Medication errors continue even in highly computerized hospital

CHICAGO Errors in drug ordering, dosage and monitoring that may have serious consequences for patients persist in hospitals even after the adoption of computerized medication systems, according to a study in the May 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Several broad-based studies during the past 15 years have demonstrated that injuries resulting from the use of a drug, called adverse drug events (ADEs), account for up to 41 percent of all hospital admissions and more than two billion dollars annually in inpatient costs, according to background information in the article. Many of these studies have also suggested that as much as a quarter of inpatient adverse drug events might be prevented through the use of computerized physician order entry (CPOE) and related computerized medication ordering and administrative systems.

Jonathan R. Nebecker, M.S., M.D., of the Veterans Administration Salt Lake City Health Care System, Salt Lake City, and colleagues conducted a daily review of the electronic medical records from a random sample of patients admitted to a VA hospital during a 20-week period in 2000. Because the Veterans Administration Healthcare System is a leader in implementing multiple computerized interventions, including computerized physician order entry, bar code-controlled medication delivery, a complete electronic medical record, automated drug-drug interaction checking and computerized allergy tracking and alerting, the authors suggest that a VA hospital offers an appropriate setting for testing the impact of computer systems on adverse drug events. Pharmacists used standardized criteria to classify adverse drug events.

Among 937 hospital admissions, 483 clinically significant inpatient adverse drug events were identified. An adverse drug event was considered clinically significant when a change in the patient's treatment plan was required. There were 52 adverse drug events per 100 admission

Contact: Susan Huff
JAMA and Archives Journals

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