types and, fortunately, most severe error types, like those wrong medications and wrong doses, are also the most likely to be preventable by clinical decision support.”
Source
• Karen Nanji, MD, MPH, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston. Email: [email protected].
Researchers at Massachusetts General Hospital (MGH) say advanced clinical decision support software can prevent up to 95% of medication errors in the operating room.
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