Medication mistakes are a major reason for treatment problems in psychiatric hospitals. These problems can be reduced through the use of an electronic prescription drug ordering system along with a computerized method for reporting such problems, according to a new study.
“Medication errors are a leading cause of adverse events in hospitals,” said study leader Geetha Javaram, M.D., M.B.A., an associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.
“With the use of electronic ordering, training of personnel and standardized information technology systems, it is possible to eliminate dangerous medication errors.”
Medication errors may be caused by illegible handwriting, order misinterpretation, personnel fatigue, pharmacy dispensing mistakes and administration errors. For example, a pharmacist may misread what a physician has written or give the wrong medication or incorrect dose to a patient.
Through the use of this computerized method, the 88-bed psychiatric unit at The Johns Hopkins Hospital in Baltimore drastically dropped from a medication error rate of 27.89 per 1,000 patient days in 2003 to 3.43 per 1,000 patient days in 2007.
Jayaram noted that during the study period, there were no medication errors that caused death or serious, permanent harm.
“Having something typed eliminates bad writing — and most errors — immediately,” she said. “It’s a good reason for going electronic.”
This computer program, which is also used hospital-wide at Johns Hopkins, also has integrated decision support for drug dosage selection, drug allergy alerts, drug interactions, patient identifiers and monitoring — important facts that can be lost with a manual system that relies on multiple human beings to ensure the correct decisions are made, Jayaram says. The more steps that are involved in the process, the greater the chance for mistakes.
One advantage in a psychiatric department, says Jayaram, is that medication errors with psychotropic drugs are rarely fatal. However, psychiatric patients also take other medications, such as insulin, blood thinners and others that can be deadly if given in the wrong doses or in the wrong combination. In a psychiatric unit, some non-psychotropic drugs are considered high-risk and it is required that they be ‘double checked’ by two nurses before they are administered, Jayaram says.
Jayaram also advises that even with computerized backstops, complacency is the enemy of safe care. Mistakes can still be made in ways no one has thought of yet, she says, so the system needs to constantly evolve.
“You have to be vigilant for new problems that might come up,” she said.
The research is published in the March issue of The Journal of Psychiatric Practice.
Source: Johns Hopkins