Hospital improves error prevention with automation

A California hospital recently saw a 250% improvement in preventing medical errors related to medications after introducing pharmacy automation. Hospital leaders say the use of bar coding and computerized physician order entry (CPOE) has greatly improved patient safety.

The reduction in medical errors was traced to the way automation helped increase clinical interventions — the opportunity for a clinical pharmacist to intervene in the drug ordering process to prevent an adverse error. Those interventions increased 250% between 2002 and 2003, says Mark Zielazinski, chief information officer for El Camino (CA) Hospital. "El Camino Hospital’s error rate was already among the lowest in the nation, having been the first hospital in the world to implement a computerized physician order-entry system, which helps to significantly reduce prescribing and transcription errors," he says, and notes that the improvements were seen with no staff increase.

The increase resulted from the implementation of patient safety technologies that include a biometric drug-dispensing system, a bedside drug bar-coding system, and an automated pharmaceutical and supply replenishment system that integrates with the CPOE system. These new technologies not only reduce medical errors and save lives, Zielazinski reports, they also provide considerable savings to the hospital. The interventions resulted in a 500% increase in direct cost avoidance.

Integrating with the CPOE, the new automated dispensing system provides pharmacists with a standard and reliable way to verify a medication order before a patient gets a drug. Mei Poon, RPH, director of pharmacy, explains how it works: A physician enters an order electronically. The order goes immediately to the pharmacy, where it is put through clinical checks. The order then goes to the medication-dispensing machine on the appropriate nursing unit.

A profile for the patient for whom the medication is being ordered already is in the system. That information is accessible to all members of the care delivery team so the orders are reviewed before the medication is dispensed, rather than after the medication has been given to the patient at the bedside.

Fingerprints required to dispense

Caregivers, using their fingerprints, access the drawers in the medication-dispensing machine, which open only for drugs listed for that patient and will not give out drugs until a pharmacist verifies the order. Interventions range from a preventing a low-impact event, like missing an aspirin dose, to a high-impact event such as giving a patient an overdose or a wrong dose of medication.

"Automating time-intensive tasks such as pill sorting and counting gives the entire care delivery team more time to spend on patient-focused tasks," Poon says. "There is clear evidence that the more time a pharmacist spends on the care and monitoring of patients, the more errors that are caught and the more harm prevented."

El Camino Hospital plans to continue improving the accuracy and efficiency of drug deliveries further this year with a fixed patient station at the bedside, bar-coded drugs on a unit-dose basis (medications arrive ready for administration in the appropriate quantity) and verified orders, checked and delivered through the front end. All members of the care delivery team will be able to access a single set of patient information, which is updated in real time.