Computerized systems often spot data entry errors

Automation is not a cure-all for reducing medical errors because errors can be introduced into computerized systems.

Nearly one-fifth of hospital and health system medication errors in 2003 involved computerization or automation, according to a report from the U.S. Pharmacopeia.

“Computerization is not a panacea for error elimination or error reduction,” John Santell, RPh, director of educational program initiatives for the Center for the Advancement of Patient Safety at U.S. Pharmacopeia, told Orthopedics Today.

“When we first started tracking computer entry errors, [errors in data entry] ranked seventh as the overall cause [of medication errors] and now it is up to fourth, so it appears that the percentage of computer entry errors is on the increase,” Santell said. “This could be partially due to the increase in computer use in facilities as well as the number of hospitals that are using the MEDMARX program.”

The findings are part of the U.S. Pharmacopeia's annual report summarizing data collected by MEDMARX, a database of medication errors with more than 800,000 records. The current report, which covers 1999 to 2003, analyzed 235,159 medication errors voluntarily reported by 570 hospitals and health care facilities.

Computer entry errors represented 11.5% of all MEDMARX records from 1999 to 2003. “Performance deficit,” a case where the health care practitioner has the required skills and knowledge to execute a task but errs nonetheless, was the single most frequently reported cause of computer entry error. “Distractions” contributed to the errors 56.5% of the time.

Automated dispensing device errors were implicated in 9000 medication error events with 1.3% of those events leading to patient harm. Wrong doses were reported more than twice as often (52.9% vs. 23.9%) when automated dispensing device-related errors were compared to the overall MEDMARX database.

Drug distribution system errors, including not only automated dispensing devices but also stocking, cart filling, and transporting medicines, were the leading causes of automated dispensing device-related errors reported in 55% of the records.

Reduced errors

The report suggested that computerized prescriber order entry reduces the risk of harmful errors, with 99% of those errors prevented from harming patients.

Lucian Leape, MD, adjunct professor of health policy at the Harvard School of Public Health, said that 99% of these errors did not harm patients and that computers help more than harm.

“If [the errors] didn't reach the patient, then they were intercepted by the computer,” Leape told Orthopedics Today. “This report represents an interesting artifact of a good thing, which is that the computer records everything that happens and intercepts medication errors before they have a chance to harm the patient.”

Santell said, “Some errors were caught afterwards. They were made by humans using the computer but there were other steps in the process and those errors were corrected before they reached the patient — by pharmacists or nurses.”