Medication Use Process Part One, Lecture # 5 PHCL 498 Amar Hijazi, Majed Alameel, Mona AlMehaid

Agenda  The Wake Up Call  Medication Process  Health Information Technology and Patient Safety  Technologies with the Potential to decrease Medication Error  General Recommendations  Barriers to Improving Patient Safety through Technology

Paper Prescription

The Wakeup Call  The above prescription resulted in a patient death as the pharmacist interpreted the medication into Plendil and not Isordil  This was the first medical practice case that was successfully prosecuted due to illegible handwriting  The jury awarded $ 450,000 in damages with 50 % of responsibility on the Cardiologist and 50 % on the Pharmacist  Institute of Safe Medication Practices (ISMP) points out that up 7,000 Americans die each year due to medication errors resulting in a cost of about $ 77 billion annually

Medication Process and ADEs Percentage Diagnostic/ Therapeutic Decisions Made Medication Ordered Order verified and submitted Diagnostic/ Therapeutic Decisions Made Medication Ordered Order verified and submitted Evaluate orders Select medication Prepare medication Dispense/ distribute medication Evaluate orders Select medication Prepare medication Dispense/ distribute medication Administer according to order and standards for drug Select correct drug for the correct patient Administer according to order and standards for drug Select correct drug for the correct patient Ordering Pharmacy Management Administer Medication 49% 14 % 26 % 11 %

Health Information Technology and Patient Safety  Medication error reduction is a prominent patient safety focus area impacted by healthcare IT  It has been shown that Adverse drug events (ADEs) account for up to 3.3 % of hospital admissions  Serious ADEs increased 2.6 fold from 1998 to 2005, as did fatalities due to medication  About 30 % of ADEs are felt to be preventable and of those about 50 % are preventable at the ordering stage  Intravenous medications (IV) are associated with 54 % of ADEs and 61 % of serious or life threatening errors

Health Information Technology and Patient Safety  On average, a hospital patient is subject to one medication error per day  About 1.5 million preventable ADEs occur yearly with about 400,000 preventable ADEs occurring in inpatients  Estimated cost of $ 5,857 per patient error resulted in about $ 3.5 billion in 2006 due to longer length of stay and additional services Technology has a great potential in reducing medication errors but there are many unanswered questions. Several studies of Health Information Technology and Medication Errors concluded that well controlled studies are lacking and patient outcomes are lacking.

Governmental and Non-Governmental Organizations Supporting Patient Safety  US Federal Agencies:  Agency for Healthcare Research and Quality (AHRQ)  Centers for Medicare and Medicaid Services (CMS)  Health Resources and Services Administration (HRSA)  The Food and Drug Administration

Governmental and Non-Governmental Organizations Supporting Patient Safety  Non-Governmental  National Patient Safety Foundation (NPSF)  The National Quality Forum (NQF)  The Joint Commission  Institute for Healthcare Improvement (IHI)  LeapFrog Group  HealthGrades  American Medical Informatics Association (AMIA)

Patient Safety Promotion  ISMP promotes patient safety through the Five Rights of medication administration:  Right medication  Right dose  Right time  Right route  Right patient  Right documentation  Right reason  Right response

Clinical Informatics to Promote Patient Safety  AHRQ's fiscal year 2001 appropriation included $50 million for initiatives to reduce medical errors and improve patient safety. Accordingly, the Agency developed a series of research solicitations (RFAs) to:  Design and test best practices for reducing errors in multiple health care settings;  Develop the science base to inform these efforts;  Improve provider education to reduce errors;  Capitalize on IT advances to translate effective strategies into widespread practice; and  Build capacity to further reduce errors

The Joint Commission – the other side of the coin They warned health care organizations that implementing health information and technology can create or perpetuate patient safety risk and preventable adverse events. So they outlined actions steps to prevent harm in this area. Some examples include:  Assessing pre-implementation need  Assessing clinical workflow  Actively engaging clinicians  Ongoing monitoring  Established training and refresh training  Establishing organizational processes  Developing and testing order sets before automating them

Medication Management and Technology Medication Reconciliation LIS RIS Problem List CDSS Medication Order Formulary Inventory Selection, Preparation and Distribution Automated Dispensing Cabinets Robotics Pharmacy Processing BCMAR Monitoring and Intervention Patient Portal Medication Administration Clinical Data Repository CPOE PIS NIS PHR

Technologies with the Potential to Decrease Medication Errors  Computerized Provider Order Entry (CPOE)  Pharmacy Information System (PIS)  Automated Medication Dispensing Devices and Robotics  Bar Code Electronic Medication Administration Record (BCMAR)  Smart Intravenous Infusion Pumps  Electronic Prescribing  Electronic Medication Reconciliation  Errors and ADEs reporting

General Recommendations  Test existing systems to ensure that they actually catch errors that injure patients  Promote adoption of standards for data and systems. Adoption of standards is critical if we are to realize the potential of information technology for error prevention. Standards for constructs such as drugs and allergies are especially important.  Develop systems that communicate with each other  Measure and prevent adverse consequences

Barriers to Improving Patient Safety through Technology  Cost  Time  Legality  Usefulness  Fear  complexity