Research Project: Peer Editing

12

Research Paper: Use of Health Information Technology in Reducing Medical Errors

Arianna Nunez
Grand Canyon University
June 2, 2021

Journal Format Used: De-Carvalho, D., Alvim-Borges, J. L., & Toscano, C. M. (2017). Impact assessment of an automated drug-dispensing system in a tertiary hospital. Clinics, 72(10), 629-636

Abstract

Medical errors have been a prevalent issue in the health care system for a long period of time leading to numerous effects. There are various forms of medical errors including errors in medications, transcribing, diagnosis, dosages among other medical processes. Medical errors have led to adverse effects such as deaths, being ranked as the third leading cause of death in the decade. This has called for alarm leading to adoption of technology in the health care system to reduce and prevent errors. Some of the technology systems adopted include the electronic health records, automated dispensing cabinets, digitized physician order entry, bedside bar-coded administration of medicine, clinical decision support system. These technological systems have been used to boost the capabilities of health professionals such as setting of reminders and alarming them of any adverse effects. They further provide guidance on the effective prescription and drug administration for a particular patient depending on their medical history and condition thus improving patient safety. Medical errors are also reduced through this technology that enables health care professionals act in a timely manner and with accuracy in the clinical actions. The use of health information systems has enabled the health care system improve delivery of care, reduce re-admission cases and lower the mortality rate as a consequence.

Use of Health Information Technology in Reducing Medical Errors

Introduction

Technology plays a vital role in the health care system and the community at large. Health Information Technology (IT) has gone a long way in remedying the demerits of paper records and other traditional methods of storing information and administering drugs. Some of these demerits include inefficiency in accessibility of health care information resulting in a challenging task for health care professionals in tracing this information. The health care system has implemented policies and actions to improve the quality of care. It is evident that the driving force of quality health care currently is the implementation of technology that has enabled health care professionals provide better care to patients. The ability of the health care system to store, analyze and share health information is directly linked to improved technology. The benefits of information technology include and are not limited to enhancing the ability of health care providers, patient access to their health information, improving patients’ quality of life and enhanced accessibility to health care even in rural areas through telemedicine. This study wishes to analyze the issue of medication errors in health care and how they have been remedied through adoption of various health information technology systems.

Methods

The study adopts a quantitative study methodology through analysis of various research study findings by other authors. The statistics on medical errors will be collected and analysis given on the efforts taken within the health care system to reduce these defects. A thematic analysis will be used for those research findings and the three main themes will be the effects of medication errors in the past years within the health care system, the various health information systems used to prevent medication errors and the benefits of these systems.

