Evaluation of medication errors with implementation of electronic health record technology in the medical intensive care unit

Abstract

T Vivian Liao,1 Marina Rabinovich,2 Prasad Abraham,2 Sebastian Perez,3 Christiana DiPlotti,4 Jenny E Han,5 Greg S Martin,5 Eric Honig5 1Department of Pharmacy Practice, College of Pharmacy, Mercer Health Sciences Center, 2Department of Pharmacy and Clinical Nutrition, Grady Health System, 3Department of Surgery, Emory University, 4Pharmacy, Ingles Markets, 5Department of Medicine, Emory University, Atlanta, GA, USA Purpose: Patients in the intensive care unit (ICU) are at an increased risk for medication errors (MEs) and adverse drug events from multifactorial causes. ME rate ranges from 1.2 to 947 per 1,000 patient days in the medical ICU (MICU). Studies with the implementation of electronic health records (EHR) have concluded that it significantly reduced overall prescribing errors and the number of errors that caused patient harm decreased. However, other types of errors, such as wrong dose and omission of required medications increased after EHR implementation. We sought to compare the number of MEs before and after EHR implementation in the MICU, with additional evaluation of error severity.Patients and methods: Prospective, observational, quality improvement study of all patients admitted to a single MICU service at an academic medical center. Patients were evaluated during four periods over 2 years: August–September 2010 (preimplementation; period I), January–February 2011 (2 months postimplementation; period II), August–September 2012 (21 months postimplementation; period III), and January–February 2013 (25 months postimplementation; period IV). All medication orders and administration records were reviewed by an ICU clinical pharmacist and ME was defined as a deviation from established standards for prescribing, dispensing, administering, or documenting medication. The frequency and classification of MEs were compared between groups by chi square; p<0.05 was considered significant.Results: There was a statistically significant increase in the number of MEs per 1,000 patient days during time periods II (N=2,592; p<0.001) and III (N=2,388; p=0.0023) compared to baseline (N=1,972). However, over time there was a significant reduction in medication errors during period IV compared to baseline (N=1,669; p=0.0008).Conclusion: In the short-term, EHR did not lead to a reduction in medication errors in the ICU; however, there was a significant decrease in medication errors after 2 years. Keywords: electronic health record, intensive care unit, medication error, patient safety, computerized physician order entry, quality improvement

Keywords

• Electronic Health Record
• Critical Illness
• Medical Intensive Care Unit
• Medication Error
• Patient Safety
• Clinical Pharmacist