Computerized systems reduce psychiatric drug errors: study

The rate of medication errors dropped 87.7% in an 88-bed psychiatric unit at Johns Hopkins Hospital in Baltimore after computerized provider order-entry and error-reporting systems were implemented, according to a report in the March issue of the Journal of Psychiatric Practice.

Researchers randomly selected 42 medical charts from 2003 and 40 each from 2005 and 2007, and collected data on the number and types of medication errors reported. Medication administration records were also examined to detect nonreported errors.

In 2003, the psychiatry department had been using a mostly pharmacy-driven, electronic error-reporting system which captured basic information. It switched to the Web-based Patient Safety Net program in 2004, that allowed all staff—though primarily nursing personnel—to log incidents at the point of care and record near-misses, according to the report. Their provider order-entry prescribing system was implemented in 2005, according to lead author Geetha Jayaram, associate professor with the Johns Hopkins psychiatry department.

The error rate per 1,000 patient days was 27.89 in 2003, 5.5 in 2005 and 3.43 in 2007, according to the report.

“This in-hospital study demonstrated that the highest rate of prescribing success is achieved with computerized systems that have integrated decision support for drug selection, dosing, drug allergy alerts, drug interactions, patient identifiers and monitoring, as compared with manual systems with minimal decision support,” the report stated.

The report describes a reduction of manual errors; however, often because of similar dates of birth or similar names, making the use of a third identifier necessary.

“We did encounter computer-generated errors, although to a lesser degree; such errors highlight the need for constant retooling of the system.”

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