Results

The research articles explored revealed that medication errors in the USS have been estimated to cause harm to about 1.5 million persons every year and with approximately 400,000 adverse effects that could easily be prevented. According to the Institute of Medicine (IOM), the third leading cause of death and about 98,000 deaths every year are caused by medical errors in hospitals within the U. S (Ehteshami, Tavakoli, & Kasaei, 2013). It is also evident that this is a global problem because other states such as the UK and Australia record cases where patients suffer adverse effects due to medication errors that could be prevented.
The effects of these medical errors include high costs incurred by the patients and the health care system, families and clinicians. Due to this harm, the health care system has given emphasis to strategies to prevent medication errors. Evidence points out that health care systems that utilize information technology have recorded less cases of medical errors. Priority has been given to the issue of medical errors due to the high numbers of death caused as compared to accidents, AIDS and cancer. Some of the most common errors that occur in the health care facilities include incorrect transfusion of blood, surgical errors, bedsores, falls, nosocomial infections and medication errors (Zaidan, et al., 2016). Further, more complications occur in the emergency department, operation room and intensive care unit. The medication errors have been further categorized into four, that is, error in transcribing, dispensation, administration or prescription which led to incorrect timing, dosage or route of administration.
Some of the information technology systems adopted include the electronic health records, automated dispensing cabinets, digitized physician order entry, bedside bar-coded administration of medicine, clinical decision support system and electronic medication reconciliation (Roman et al., 2016). The electronic health records are very essential in accessing patient information and integrating health care services in an effective and timely manner. The records contain a patient’s information throughout their lifetime and this information is secured and maintained properly in the system. Some of the crucial information contained in electronic health records include the patient’s immunization history, diseases and injuries suffered, allergies, plans and procedures that they have undertaken in clinical environments and more data on their demographic and environmental aspects (Agrawal, 2009).
The bedside barcode medical administration system has been supported due to the use of electronic health records. This health information system was implemented to improve patient safety and was predicted to prevent about 50,000 adverse effects of the medication and injection errors (Kaushal, Shojania, & Bates, 2003). This system works by providing a barcoded wristband to every patient. The wristband contains information that uniquely identifies a patient when they are admitted in the health care facility. Any new medication orders are then entered in the system and are immediately detected by the pharmacy and nursing departments. The pharmacist then checks all the medication orders for issues such as allergies, errors in dosage and drug interactions. The pharmacist then prepares a prescription package and gives it a barcode label before transferring it to the nurse. The nurse then follows with scanning of the medication label for confirmation of dosages, type of medicine and the patient’s wristband to enable management of the medication.
Computerized provider order enter (CPOE) is another effective health information system that has been implemented in the care system. It essentially enables health care providers record care order online in it. The CPOE integrates the process of drug prescription and gives an accurate and standard instruction. According to research, it has the greatest positive impact in preventing medical errors of up to 83% (Kaushal, Shojania, & Bates, 2003). CPOE enables health care providers enter accurate and legible orders, facilitates presentation of appropriate laboratory result, detects and alerts on allergies and provides suggestions on the proper dosage and sequencing of medicine in a prescription.
The clinical decision support system (CDSS) was adopted to remedy the issue of incomplete information on patients and drugs which has been a major cause of medical errors. CDSS operates by providing clinical knowledge selectively and in proper time. This information merges patient information accurately with the complete data repository. The CDSS provides information such as rules and recommendations that guide care, evidence-based standards, reference books and library databases (Ehteshami, Sadoughi, Ahmadi, & Kashefi, 2013). Further, the system provides reminders to health care professionals on implementation of effective care such as preventative care and also alert on health issues including allergies.
The benefits of using these information technology systems include that health care system has increased its ability to reduce costs of up to $88 billion in a period of 10 years (Asghar, Rezaei, Tavakoli, & Kasaei, 2013). Similarly, there are fewer complications due to supported clinical decisions and lower mortality rates. The electronic health records have enabled the health system offer medical warnings and reminders, detect any errors in the patient’s information and pattern, detect the unusual test results of the patient or threatening drug interactions and other adverse effects. The electronic records also guide the health care professional in comprehending the care plan and more knowledge database critical for effective care. The barcode medication administration system has been found to be effective in reduction of medical errors due to these procedures that enhance accuracy in prescriptions (De-Carvalho, Alvim-Borges & Toscano, 2017). Further, it enhances the stages of medical management process which are the five rights: right dosage, right patient, right route, right time and right drug. It can therefore be quantified that this technology system is key in improving patient safety, improving documentation, management of drugs, reducing medical errors and preparing patient bills.
The effectiveness of CPOE has been recorded in various sectors of health institutions. These include that they enable health professionals remember to include aspirin in some conditions such as artery diseases. Secondly, they prevent any excessive use of laboratory tests for diagnosis and use of antibiotics. Thirdly, they enable health professionals make safe use of medications by suggesting certain doses to every patient and maintain communication with other departments in the health care facility such as the pharmacy, radiology and laboratory. Fourthly, it has enabled the organizations reduce the length of patient stay from 12 days to 10 days in the Intensive Care Unit (Cheung-KC, Bouvy, & Smet, 2009). Fifthly, it has reduced costs. In general, the system has integrated various dockets in the health care system that have improved quality of care, timely services, accuracy in prescriptions and guidance to health care professionals regarding orders as it provides the patient’s problem list including their allergies.
The CDSS has been further recommended in the health care system due to its advantages. These includes reduction of grave medical errors, reduction of effects caused by antibiotics and reduced costs (Suryadinata, 2017). Furthermore, it is efficient in warning health professionals of health problems in drug administration and instructing on effective use of medications. It also facilitates reporting of adverse drug effects. By facilitating the decisions of health professionals, the cases of rehospitalization and mortality rates have significantly been lowered. In a study, adoption of an electronic discharge summary that served as a reminder to physicians on prescriptions recorded an improvement in prescription rate from 88% to 100% (Agrawal, Khaneja, & Onyebuke, 2007).

