Clearly, no one wants to get sicker while they are in the hospital. And certainly, no one wants to take a medication that could harm them. It would be easy to assume that your nurse is giving you the right medication at the right time, but unfortunately that is not always the case. Medication errors in hospitals are common and can be dangerous. Since most hospitalized patients receive medication, it’s important for hospitals to have robust programs to avoid medication errors. But, how can hospitals reduce medication errors? What can you do to protect yourself or a loved one?
How common are medication errors in hospitals?
A 2006 report by the Institute of Medicine estimates at least one medication error per patient every day in hospitals and long-term care facilities! The report also states that each year there are 1.5 million preventable adverse drug interactions in US hospitals and long-term care facilities. It is worth noting that this report is over 12 years old. Improvements to ordering methods, as well as hospital efforts to reduce medication errors, may have reduced the number of errors. However, any improvements are just scratching the surface. A 2016 report estimates that preventable medication errors impact more than 7 million patients across all care settings, including patients at home.
What kinds of errors occur?
Errors include patients getting the wrong drug, the wrong dosage, drug overdoses, and overlooked drug interactions and allergies.
For one patient’s multiple experiences with medication errors, read this blog post: Medication Errors in Long-Term Care Facilities – One Patient’s Cautionary Tale.
How do errors occur?
There are opportunities for errors at many places along the way, including:
- Doctors** can make mistakes when ordering medication. He/she can order the wrong medication – which can happen more easily than you would think because many medications have similar names. Or, doctors can order the incorrect dosage, due to mathematical errors, a misplaced decimal point, or other mistakes.
- Pharmacists can misread the prescription, especially when it is handwritten. Additionally, the pharmacist can select the wrong medication, or pick the right medication but the wrong dosage. Or, the pharmacist can mix up patients and provide one patient with another patient’s medication.
- Nurses can give a medication to the wrong patient or give a medication at the wrong time.
What’s the most common cause of medication errors in hospitals?
According to The Leapfrog Group, about 90% of medication errors occur during manual ordering and transcribing (often related to misreading handwritten prescriptions and misinterpreting the prescription).
How can hospitals reduce medication errors? CPOE systems to the rescue!
Computerized physician order entry (CPOE) systems allow doctors to electronically prescribe medications. Not only do these systems eliminate mistakes associated with doctors’ notoriously bad handwriting, the systems detect errors as doctors enter orders. How? The orders are automatically checked for potential errors or problems, based on integrated patient information, including information on lab results, allergies, and medications currently taken by the patient.
Specific benefits of CPOE systems include:
- The doctor receives a warning when there is a possibility of a drug interaction, allergy or overdose.
- CPOE systems contain drug-specific information that eliminates confusion among drugs with similar names.
- Accurate, current information helps doctors keep up with new drugs.
- Improved communication between physicians and pharmacists.
- A reduction in healthcare costs.
How much can CPOE systems help?
According to a report by The Leapfrog Group, many studies have shown significant reductions in errors with the use of CPOE systems. Researchers estimate that using CPOE systems at all non-rural U.S. hospitals could prevent 3 million adverse drug events each year. Further evidence that CPOE systems can help reduce medication errors:
- A study at Boston’s Brigham and Women’s Hospital found that CPOE systems reduced error rates by 55%. A subsequent study by the same group found that serious medication errors fell by 88%.
- Another study conducted at Salt Lake City’s LDS Hospital showed a 70% reduction in antibiotic-related adverse drug events after implementing a decision support tool for antibiotics.
Furthermore, researchers conducted a systematic literature review and concluded that processing medication orders through a CPOE system decreases the likelihood of error on an order by 48%. Interestingly, the authors note that it is unclear whether this translates to a reduction in patient harm. But, in my opinion, it’s hard to imagine that less errors would not lead to less patient harm.
Electronic ordering systems are not perfect!
