One day last week I was driving home and happened by a school that doubles as a community swimming pool in the summer. The street had several large speed bumps, forcing me to move rather slowly. I’m usually irritated by speed bumps because they slow me down. This day, however, I was happy they were there because a little boy darted out in front of me. I drive a ¾ ton Ford f250 crew cab pick-up. It’s big and heavy. I have serious doubts that a child would stand much of a chance if they went head-to-head with my truck. Fortunately I was coasting along at a safe 10 MPH secondary to the speed bumps and easily came to a stop at a comfortable distance away. At that moment I was thankful for the safety feature built into the pavement on the road, i.e. the speed bumps.
Much of the technology in healthcare resembles speed bumps, irritating, but necessary to provide safety along the road. There is a landmark article (JAMA 1995;274:35-43) that takes a detailed look at system failures that contribute to adverse drug events (ADEs) in healthcare. Errors in the article are broken down as follows:
– Prescribing 39% (of these nearly half were intercepted by either pharmacy or nursing)
– Transcribing 12%
– Dispensing 11%
– Administering 38% (only 2% of drug administration errors were intercepted)
Based on the four areas described above – prescribing, transcribing, dispensing, administering – where are the technology speed bumps?
Prescribing – The speed bump here is clearly Computerized Provider Order Entry (CPOE).
Transcribing – Transcription as described in the study included unit secretaries re-writing orders on paper records for nursing. This is completely eliminated by CPOE and an Electronic Health Record (EHR). In addition, transcription errors are reduced by Pharmacy Information Systems (PhIS) like Siemens Pharmacy, MEDITECH, Cerner , etc., Barcode Medication Administration (BCMA) and electronic Medication Administration Records (eMARS).
Dispensing – A solid PhIS can be used to reduce distribution errors secondary to utilizing a standardized method. Automated storage (i.e. Talyst) and automated TPN preparation (i.e. Abacus and ExactaMix by Baxa ) are also helpful in standardizing workflow and decreasing the risk of error by using barcodes. Automated Dispensing Cabinets (ADCs) are helpful when used in combination with PARx to ensure accurate replenishment. Combined with BCMA this closes the circle and provides a nice safety net.
Administering – This is probably one of the most difficult areas in which to implement technology to increase patient safety. However, medication administration becomes important because it is the “last line of defense†prior to a patient receiving a medication. Smart pumps (i.e. Alaris), ADCs (i.e. Pyxis) and BCMA are all important speed bumps in the medication administration phase.
That’s a lot of speed bumps. The important thing to remember is that everything listed above is not designed to irritate you, but rather designed to improve patient safety. For the sake of clarity, perhaps a name change is in order; how about “safety bumps�
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