Medication Malpractice Newsroom

We Do Not Know For Certain How Much Of A Reduction In Error Rates Is Associated With Implementing

This uncertainty is due to the limited number of studies, varied definitions and methodologies that have been used in the studies that have been performed, and the small number of institutions involved in these studies, making any one study subject to local and regional variations in providers, patient populations, etc. As a result we reran estimates of the cost savings that could be expected from an integrated medication system that included unit dosing and bar-coding of medications assuming that error reductions resulting from these two applications would only be in the order of 40% and 30%, respectively. We estimated potential savings of over $820,000 even with the lower rates, a significant impact of these interventions.

We used the model to estimate the effects of implementing information technology in reducing ADEs assuming two different rates at which medical errors translate into ADEs, namely 8% and 26%. These rates were arrived at from a study of medication errors on two medical/surgical units in the hospital we studied. Over a 12-week period a clinical pharmacist and a medical student examined every drug order that was entered into the hospital information system and compared it to the original written order. Errors were classified by type and severity.9,10 The medication error rate was found to be 32 errors per 1,000 orders, a relatively high rate when compared to other published studies. Eight percent of the drug errors were classified as potentially serious or fatal and might have led to serious toxic reactions, inadequate treatment or death of the patient if not detected before administration of the medication. This rate was used as the lower estimate of ADEs resulting from medication errors in our study. The higher estimate assumed that an additional 18% of medication errors that involved omitted drugs, duplicate orders or incorrect information that would have resulted in inadequate treatment or toxic reactions if not detected also would have resulted in ADEs. The higher estimate was based on the assumption that 26% of medication errors could have resulted in ADEs.

While we do not know the real rate at which medication errors translate into ADEs, we feel that these estimates are justified on the basis of our own and other studies that have assessed the potential of medication errors to cause ADEs. The estimates range from 0% to 58%.10–13 Bates and others14 studied the relationship between medication errors and ADEs. They used self-report by pharmacists, nurse review of patient charts and review of medication sheets to detect medication errors. Incidents suspected of leading to ADEs were evaluated and classified as ADEs, potential ADEs, medication errors with no injury or other errors. The study found that 1% of the medication errors resulted in ADEs (2% if missed doses were excluded) and an additional 7% of the errors represented potential ADEs. Einbinder and Scully15 found an even higher rate of ADEs using a clinical data repository at the University of Virginia hospital and the rules developed and used in a computer-based ADE monitor at Brigham and Women’s Hospital.16

Finally, Shojania points out that $1.4 million, our estimate of the possible cost-savings that could be realized by introducing the information technology to reduce medication errors, does not provide an adequate return on investment to justify investing in CPOE systems. If only the direct cost saving from the implementation of information technology to reduce the additional days of hospitalization caused by ADEs is considered, this may be the case. However, as we discussed in the original article,2 these information technology applications need to be combined with other prevention strategies to reduce ADEs even further. Other strategies include better reporting of medical errors17 and the inclusion of a clinical pharmacist in the provision of patient care. One study found that involving a clinical pharmacist in rounds on ICU units resulted in a two-thirds reduction in medical errors.8