Although CPOE systems are very helpful, they are not perfect. These systems are designed to electronically alert a doctor if there is a potential problem in a medication order, such as possible dangerous interactions. The computer algorithms that detect potential issues are only as good as the data behind them. And that is a problem. One-third of respondents to a recent survey of members of the American Society of Clinical Psychopharmacology think their e-prescribing system has given erroneous warning information. And 1/3 of those doctors stated the alerts were inaccurate 50% or more of the time.
Additionally, a new study of EHRs used in hospitals to order medication found that safety issues persist. Although these systems are supposed to alert a doctor if a medication he/she is ordering could harm the patient, in 2018 the EHRs only correctly identified safety issues 66% of the time. Even though this is an increase from only correctly identifying 54% of issues in 2009, it’s still far from 100%. Importantly, researchers found that these systems detected 98% of drug allergy information in 2018, but were less successful identifying drugs that would harm patients based on their diagnosis.
Finally, a 2017 report found that users of electronic health records are highly prone to making medication errors that negatively impact patient safety. The report states that IT glitches, poor training, improper use of CPOE systems, EHR documentation issues and the practice of using both paper and electronic records contribute to medication errors. This report concludes that using Electronic Health Records can “leave patients just as vulnerable to medication errors as they were when providers used paper charts”.
Does your hospital use a CPOE system?
It’s clear that your chance of medication errors is reduced if you stay at a hospital that uses a CPOE system. But, it’s not enough that they have a CPOE system. The system must include software to prevent errors and should be used by all prescribers. Additionally, the system should be fully integrated into the patient health records.
How does your hospital rate on CPOE system use? Use Leapfrog’s Hospital Safety Grade website to evaluate hospitals. Enter your city/town or zip code to see a list of hospitals in your area. Select the ‘Practices to Prevent Errors’ tab and you will see the score for ‘Doctors order medications through a computer’.
CPOE systems are not enough to eliminate errors.
With so many possible ways hospital staff can make medication errors, it is obvious that CPOE systems are not going to eliminate all errors. Doctors, nurses and pharmacists are all humans, and humans make mistakes. Period.
What else can you do to reduce your risk of medication errors in the hospital?
Because medication errors can be harmful, and may even cause death, you cannot assume that everything is A-OK. The best strategy is to remain alert and speak up if you suspect an issue.
I suggest you follow these recommendations:
- Make sure all your nurses and doctors know about allergies and/or side effects you’ve experienced from medications.
- Keep a complete list of all medications you take, including over-the-counter medications, at your bedside. Share this list with your nurses and doctors. Update your list as doctors prescribe new medications.
- Create a schedule on paper that shows your medications and when you should take them. When a nurse is giving you medications, make sure you are getting the right medications at the right time.
- Don’t be afraid to ask the nurse what medications he/she is giving you. Medication containers should have a label that includes the name and dosage of the medication. If you do not see a label, or have any concerns, ask your nurse what the medicine is.
- If something doesn’t look or sound familiar, do not take it! Likewise, if it’s not the right time of day, don’t take it! Ask to speak to your doctor, or the attending nurse, before taking it. Since your life may depend on it, it’s critical that you stand your ground!
- Ask your nurse if any of your medications are considered “high-alert”. These medications, such as insulin and blood thinners, must be given the right way at the right time. If any of your medications are high-alert, ask what steps staff take to make sure you get these high-alert medications in the proper manner and time.
- Never take any medications you brought with you from home without discussing it with your doctor and nurse. You could develop an adverse drug reaction or other issue.
Want to learn more?
Read my posts for more information on medication safety:
- Reduce Your Risk of Medication Errors.
- Can Your Medication Make You Sicker?
- Dangers of Black Market Medications – More Common Than you Think.
- Easy Steps to Take Medication as Prescribed.
- Are Antibiotics Helpful or Harmful? What You Need to Know.
- Doctors Prescribe Too Many Medications.
- Is Off-Label Medication Safe?
- Are Medications Safe?
**Although nurse practitioners and other health professionals prescribe medications, for ease of reading, “doctor” refers to all who prescribe medications.
NOTE: I updated this post on 6-1-20.