Patient Safety Proposals
In March 2003, Health and Human Services Secretary Tommy G. Thompson announced two proposed rules from the FDA that will use state-of-the-art technology to improve patient safety. Here is a snapshot of each rule:
* Bar codes: Just as the technology is used in retail and other industries, required bar codes would contain unique identifying information about drugs. When used with bar code scanners and computerized patient information systems, bar code technology can prevent many medication errors, including administering the wrong drug or dose, or administering a drug to a patient with a known allergy.
* Safety Reporting: The proposed revamping of safety reporting requirements aims to enhance the FDA's ability to monitor and improve the safe use of drugs and biologics. The rule would improve the quality and consistency of safety reports, require the submission of all suspected serious reactions for blood and blood products, and require reports on important potential medication errors.
Hospital Strategies
Hospitals and other health care organizations work to reduce medication errors by using technology, improving processes, zeroing in on errors that cause harm, and building a culture of safety. Here are a couple of examples.
Pharmacy intervention: It was a challenge for health care providers, especially surgeons, at Fairview Southdale Hospital in Edina, Minn., to ensure that patients continued taking their regularly prescribed medicines when they entered the hospital, says Steven Meisel, Pharm.D., director of medication safety at Fairview Health Services. "Surgeons are not typically the original prescribers," he says. The solution was to have pharmacy technicians record complete medication histories on a form. In a pilot program, the technicians called most patients on the phone a couple of days before surgery. A pharmacist reviewed the information and then the surgeon decided which medications should be continued. After three months, the number of order errors per patient dropped by 84 percent, and the pilot program became permanent.
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 1,500 hospitals in 2001 and found that about 3 percent of hospitals were using CPOE, and the number is rising. Eugene Wiener, M.D., medical director at the Children's Hospital of Pittsburgh, says, "There is no misinterpretation of handwriting, decimal points, or abbreviations. This puts everything in a digital world."
The Pittsburgh hospital unveiled its CPOE system in October 2002. Developed by the hospital and the Cerner Corporation in Kansas City, Mo., Children'sNet has replaced most paper forms and prescription pads. Wiener says that, unlike with adults, most drug orders for children are generally based on weight. "The computer won't let you put an order in if the child's weight isn't in the system," he says, "and if the weight changes, the computer notices." The system also provides all kinds of information about potential drug complications that the doctor might not have thought about. "Doctors always have a choice in dealing with the alerts," Wiener says. "They can choose to move past an alert, but the alert makes them stop and think based on the specific patient indications."
--M.M.
