Medication Errors

Automation doesn't mean an end to errors

Current advances are tools, not solutions

It's hard to go through the literature of a company that produces automated pharmacy systems without several references to how the product will decrease medication errors. But while the sales pitches make safety claims, industry watchers say there still are many technological pitfalls, primarily because the money and willingness to invest in a fully integrated system are not always there. Meanwhile, physicians still resist even the simplest order entry systems.

Integrated and bar-coded robot retrieval, packaging, dispensing, and administration systems could cost anywhere from several hundred thousand dollars to $1.5 million. With the continuing cutbacks throughout health care, finding money for automation isn't easy. But some money-saving efforts provide a false economy; integration is the key.

The new devices include features like these:

    · bar coding that provides tracking from robot retrieval and packaging to dispensing cabinet;

    · automated restocking;

    · cart systems that have features such as drawers that automatically light up and unlock when the right medication is typed into the terminal;

    · safe-like boxes directly adjacent to cart systems that contain narcotics not included in unit dosing, which pop open only after terminal password entry and a card swipe;

    · infusion pumps with increased automatic loading and multidose calculation - complete with warning flashes for misloading levels - while a patient's volume history is coordinated;

    · computer software that alerts clinicians to potentially adverse interactions and background information such as known allergy reactions. (See related article about new electronic systems, below right.)

A gap between the box and the bedside

If you purchase a robot, be sure to purchase the bar code reading system for it. "These machines have the potential to make major system changes that will reduce errors," says Ken Barker, PhD, head of the department of pharmacy care systems at Auburn (AL) University. "But, unfortunately, the options that affect error reductions too often get cut off at the time of purchase." The most important thing to look for in an automated dispensing system is comprehensiveness. If it only automates a small part of the system, then the errors caused by the interfaces may exceed those prevented by the system itself.

Mark Neuenschwander, a pharmacy automation consultant in Bellevue, WA, agrees. "The most important aspect of automation is point-of-administration scanning. There's a gap between the box and the bedside." Until the industry eliminates that breach between the decentralized cabinet and the patient, medication errors will continue, he says.

Another problem with bar coding systems is a lack of prepackaged drugs to feed the dispensing machines. If hospital officials want to invest in a completely integrated scanning system, covering all kinds of medications, it first must repackage most of its drugs in-house, which opens the door to potential human error.

Conversely, relying too heavily on automation creates other problems. "We see a lot of medication errors as drugs are sent to the equipment," says Michael Cohen, president of the Institute for Safe Medication Practices in Warminster, PA. The wrong item gets picked with no screening process that requires an independent check by a second individual.

"In the hospital, the prescription is recorded, the device does its thing, and the nurse gets the drugs and dispenses. But the pharmacist should be involved to make sense of interactions, dosages, and so on," says Charles Myers, MS, MBA, assistant vice president for professional affairs at the American Society of Health-System Pharmacists in Bethesda, MD. "Automation is being installed without that oversight." That information can be linked to pharmacy computers, but frequently that step is missed.