Effect of Bar-Code Technology on the Safety of Medication Administration
This study from a large academic hospital looked at medication errors before and after the implementation of technology for bar-code electronic medication-administration records. After implementation of the bar-code system, errors in transcription of medication orders were eliminated and errors in m...
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| Vydáno v: | The New England journal of medicine Ročník 362; číslo 18; s. 1698 - 1707 |
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| Hlavní autoři: | , , , , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
| Vydáno: |
Waltham, MA
Massachusetts Medical Society
06.05.2010
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| Témata: | |
| ISSN: | 0028-4793, 1533-4406, 1533-4406 |
| On-line přístup: | Získat plný text |
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| Abstract | This study from a large academic hospital looked at medication errors before and after the implementation of technology for bar-code electronic medication-administration records. After implementation of the bar-code system, errors in transcription of medication orders were eliminated and errors in medication administration and potential drug-related adverse events were reduced.
After implementation of a bar-code system, errors in transcription of medication orders were eliminated and errors in medication administration and potential drug-related adverse events were reduced.
Medication errors in hospitals are common
1
,
2
and often lead to patient harm. One study identified 6.5 adverse events related to medication use per 100 inpatient admissions; more than one fourth of these events were due to errors and were therefore preventable.
2
Among serious medication errors, about one third occur at the ordering stage of the medication process, another third occur during medication administration, and the remaining third occur in about equal numbers during the transcription and dispensing stages.
3
Health care information technology has been touted as a promising strategy for preventing medication errors.
4
–
6
For example, computerized physician-order entry . . . |
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| AbstractList | Background Serious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such errors, technology has been developed to verify medications by incorporating bar-code verification technology within an electronic medication-administration system (bar-code eMAR). Methods We conducted a before-and-after, quasi-experimental study in an academic medical center that was implementing the bar-code eMAR. We assessed rates of errors in order transcription and medication administration on units before and after implementation of the bar-code eMAR. Errors that involved early or late administration of medications were classified as timing errors and all others as nontiming errors. Two clinicians reviewed the errors to determine their potential to harm patients and classified those that could be harmful as potential adverse drug events. Results We observed 14,041 medication administrations and reviewed 3082 order transcriptions. Observers noted 776 nontiming errors in medication administration on units that did not use the bar-code eMAR (an 11.5% error rate) versus 495 such errors on units that did use it (a 6.8% error rate) -- a 41.4% relative reduction in errors (P<0.001). The rate of potential adverse drug events (other than those associated with timing errors) fell from 3.1% without the use of the bar-code eMAR to 1.6% with its use, representing a 50.8% relative reduction (P<0.001). The rate of timing errors in medication administration fell by 27.3% (P<0.001), but the rate of potential adverse drug events associated with timing errors did not change significantly. Transcription errors occurred at a rate of 6.1% on units that did not use the bar-code eMAR but were completely eliminated on units that did use it. Conclusions Use of the bar-code eMAR substantially reduced the rate of errors in order transcription and in medication administration as well as potential adverse drug events, although it did not eliminate such errors. Our data show that the bar-code eMAR is an important intervention to improve medication safety. (ClinicalTrials.gov number, NCT00243373 .) This study from a large academic hospital looked at medication errors before and after the implementation of technology for bar-code electronic medication-administration records. After implementation of the bar-code system, errors in transcription of medication orders were eliminated and errors in medication administration and potential drug-related adverse events were reduced. After implementation of a bar-code system, errors in transcription of medication orders were eliminated and errors in medication administration and potential drug-related adverse events were reduced. Medication errors in hospitals are common 1 , 2 and often lead to patient harm. One study identified 6.5 adverse events related to medication use per 100 inpatient admissions; more than one fourth of these events were due to errors and were therefore preventable. 2 Among serious medication errors, about one third occur at the ordering stage of the medication process, another third occur during medication administration, and the remaining third occur in about equal numbers during the transcription and dispensing stages. 3 Health care information technology has been touted as a promising strategy for preventing medication errors. 4 – 6 For example, computerized physician-order entry . . . Serious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such errors, technology has been developed to verify medications by incorporating bar-code verification technology within an electronic medication-administration system (bar-code eMAR). We conducted a before-and-after, quasi-experimental study in an academic medical center that was implementing the bar-code eMAR. We assessed rates of errors in order transcription and medication administration on units before and after implementation of the bar-code eMAR. Errors that involved early or late administration of medications were classified as timing errors and all others as nontiming errors. Two clinicians reviewed the errors to determine their potential to harm patients and classified those that could be harmful as potential adverse drug events. We observed 14,041 medication administrations and reviewed 3082 order transcriptions. Observers noted 776 nontiming errors in medication administration on units that did not use the bar-code eMAR (an 11.5% error rate) versus 495 such errors on units that did use it (a 6.8% error rate)--a 41.4% relative reduction in errors (P<0.001). The rate of potential adverse drug events (other than those associated with timing errors) fell from 3.1% without the use of the bar-code eMAR to 1.6% with its use, representing a 50.8% relative reduction (P<0.001). The rate of timing errors in medication administration fell by 27.3% (P<0.001), but the rate of potential adverse drug events associated with timing errors did not change significantly. Transcription errors occurred at a rate of 6.1% on units that did not use the bar-code eMAR but were completely eliminated on units