Eric Smolin from Howard Medical explains the role technology plays in mitigating medication errors in the healthcare service.
No one likes to make mistakes – and yet they are an indisputable fact of life. The challenge for organisations and industries is first to make them as unlikely as possible, and then to have mitigation mechanisms in place should the worst happen.
There are few sectors in which the impact of error can be more dramatic than healthcare. Errors in the prescription and dispensation in medication, in particular, are critically important issues. There is a huge cost attached to so-called ‘adverse drug events’ – around $2,257 for each incident, according to the FDA. A 2000 report entitled ‘To Err is Human: Building a Safer Health System’ suggested that these events cost the US $37.6 billion every year, with around $17 billion of those costs associated with preventable errors.
Then there are the extra medical costs of treating drug-related injuries occurring in hospitals, which are said to amount of around $3.5 billion every year in the US – without taking into account lost wages and productivity or additional healthcare costs. This is according to the Institute of Medicine’s ‘Preventing Medication Errors: Quality Chasm Series’. Furthermore, medication errors are the source of 5% of malpractice claims, and the average jury award for medication error cases is $636,844.
A deadly issue
But financial impact is just the thin end of the wedge. Medication errors don’t just cost healthcare organisations money – they can kill. In 2018, a combined study by the Universities of York, Manchester and Sheffield revealed that an estimated 237 million medication errors occur in the NHS in England every year, with avoidable adverse drug reactions (ADRs) causing an estimated 712 deaths and possibly a contributory factor to between 1,700 and 22,303 more. Commenting on the research on BBC News, the health secretary at the time, Jeremy Hunt, said ‘we are seeing four to five deaths every single day because of errors in prescription or dispensing or the monitoring of medications’.
Meanwhile in the US, estimates suggest that of the two and a half million deaths every year, around 98,000 are due to medical error. This makes medical error the third most common cause of death in the country, after heart disease and cancer.
The WHO view
Little wonder, then, that the World Health Organisation (WHO) has set the theme of ‘Medication Without Harm’ for its third Global Patient Safety Challenge, stating that ‘unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in health care systems across the world’.
But just how can medication without harm be delivered? How can these errors best be reduced?
Medication error: the causes
First, we need to understand the major causes of medication error.
WHO has argued that ‘medication errors occur when weak medication systems and/or human factors such as fatigue, poor environmental conditions or staff shortages affect prescribing, transcribing, dispensing, administration and monitoring practices, which can then result in severe harm, disability and even death’.
This combination of weak medication systems and human factors is supported by Steve Shirley, CIO and vice president of IT for Parkview Medical Centre in Pueblo, Colorado. He observed nurses spending less than 20% of their time on direct patient care thanks to ‘technology that doesn’t support their workflow, administration, care team coordination and communication needs’ – yet a hefty 40% of their time on actually administering medicines.
Meanwhile, research by the California Healthcare Foundation has found that the majority of medication errors – between 50% and 75% – occur at the administering stage. Between 7% and 20% occur at the ordering stage, between 7% and 10% at the transcribing stage, and between 10% and 15% at the dispensing stage.
Medication error: a digital solution
Tackling medication errors, then, requires a multifaceted strategy, one which simultaneously improves accuracy and reduces the workload for medical staff. The workflow getting medications from pharmacy to patient must be optimised, and the entire process must be automatically recorded and audited, so that errors can be identified and rectified easily.
This is where Bar Code Medication Administration (BCMA), or electronic prescribing and medicines administration (ePMA) as it is referred to in the UK, comes in.
It is a bar code system designed by Glenna Sue Kennick to prevent medication errors in healthcare settings and to improve the quality and safety of medication administration. Its overall goals are to improve accuracy, prevent errors, and generate online records of medication administration.
It consists of a bar code reader, a portable or desktop computer with wireless connection, a computer server, and some software. When a nurse gives medication to a patient in a healthcare setting, the nurse can scan the barcode on the patient’s wristband on the patient to verify the patient’s identity. The nurse can then scan the bar code on medication and use software to verify that he/she is administering the right medication to the right patient at the right dose, through the right route, and at the right time – the so-called ‘five rights of medication administration’. Whilst it cannot – and should not – replace the expertise and professional judgment of the nurse, the implementation of BCMA has shown a decrease in medication administration errors in the healthcare setting. When this is also coupled with a closed-loop medication system available on advanced medical carts, this further aids a decrease in errors.
The benefits of introducing ePMA are broad. Costs associated with lengthy hospital stays resulting from adverse drug events are reduced. Costs associated with litigation stemming from preventable errors are reduced. Confidence and communications amongst staff are improved, and with smoother, more efficient workflows they are able to deliver even better standards of care. Above all, patient safety is improved through the prevention of medication errors.