Electronic Health Records and How They Prevent Medication ErrorsBy Mohammed Abdin | Wed, 05/12/2021 - 09:07
Healthcare providers have been trying to prevent medication errors for decades. Eliminating medication errors is a challenge every member of the patient’s care team faces daily — from the hospital pharmacist to the primary care physician. In the US, more than 250,000 people die every year because of medical mistakes, making it the third-leading cause of death after heart disease and cancer.
Over the years, there have been many attempts to reduce medical errors, which have led to improvement. Starting from manual physician checks to avoid potential incidents (i.e., sanitization before procedures) to artificial intelligence in an electronic health record identifying and preventing the error before the patient is harmed (i.e., software and systems that help in clinical decision-making).
One of the most common and life-threatening medical errors is medication errors, which can happen during all stages of treatment, including prescribing, dispensing, and administration processes.
What are Medication Errors?
The National Coordinating Council for Medication Error and Prevention (NCCMERP) has approved the following working definition of medication errors:
"A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer. Such events may be related to professional practice, healthcare products, procedures, and systems, including prescribing, order communication, product labeling, packaging, and nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use."
Manifestations of Medication Errors
Below are typical examples of medication errors that frequently impact patient safety.
Drug-Drug Interactions occur when the patient is prescribed two or more drugs that interact with each other in a way that causes patient harm. This interaction can happen with the same prescription or between different medications. For example, Nonsteroidal Anti-Inflammatory Agents (COX-2 Selective) may enhance the anticoagulant effect of anticoagulant drugs.
Drug–Disease Contraindications happen when the patient is prescribed a drug that worsens a pre-existing condition or because it causes a side-effect. For example, Diltiazem (Calcium Channel Blockers used for angina and hypertension) can cause fluid retention if prescribed to a heart failure patient.
Drug-Allergy Interactions occur when a patient with a medication allergy is prescribed a drug or similar drug class that may lead to potential negative reactions.
Therapeutic Duplication appears when prescribing two or more drugs of the same active ingredients or from the same therapeutic class. For example, prescribing two different statins (lipid-lowering agents) to the same patient.
Dosing Errors are pervasive and can arise when a patient receives either the wrong drug dosage, the wrong frequency (times per day) or the wrong duration (number of days) of a medication.
Pregnancy / Lactation Errors happen when prescribing drugs that should not be used during pregnancy, during a particular phase of pregnancy, or by lactating mothers.
Age / Gender Errors occur when prescribing drugs or dosages not relevant to or restricted in specific age groups (i.e., adult dose for children) or prescribing drugs not intended for a particular gender (i.e., female hormones to a male patient).
Route of Administration Errors are also prevalent and sometimes fatal medication errors. For example, prescribing an intramuscular injection with direction to be taken intravenously.
Below are alarming statistics detailing the severity of the medication errors.
- It is estimated that severe medication errors kill 7,000 patients every year.
- Over 1.5 million people are injured each year because of medication errors.
- Medication error morbidity and mortality costs are estimated to run $77 billion per year.
- 3 percent of all hospital admissions are related to problems with medications.
- 42 percent of the people questioned in a recent survey said either they or someone they know had suffered harm due to a medical mistake.
When turning the compass to another part of the world, will these statistics be any different? Let’s look at the Middle East and specifically Saudi Arabia. A recently completed national survey indicates that medication errors are not a localized problem.
- Only 30 percent of the hospitals had a medication safety committee.
- 9 percent of hospitals had a medication safety officer.
- Only 33 percent of hospitals had a list of LASA medications.
- Only 37 percent of the hospitals provided a medication list to patients at discharge.
- While 61 percent of hospitals used a computer system in their pharmacy to enter prescriptions, only 29 percent of these hospitals required entry of a patient’s allergies before entering a drug order.
Below are more statistics from Saudi Arabia that provide more details regarding the causes of medication errors.
- 46 percent of errors were due to human factors like low-performance standards or lack of clinical knowledge.
- 35 percent of errors happen due to miscommunication, such as the misinterpretation of an order or written communication.
- Dosing errors are the most common medication errors - 34 percent
- Route of administration errors - 30 percent
- Wrong dosage form - 30 percent
- Duplicate therapy errors - 1 percent
The consequences of medication errors are grave as they affect patients’ safety and are sometimes life-threatening. However, the full impact of medication errors also contributes to a significant financial burden on the entire healthcare system. Let’s consider two medication error scenarios and examine the resulting effect on economic and business results.
- If 3 percent of hospital admissions are due to medication errors, in a 500-bed hospital there will always be 15 beds occupied because of medication errors. The cost per bed per day is US$770 (average daily bed cost in Saudi Arabia). With a bit of math, this hospital spends US$4.2 million every year because of errors that could have been prevented.
- Another example is the prescribing of duplicate therapy. Per hospital statistics, 1 percent of prescriptions contain at least one therapeutic duplication. For a hospital that dispenses 1,500 prescriptions per day, there will be 15 drug duplications. This means 15 medications are prescribed that could have been dispensed for another patient. The average medication cost is US$15 (the average cost per single medication in Saudi Arabia). Besides causing harm to patients, these 15 duplications will cost the hospital US$225 per day, or more importantly over US$82,000 per year.
While medication errors cause harm to patients and financial loss to healthcare facilities, there is a reason for optimism. With the right approach, technology and training, they are preventable. That’s right; we CAN prevent medication errors.
How to Prevent Medication Errors?
There are many ways to prevent medication errors. Some are related to human practice, including educating the practitioner and the patient. Others are related to the technology that the healthcare organization adopts. The most important tool to fight medication errors is the Electronic Health Record (EHR) and Clinical Decision Support (CDS).
Ecaresoft is a healthcare technology company that is on a mission, through its partnerships with world-leading companies, to eliminate medication errors. We help hospitals and clinicians follow the highest safety standards. We do this by providing the best clinical decision support systems that alert physicians, nurses, and pharmacists of potential medication errors either during the prescription process, dispensing process, or administration process. We also enable healthcare providers to offer their patients the most current information about their diagnosis and their prescribed medications. Improving medication education and compliance is a key factor to reduce the errors that happen due to the lack of patient knowledge.
The battle of science and technology against medication errors will never end. Advances in medications and treatments are happening at a rapid pace. But this also means the potential for medication errors is also increasing. While science is dynamically improving, healthcare technology must also innovate. The better, more intelligent, and more advanced the technology or software the health facility uses, the more medication errors can be avoided. The decision for the hospital management is always difficult when evaluating which EHR/CDS software to implement. Some focus on the cost, others look for the brand, and there is a group that values ease-of-use. These are good; however, the best option is always to consider patient safety and add hospital revenue to the equation.