that did use it. Use of the bar-code eMAR substantially reduced the rate of errors in order transcription and in medication administration as well as potential adverse drug events, although it did not eliminate such errors. Our data show that the bar-code eMAR is an important intervention to improve medication safety. (ClinicalTrials.gov number, NCT00243373.) Serious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such errors, technology has been developed to verify medications by incorporating bar-code verification technology within an electronic medication-administration system (bar-code eMAR).BACKGROUNDSerious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such errors, technology has been developed to verify medications by incorporating bar-code verification technology within an electronic medication-administration system (bar-code eMAR).We conducted a before-and-after, quasi-experimental study in an academic medical center that was implementing the bar-code eMAR. We assessed rates of errors in order transcription and medication administration on units before and after implementation of the bar-code eMAR. Errors that involved early or late administration of medications were classified as timing errors and all others as nontiming errors. Two clinicians reviewed the errors to determine their potential to harm patients and classified those that could be harmful as potential adverse drug events.METHODSWe conducted a before-and-after, quasi-experimental study in an academic medical center that was implementing the bar-code eMAR. We assessed rates of errors in order transcription and medication administration on units before and after implementation of the bar-code eMAR. Errors that involved early or late administration of medications were classified as timing errors and all others as nontiming errors. Two clinicians reviewed the errors to determine their potential to harm patients and classified those that could be harmful as potential adverse drug events.We observed 14,041 medication administrations and reviewed 3082 order transcriptions. Observers noted 776 nontiming errors in medication administration on units that did not use the bar-code eMAR (an 11.5% error rate) versus 495 such errors on units that did use it (a 6.8% error rate)--a 41.4% relative reduction in errors (P<0.001). The rate of potential adverse drug events (other than those associated with timing errors) fell from 3.1% without the use of the bar-code eMAR to 1.6% with its use, representing a 50.8% relative reduction (P<0.001). The rate of timing errors in medication administration fell by 27.3% (P<0.001), but the rate of potential adverse drug events associated with timing errors did not change significantly. Transcription errors occurred at a rate of 6.1% on units that did not use the bar-code eMAR but were completely eliminated on units that did use it.RESULTSWe observed 14,041 medication administrations and reviewed 3082 order transcriptions. Observers noted 776 nontiming errors in medication administration on units that did not use the bar-code eMAR (an 11.5% error rate) versus 495 such errors on units that did use it (a 6.8% error rate)--a 41.4% relative reduction in errors (P<0.001). The rate of potential adverse drug events (other than those associated with timing errors) fell from 3.1% without the use of the bar-code eMAR to 1.6% with its use, representing a 50.8% relative reduction (P<0.001). The rate of timing errors in medication administration fell by 27.3% (P<0.001), but the rate of potential adverse drug events associated with timing errors did not change significantly. Transcription errors occurred at a rate of 6.1% on units that did not use the bar-code eMAR but were completely eliminated on units that did use it.Use of the bar-code eMAR substantially reduced the rate of errors in order transcription and in medication administration as well as potential adverse drug events, although it did not eliminate such errors. Our data show that the bar-code eMAR is an important intervention to improve medication safety. (ClinicalTrials.gov number, NCT00243373.)CONCLUSIONSUse of the bar-code eMAR substantially reduced the rate of errors in order transcription and in medication administration as well as potential adverse drug events, although it did not eliminate such errors. Our data show that the bar-code eMAR is an important intervention to improve medication safety. (ClinicalTrials.gov number, NCT00243373.) |
| Author | Gandhi, Tejal K Bane, Anne Moniz, Thomas Bates, David W Ditmore, Matthew Yoon, Catherine S Lipsitz, Stuart Keohane, Carol A Rothschild, Jeffrey M Levtzion-Korach, Osnat Kachalia, Allen B Whittemore, Anthony D Poon, Eric G Hayes, Judy Churchill, William W |
| Author_xml | – sequence: 1 givenname: Eric G surname: Poon fullname: Poon, Eric G – sequence: 2 givenname: Carol A surname: Keohane fullname: Keohane, Carol A – sequence: 3 givenname: Catherine S surname: Yoon fullname: Yoon, Catherine S – sequence: 4 givenname: Matthew surname: Ditmore fullname: Ditmore, Matthew – sequence: 5 givenname: Anne surname: Bane fullname: Bane, Anne – sequence: 6 givenname: Osnat surname: Levtzion-Korach fullname: Levtzion-Korach, Osnat – sequence: 7 givenname: Thomas surname: Moniz fullname: Moniz, Thomas – sequence: 8 givenname: Jeffrey M surname: Rothschild fullname: Rothschild, Jeffrey M – sequence: 9 givenname: Allen B surname: Kachalia fullname: Kachalia, Allen B – sequence: 10 givenname: Judy surname: Hayes fullname: Hayes, Judy – sequence: 11 givenname: William W surname: Churchill fullname: Churchill, William W – sequence: 12 givenname: Stuart surname: Lipsitz fullname: Lipsitz, Stuart – sequence: 13 givenname: Anthony D surname: Whittemore fullname: Whittemore, Anthony D – sequence: 14 givenname: David W surname: Bates fullname: Bates, David W – sequence: 15 givenname: Tejal K surname: Gandhi fullname: Gandhi, Tejal K |
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| CODEN | NEJMAG |
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| Snippet | This study from a large academic hospital looked at medication errors before and after the implementation of technology for bar-code electronic... Serious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such errors,... Background Serious medication errors are common in hospitals and often occur during order transcription or administration of medication. To help prevent such... |
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| SubjectTerms | Academic Medical Centers - organization & administration American Recovery & Reinvestment Act 2009-US Automatic Data Processing Biological and medical sciences Drug Administration Schedule Drug dosages Drug-Related Side Effects and Adverse Reactions General aspects Hospitals Humans Medical errors Medical Order Entry Systems Medical sciences Medication Errors - prevention & control Medication Errors - statistics & numerical data Medication Systems, Hospital Nurses Order entry Organizational Case Studies Organizational Innovation Pharmaceutical Preparations - administration & dosage Physicians United States |
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| Title | Effect of Bar-Code Technology on the Safety of Medication Administration |
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