The U.S. Pharmacopeia intends to study the impact of computerized entry systems on medical errors by asking for more details in its MedMARX reports.

"We want to stratify computer entry errors in a more granular way so that we can pick out things like computerized prescriber order entry specifically, to be able to look at that particular component of computerization and see how that is affecting, or being affected by, error occurrences overall," USP VP-Practitioner & Product Experience Diane Cousins said during a May 21 teleconference.

"I know that bar-coding technologies are being employed in healthcare facilities to reduce errors and improve patient safety," she said. "So another area of computer entry that we would like to stratify is the whole implementation of bedside point of care technology and the use of barcoding."

Cousins presented the 2000 data report for MedMARX, USP's medication error reporting database for hospitals. The 2000 report showed that computer entry was the fifth most common cause of error, up from seventh in 1999.

"I think this is an interesting finding because as you all know computerization is being looked at as a solution for error and the fact is that it's certainly possible that computers can also contribute to errors if not designed well or not implemented well - if training is not well provided, for example," Cousins said.

Because "computer entry" in the current MedMARX definition "spans the entire range of the continuum of the medication use process," USP cannot tell if errors reported occur at physician entry or another point.

"The fact that we are seeing computer entry move up could mean first of all, as I said before, that hospitals may be documenting these better, but it also could mean that systems are being computerized more broadly and therefore creating error traps of the sort that may result in future errors in the system."

Computer entry accounted for 10% of errors reported in 2000, compared to 4.7% for 1999. The total number of computer entry errors ballooned (from 458 to 4,003) because the number of hospitals reporting to MedMARX grew from 56 to 184.

Cousins noted that "knowledge deficit" was a less common cause of error in 2000 compared to 1999, moving from the third most common to the seventh. "This could represent a good thing in that healthcare professionals may be trained better, educated better and thus reduce the number of errors overall."

"I suspect that would happen as hospitals use MedMARX over time because the more they become aware of where these error categories are, they share this knowledge with their staff and educate them to the point where errors are avoided."

USP wants to encourage more reporting of medication errors to develop a larger database that can be used to analyze causes and solutions for medication errors.

Although the database is anonymous, the 2000 report notes that "hospital facilities and personnel continue to have concerns regarding dissemination of reported information where patient harm resulted. Historically, this type of information has only received protection from discoverability when used internally for quality improvement."

USP has endorsed the "Medication Error Prevention Act of 2002" (HR 4673), sponsored by Rep. Connie Morella (R-Md.). The bill would provide legal protections for reports to MedMARX.

MedMARX would also presumably be covered by a bill in the Senate sponsored by Sens. Bill Frist (R-Tenn.) and James Jeffords (I-Vt.). The senators moved forward with the "Patient Safety & Quality Improvement Act" after negotiations with Sen. Edward Kennedy (D-Mass.) broke down.

The bill, based on Institute of Medicine recommendations, would prevent any non-identifiable patient safety information that hospitals or doctors provide to a designated patient safety organization from resulting in criminal charges, subpoena, or discovery in connection with a malpractice lawsuit. The legislation also would provide for an HHS database for such information.

Kennedy is concerned that the bill's legal shield is too broad and may prevent state medical board review.

Medication Error Study By USP Will Examine Computerized Entry Systems

More from Archive

More from Pink Sheet