More hospitals should use common technologies to reduces medication errors

The Leapfrog Group, a national watchdog organization focused on healthcare safety and quality, yesterday released the first of a four-part series that analyzes how responding hospitals perform in deploying Computer Physician Order Entry (CPOE) systems and Bar Code Medication Administration systems – two technologies that can save lives when used properly.

The “2019 report on Medication Safety” is based on results of the 2018 Leapfrog Hospital Survey, with data submitted by over 2,000 U.S. hospitals. It looks at how well the systems reduce medication errors, the most common error made in hospitals. The numbers are improving, said Leapfrog, but they should be even better considering how universal the technologies are in most hospitals.

Computerized physician order entry systems: Computerized physician order entry (CPOE) systems allow clinicians to place medication order without having to write them by hand and a good CPO system, says Leapfrog, will also alert licensed prescribers if the medication ordered could be dangerous to the patient, such as an interaction with an existing medication or the wrong dose.

For this year’s report, Leapfrog says it focused on two aspects of CPOE use: percentage of inpatient medication orders entered through a CPOE system and performance on Leapfrog's CPOE Evaluation Tool, a simulation test designed to evaluate how well CPOE systems are alerting prescribers to potential errors. To meet Leapfrog's standard, hospitals must enter at least 85 percent of their inpatient medication orders via a CPOE system and prove that at least 60 percent of medication orders triggered the appropriate warning.

·        65% of hospitals fully met the Leapfrog standard; hospitals that fully meet CPOE standards are more likely to be teaching than non-teaching (72 percent versus 62 percent) and more likely to be urban than rural (68 percent versus 47 percent).

·         62% of hospitals are ordering inpatient medications via a CPOE system the large majority of the time.

·         70% of hospitals proved through Leapfrog's CPOE Evaluation Tool that their CPOE system alerts physicians to common, serious prescribing errors.

Bar code medication administration systems: Bar code medication administration systems are used at the patient’s bedside during medication administration. The clinician scans a bar code on the patient's ID band and a matching code on the medication prior to administration which confirms the right patient receives the right medication at the right time. Hospitals were evaluated on the extent to which barcoding is used and whether the hospital implements barcoding using best practices for patient safety. Among responding hospitals, 45 percent fully meet Leapfrog's standard for bar code medication administration standards, which the organization says are four-fold:

· Have a bar code medication administration system connected to an electronic medication administration record in 100 percent of medical/surgical, labor and delivery and intensive care units (achieved by 98 percent of hospitals);

· Scan both a patient's wristband and medication when administering medication at bedside at least 95 percent of the time (achieved by 70 percent of hospitals);

· Implement decision supports to flag (1) wrong patient, (2) wrong medication, (3) wrong dose, (4) wrong time, (5) vital sign check, (6) patient-specific allergy check, and (7) second nurse check needed (achieved by 63 percent of hospitals); and,

· Have at least six of eight best practices in place to prevent dangerous workarounds that impede the safety of the BCMA system (achieved by 78 percent of hospitals).

The report said this more hospitals in the 2018 survey met the standard fully compared to 2017 – up from 34.5 percent to 45 percent. However, Leapfrog says it’s not high enough.

"We're moving in the right direction to save lives, but much more needs to be done,” said Leah Binder, Leapfrog President and CEO in a news release. “Given nearly all hospitals have this technology, there's no reason we shouldn't be at 100 percent compliance in effective use."

Three future reports will cover hospital trends in maternity care, never events and surgical volumes.