Sydney: Every time you are prescribed a medication in the hospital, a computer tells the doctor whether it is suitable for you and what the dosage is. Every time health professionals update patient records on the computer, they have to fill in the relevant information in the correct place or choose an option from a drop-down menu.
But as a growing body of research shows, these electronic systems are not perfect.
Our new study shows how often these technology related errors occur and what they mean for patient safetyThey often occur due to programming errors or poor design and have less to do with the healthcare workers using the system.
What do we observe? What do we find?
Our team reviewed over 35,000 medication orders at a major metropolitan hospital to understand how frequently technology-related errors occur.
We focus on errors that occur when prescribing or ordering medications through a computer system. In many hospitals, these systems have replaced the clipboard that used to hang at the end of the patient’s bed.
Our research showed that up to one in three medication errors They are related to technology, that is, the design or functionality of the electronic medication system facilitated the error.
We also examined how technology-related errors changed over time by reviewing error rates at three time points: in the first 12 weeks of using the system, and one and four years after its implementation.
We can expect technology-related errors to become less frequent over time as healthcare professionals become more familiar with the systems. However, our research showed that while there is an early “learning curve,” technology-related errors remained a problem for many years after the implementation of electronic systems.
In our study, the rate of technology-related errors was the same four years after system implementation as it was during the first year of use.
How could errors occur?
Errors can occur for a variety of reasons. For example, doctors may be faced with a long list of possible dosage options for a medication and accidentally choose the wrong one. This can result in a lower or higher dose than intended.
In our study, we found that high-risk medications were frequently associated with technology-related errors. These included oxycodone, fentanyl, and insulin, all of which can have serious adverse effects if prescribed incorrectly.
Technology-related errors can also occur at any time during patient care when a computer is used.
In the United States, a nurse accessed and administered the wrong medication. She obtained it from a computer-controlled dispensing cabinet (known as an automated dispensing cabinet), which is used to store, dispense and track medications.
Due to poor design, the cabinet allowed the nurse to search for a medication by entering only two letters. A good design would not have shown any medication options with only two letters.
The nurse selected and administered the wrong medication to the patient, resulting in cardiac arrest and the nurse facing criminal prosecution.
Automatic dispensing cabinets They are increasingly being implemented in Australian hospitals.
Earlier this year we learned of an error in South AustraliaThe company’s electronic medical record system miscalculated the due dates of more than 1,700 pregnant women, possibly leading to premature inductions of labor.
We produce a series of health system safety bulletins that describe and address specific examples of poor system design that we have identified during our research or that others working in the system have brought to our attention.
These include a drop-down menu that allows a drug to be prescribed by injection into the spine. This particular drug would be lethal if administered in this manner.
In another case, a built-in calculator is displayed that rounds medication doses up or down based on set rules, but this can lead to incorrect doses in very young or low-weight children.
In each example, we include recommendations for optimizing systems. Organizations can use these specific examples to test their systems and take action.
What else could improve security?
With the increasing digitalisation of our hospitals and healthcare services, the risk of technology-related errors increases. And that’s without even mentioning the potential for error in the artificial intelligence used in our healthcare systems.
We are not calling for a return to paper records, but until we commit to making computer systems secure, we will never fully realize the enormous potential that digital systems could offer in healthcare.
Systems need to be continuously monitored and updated to make them easier and safer to use and to prevent problems from becoming catastrophic.
Healthcare IT administrators and developers need to understand errors and recognize when system design is suboptimal.
Since doctors are often the first to spot problems, there should also be mechanisms in place to promptly investigate and address their concerns, backed by systematic data on technology-related errors. (The Conversation) PY PY
