Computerized Doctors' Orders Reduce Medication Errors

Illegible handwriting and transcription errors are responsible for as much as 61 percent of medication errors in hospitals. A simple mistake such as putting the decimal point in the wrong place can have serious consequences because a patient's dosage could be 10 times the recommended amount.

Drugs with similar names are another common source of error, such as the pain medication Celebrex and the antidepressant Celexa, or the tranquilizer Zyprexa and the antihistamine Zyrtec.

"These medication errors are very painful for doctors, as well as the patients. Nobody wants to make a mistake," said Tatyana Shamliyan, lead review author and a research associate at the University of Minnesota School of Public Health.

The University of Minnesota researchers looked at 12 studies that compared medication errors with handwritten and computerized prescriptions from in-hospital doctors. Nearly a quarter of all hospital patients experience medication errors, a rate that has increased from 5 percent in 1992, according to the study.

Medication errors include prescribing the wrong drug or incorrect dosage or administering a drug at the wrong time or not at all. "Most errors typically go undetected unless they led to an adverse event," said review co-author Robert Kane.

In addition to improving patient safety, computerized systems make life easier for pharmacists. "They don't have to decipher the chicken scratch," said Karl Gumpper, director of the pharmacy informatics and technology section of the American Society of Health-System Pharmacists, based in Bethesda, Md. Pharmacists frequently have to call the prescribing doctor or interview the patient because of problems in deciphering handwriting.

Currently, only about 9 percent of hospitals have computerized prescription systems. Some hospitals have stand-alone systems, while others have computerized prescriptions as part of an electronic medical record system.

Each year, more health systems implement computerized order entry systems and more will do so as electronic medical records become more common. "It's a growth industry," Kane said.

A small handful of institutions, including Brigham and Women's Hospital in Boston and Vanderbilt University Medical Center in Nashville, have been leaders in integrating computerized prescriptions, experts say.

It takes 12 to 36 months to implement computerized prescribing system, Gumpper said. Currently, no industry standard system exists. Some hospitals use systems created in-house, while others use commercial products created by companies such as Epic Systems, based in Verona, Wis. or McKesson Corp., based in San Francisco.

Some systems guide doctors through the prescription process, asking questions that might help avoid errors. Some even use voice recognition.

There are two reasons why more hospitals have not switched to electronic prescription systems, says Arthur Levin, director of the Center for Medical Consumers in New York. First, "Physicians, like most of us, don't like change," he said. In addition, electronic prescription systems are costly and difficult to integrate into the complex, sometimes-chaotic hospital structure.

Regardless, in hospitals with a computerized prescription system, the number of medication errors dropped, especially among adult patients. However, the rate of one type of error --prescribing the wrong drug -- did not decrease, and in five studies, the number of adverse events from drug errors did not decrease.

Each year, more than one-half million patients sustain injuries or die in hospitals from adverse events, according to the study.

In hospitals with a higher number of medication errors -- more than 12 percent -- computerized systems made the biggest improvement, the researchers found.

Medical schools in the United States rarely address penmanship. It is the same in Russia, says Shamilyan, who studied there. However, at least one medical school in the United States, Indiana University in Indianapolis, teaches penmanship to students in hopes of avoiding errors.

As nearly every industry becomes more computerized, Levin says the doctor's prescription pad should go the way of scarification used in the 19th century for bloodletting. "Written and verbal orders should be a no-no," he said.

Reference; Shamliyan TA, et al. Review of the evidence: impact of computerized physician order entry system (CPOE) on medication errors. Health Services Research online, 2007.