Dual HIT Programs Reduce Medication Errors at Hopkins

Coupling electronic prescription drug ordering with computer reporting of adverse events can dramatically reduce medication errors in psychiatric units, Johns Hopkins researchers say.

"Medication errors are a leading cause of adverse events in hospitals," says study leader Geetha Jayaram, MD, 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."

The findings, published in the March issue of The Journal of Psychiatric Practice, detail how the 88-bed psychiatric unit at The Johns Hopkins Hospital in Baltimore went 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. During the study period there were no medication errors that caused death or serious, permanent harm, the study said.

Potentially lethal medication errors can be caused by illegible handwriting, misinterpretation of orders, caregiver fatigue, pharmacy dispensing errors and administration mistakes. "Having something typed eliminates bad writing — and most errors — immediately," Jayaram said. "It's a good reason for going electronic."

The computer program used in the psychiatric department, and hospital-wide at Johns Hopkins, includes integrated decision support for drug dosage selection, drug allergy alerts, drug interactions, patient identifiers and monitoring — data that can be lost with a manual system that relies on layers of human beings, Jayaram said, adding that the more the number of steps involved in the process, the greater the likelihood of mistakes.

At the time that the drug ordering system was installed, Hopkins began using the Patient Safety Net error reporting system, a Web-based reporting tool. When a mistake is made it is to be reported on the PSN. This system allows for follow up, corrective action, and the ability to learn from common mistakes. It also categorizes unsafe conditions and near-miss events.

Jayaram says the HIT programs have helped to create a "culture of safety" in the psychiatry department, along with annual safety training, reporting of all adverse events as they occur, and feedback that focuses not by blaming, but on how to prevent a reoccurrence through education and corrective action.

While medication mistakes involving psychotropic drugs are rarely deadly, Jayaram said psychiatric patients also take other kinds of medication — insulin, blood thinners, and others that can be lethal if given in the wrong doses or in the wrong combination. In a psychiatric department some nonpsychotropic medications are considered high-risk and, as a precaution, two nurses must check them off before they are administered.

Even with computerized backstops, Jayaram said complacency can be a problem and new problems can arise so the system is constantly evolving. "You have to be vigilant for new problems that might come up," she said.