Abstract
Over three-quarters of a million people are injured or die in hospitals annually from adverse drug events. The majority of medication errors result from poorly designed health care systems rather than from negligence on the part of health care providers. Health care systems, in general, rely on voluntary reporting which seriously underestimates the number of medication errors and adverse drug events (ADEs) by as much as 90%. This chapter reviews the literature on (1) the incidence and costs of medication errors and ADEs; (2) detecting and reporting medication errors and related ADEs; (3) and the use of information technology to reduce the number of medication errors and ADEs in health care settings. Results from an analysis of data on medication errors from a regional data sharing consortium and from computer simulation models designed to analyze the effectiveness of information technology (IT) in preventing medication errors are summarized.
TopBackground
It is estimated that three quarters of a million people are injured or die each year from adverse drug events (ADEs) (Bates, 1996: Classen, Pestotnik, Evans, Lloyd, & Burke, 1997: Lazarou, Pomeranz & Corey, 1998). One study of medication errors in 36 hospitals and skilled nursing facilities in Georgia and Colorado found that 19% of the doses were in error; seven percent of the errors could have resulted in adverse drug events (ADEs) (Barker, Flynn, Pepper, Bates, & Mikeal, 2002). Overall it has been estimated that adverse drug events (ADEs) occur in from two to seven out of every 100 patients admitted to a hospital in the USA (Bates, Cullen, Laird, et al.., 1995; Classen, Pestotnik, Evans, Lloyd, & Burke, 1997). Medication errors and associated ADEs increase the cost of hospitalization by about $4,700 per incident (Bates, Spell, Cullen, et al., 1997). The increased costs for a 700-bed hospital due to ADEs were estimated to be $2.8 million annually. Johnson and Bootman (1995) estimated the annual cost of morbidity and mortality due to drug therapy in 1995 for the U.S. to be $76.6 billion.
ADEs also occur among outpatients at an estimated rate of 5.5 per 100 patients (Honigman, Lee, Rothschild, et al., 2001). A recent analysis of hospital emergency departments in the U.S. estimated that ADEs account for 2.4 out of every 1,000 visits (Budnitz, Pollock, Weidenbach, Mendelsohn, Schroeder, & Annest, 2006).
Most errors are not reported making it difficult to ascertain the true rate of medication errors. Hospitals generally rely on voluntary reporting, which may result in the detection and reporting of as little as 10% of ADEs (Cullen, Bates, Small et al., 1995). One study of hospital units found that only 36 errors were reported on incident reports and 84 errors were reported on anonymous questionnaires over a period of 59,470 patient days (Barker & Allan, 1995). It was estimated that as many as 51,200 errors may have occurred in dispensing and administering medications over this period of time.
Key Terms in this Chapter
Computerized Decision support systems: A computer-based system that consists of a knowledge base and an inference engine that generates advice to the providers
Computerized Decision support systems: A computer-based system that consists of a knowledge base and an inference engine that generates advice to the providers
Electronic Health Record (EHR): An electronic repository of information about a patient’s health care and clinical information management tools that provide alerts, reminders and tools for data analysis
Computerized physician order entry (CPOE): Clinical systems that electronically relay the physician’s or nurse practitioner’s diagnostic and therapeutic plan for action
Computerized physician order entry (CPOE): Clinical systems that electronically relay the physician’s or nurse practitioner’s diagnostic and therapeutic plan for action
Medical alerts: a computer generated message to the provider that is created when a record or event meets prespecified criteria
Adverse drug events (ADE): A medication that results in unintended harm to a patient
Adverse drug events (ADE): A medication that results in unintended harm to a patient
Electronic Health Record (EHR): An electronic repository of information about a patient’s health care and clinical information management tools that provide alerts, reminders and tools for data analysis
Medical alerts: a computer generated message to the provider that is created when a record or event meets prespecified criteria