Medication errors computers

ADEs and medication errors can be extracted from practice data, incidents reports from health professionals, and patient surveys. Practice data include charts, laboratory, prescription data, and administrative databases, and can be reviewed manually or screened by computer systems to identify signals. A method of ADE and medication error detection and classification has been presented that is feasible and has good reliability (Marimoto et al. 2004). It can be used in various clinical settings to measure and improve medication safety. 

A hospital trolley developed by Bayer and GMP is described. The trolley is equipped with a portable computer for the collection and management of patient information with the aim of reducing medical errors. The main component is a sandwich stracture reaction injection monlded in Bayer s Baydnr 60 PU and consisting of a cellnlar core and a smooth skin. Other components are made of PP, PMMA or polycarbonate. Developments by GMP in the nse of PU foams in refrigerator manufacture are also reviewed, and tnmover fignres are presented for the Company. 

Computerized Physician Order Entry (CPOE) Studies have shown that CPOE is effective in reducing medication errors. It involves entering medication orders directly into a computer system rather than on paper or verbally. The Institute for Safe Medication Practices conducted a survey of... 

Discussion. Computerized systems have become important tools in today s pharmacy settings. Computers have made prescription processing faster, easier, and more efficient. Computers have also provided for patient information to be readily available. However, as reliance on computers systems grows, care should be taken not to become totally dependent on these systems as the sole check in preventing medication errors. 

Advances in technology can facilitate the generation and transfer of patient documentation. As more pharmacies use the Internet as a means of communication, information can be transferred quickly and accurately over greater distances. Handheld computers and specialty software allow health care practitioners to document information in an electronic format that can be transformed immediately for rapid transfer to others. Reports in the literature have described methods to assess pharmacist interventions related to medication errors, the use of computer-based systems, and recently, the use of personal digital assistants (PDAs) in specific patient care areas. Many of these documentation systems tend to be individualized apphcations in which the transfer of data to other providers is not possible or quite limited. Often these systems focus on the generation of reports for workload analysis or accreditation purposes. 

Chart review involves researchers reviewing prescriptions, prescribing charts or computer-prescribing records to identify medication errors. It is widely used for detecting prescribing errors however, it relies on the clinical skills of researchers to detect the error, and inter-observer difference (inter-rater reliability) can be problematic when different... 

Farrar K, CaldweU N, Robertson J, et al. Use of structured paediatric-prescribing screens to reduce the risk of medication errors in the care of children. Br J Healthc Comput Inf Manag. 

The system that has probably had the largest impact on medication error is computerized physician order entry (CPOE), in which medication orders are written online. This improves orders in several ways. First, they are structured, so they must include a drug, dose and frequency the computer, unlike a person, can refuse to accept any order without this information. They are always legible,... 

These two examples hint at a few of the reasons for the importance of knowledge-based systems. A medical faciHty may handle hundreds of infectious disease cases a year. Speedy, accurate diagnosis of these cases, aided by a system such as Mycin, may help the medical faciHty handle more patients, more effectively. Likewise, configuring large computer systems composed of many components can be a time-consuming and error-prone task. 

Adverse events need to be coded consistently with respect to letter case. Problems can occur when there is discordant coding using all capital letters, all lower-case letters, or combinations thereof, as computer software will interpret these capitalization variations as different events. Letter case sensitivity can be important when two or more words are used to describe an adverse event. For example, some databases utilizing the Medical Dictionary for Regulatory Activities (MedDRA) coding dictionary employ a coding system in which only the first letter of the first word of an adverse event is capitalized (e.g., Atrioventricular block complete ). Failing to adhere to uniform letter case conventions across the data can result in severe errors in data analysis. 

Computer systems validation personnel must also deal with design errors. A program that perfectly meets a lousy specification is a lousy program. Specifically for medical devices, books on software reliability tend to set aside the user interface issue, and treat it as the sole province of the human factor analyst. The reliability of a system is determined by how all its various parts, including the people who use it, work together. 

Computerized physician provider order entry (CPOE) is defined as the computer system that allows direct entry of medical orders by the physician or person with appropriate licensure and privileges to do so. Directly entering orders into a computer has the benefit of reducing errors by minimizing the errors caused by handwritten orders, but even a greater benefit is realized when the combination of CPOE and clinical decision-support tools is implemented together. 

A label and/or a medication profile is printed. A copy of the original prescription or medication order continues to accompany the label or medication profile while the order is filled. Orders never should be filled solely on the basis of what appears on the label or medication profile because the computer entry may have been in error. 

Unmanned satellite laboratories are a possible alternative to a central laboratory facility. To demonstrate the practicality of such an approach, investigators at the University of Virginia have developed remote automated laboratory systems- (RALS) designed to automate POCT in hospital intensive care units. The results from the analytical instruments in each RALS are sent to a central monitoring workstation several floors away from the satellite laboratory by a network interface, where results are viewed and either accepted or rejected by a trained medical technologist before being released for clinical use. Error codes built into the analytical instruments are also passed to the main laboratory by the computer netw ork. Technologists in the control center can also shut down the satellite laboratory when necessary, as in the case of instrument failure. Patient information is downloaded from the hospital information system in real time so that users can select their patients and the tests to perform from a fist presented on the computer touchscreen. 

An analysis of self-reported interventions by hematology-oncology pharmacists and staff was also performed to document pharmaceutical care interventions over a period of approximately 8 months at the Walter Reed Army Medical Center.The interventions were analyzed to determine the types of interventions that are most frequently performed, prescribing errors encountered, medication cost avoidance that resulted from the interventions and types of interventions that are associated with medication cost interventions, and intervention acceptance rate by physicians. Interventions were entered into a personal computer and analyzed using CliniTrend Web Support System software (ASHP). Medication cost avoidance was determined if less medication was used, an equally effective but less costly medication was used, or a medication that could not be reused was not prepared. 

Cimino et al, 2004 (USA) 2 weeks pre-intervention 3 month site-specific error reduction interventions 2 weeks post-intervention Paediatric hospitals - 9 PICUs Prospective study Three levels of surveillance used (1) pharmacy order review for errors and computer order entry step (2) PICU nurse order transcription and review for errors step (3) an oversight team check Sample = 12 026 medication orders ror rate 0.22 per order... 

In the determination of metals from biological and medical matrixes, thermal ionization mass spectrometry is seldom used. Disadvantages of thermal ionization MS are the great fluctuations in the results, caused by different instrumental requirements. Isotope fractionation resulting from vaporization of the sample and the dependence of this process on temperature are the main sources of error. However, the development of computer-controlled sample preparation and measurements have minimized these errors ... 

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