Discussion

The process of decision-making in clinical systems is a complex process that demands high human ability in giving undivided attention, memorizing, recalling and synthesizing huge amounts of data. Health care professionals are prone to making errors in the various medical processes either in recording information, interpretating, analyzing and prescribing or in making dosages. Health care organizations experience various medical errors including administrative activities, diagnoses, treatment and other medical actions. Numerous deaths and adverse drug effects have been attributed to medical errors, being listed as the third leading cause of death above accidents and terminal illnesses. Some of the effects of medical errors also include falls, bed sores, incorrect surgery procedures and other harm caused especially in intensive and emergency care units (Asghar, Rezaei, Tavakoli, & Kasaei, 2013). Due to these effects, the health sector has given attention and invested resources to reduce medical errors in health care organizations.
Medical errors lead to preventable adverse effects that can be easily remedied with appropriate resources. Technology has come in handy to enable the health care system provide safe, timely and quality care. Some of the effective technology systems that have been adopted include the electronic health records, CDSS, CPOE. These systems have enabled the health professionals make effective decisions regarding patient care. They remind the health specialists on orders and provide important patient information that guides the creation of an informed treatment plan (Vincente et al., 2017). This is especially so in identification of allergies and other drug interactions that the patient is prone to.
The health information systems enable integration of different departments in the health care facility such as the pharmacy to nursing and radiology units. This is important in improving accuracy of information since it is confirmed and reviewed by various professionals within the institution before approval and administration to the patient as was seen in bedside barcode medical administration systems (Alford, 2016). Through this system, it is easier to detect any defects arising within the diagnosis or dosages in relation to the patient’s state and medical history. Early detection of these errors enables the health professionals avoid making mistakes in administration of drugs and injections thus preventing adverse effects.
The electronic health records are an effective means of implementing preventive care and reducing medical errors. They provide clinical warnings and reminders to the health care specialists enabling them make accurate medication and treatment plans. They also enhance their intelligence capabilities which facilitates their clinical decision-making process (Ehteshami, Sadoughi, Ahmadi, & Kashefi, 2013). The immunization among other medical histories is important in enabling the physician provide patient-centered care to patients. Furthermore, the electronic health records play a major role in enhancing recovery of patients with terminal illnesses such as diabetes which demands frequent medical services to those patients.
Generally, the technological systems enable health care professionals achieve the five rights. They reveal important patient information that direct care providers to make the right diagnosis and provide effective medications (Noparatayaporn et al., 2017). The label systems enable the health care providers identify and treat the right patient and the right route as they are properly indicated in the system. Through several procedures that involve online communication and confirmation between health care providers, the right dosage is provided. Further, alarm can easily be raised in case of any drug interactions suspected thus providing preventative care (Asghar, Rezaei, Tavakoli, & Kasaei, 2013). The right time is achieved due to the effectiveness the information technology systems employ enabling the health care provider to retrieve information very fast, make analysis and recommend the next course of action to enhance patient safety especially in emergency situations. Further, the reminders enable health care professionals give timely care (Sinnemaki et al., 2017). Therefore, it is proper to state that the information technology systems bridge the gap between human errors that professionals are prone to and effective decision making by presenting and updating this critical information at the time of making decisions.

Conclusions

This paper analyzes the use of information technology systems in health care to reduce medical errors. It can be affirmed that technology has enabled the health care system prevent several medical errors. The health information systems improve the accuracy and efficiency of the health system in numerous processes from the recording of patient information, test results, diagnosis, facilitating communication between the patient and health professionals and evaluation of risks. They boost the capabilities of health care providers and decision-making processes. Prior to adoption of the health information systems, there was a grave health concern due to the number of deaths recorded on the basis of medical errors. Among those errors were medication errors, incorrect surgeries, defects in dosage and adverse drug effects due to drug interactions. Technology therefore came in as a savior to the issue of increased medical errors.
This research would therefore like to propose recommendations that the health care system should adopt to ensure maximization of the utilization of information technology systems in health care. First, the health care specialists should be trained frequently in the health care organizations on the proper use of technology. They should be trained on effective retrieval, interpretation and maximization of the systems as resources that can increase their clinical knowledge when making prescriptions and clinical decisions. The training should also purpose to increase the health providers’ knowledge on detecting medical errors and adverse drug effects. Patient education should also be provided together with their families on the medication administration. Secondly, standardization of administration of drugs should be implemented in health care facilities such that there is clarity and detailed information on the route of administration and full drug name. This will help reduce medication errors even after hospitalization. Thirdly, the most effective forms of technology should be localized in every health care facility and workflows redesigned to enable effective utilization of these technological systems. A more integrated list of the role and advantages of technologies should be created and prioritization given as according to their benefits in improving patient care and reducing medical errors. Fourthly, it is recommended that more research should be carried out on the causes, effects and ways to reduce medical errors. The research will reveal more issues with regard to how cases of medical errors are still prevalent despite the use of technology. Further research cab reveal means by which the health care system can be reviewed to enhance the operation of health information technologies in enhancing clinical decisions, reducing errors and improving safety in care provision.

References
Alford, K. F. (2016). Progressive Care Nurses’ Attitudes, Beliefs, and Perceptions of Automated Medication Dispensing Cabinet Workarounds: A Mixed Methods Study. The University of Texas Health Science Center at San Antonio.
Agrawal, A. (2009). Medication errors: prevention using information technology systems. British Journal of Clinical Pharmacology, 67(6), 681-686. doi:10.1111/j.1365-2125.2009.03427.x
Agrawal, A., Khaneja, M., & Onyebuke, I. (2007). ‘Smart’ electronic discharge summary to improve care of heart failure patients at discharge. Annual Symposium on Health Care Services in New York. Research and Practice. Retrieved June 1, 2021
Asghar, E., Rezaei, P., Tavakoli, N., & Kasaei, M. (2013). The role of health information technology in reducing preventable medical errors and improving patient safety. International Journal of Health System and Disaster Management, 1(4), 195-199. Retrieved June 1, 2021
Cheung-KC, Bouvy, M., & Smet, P. (2009). Medication errors: the importance of safe dispensing. British Journal of Clinical Pharmacology, 67, 676-680. Retrieved June 1, 2021
De-Carvalho, D., Alvim-Borges, J. L., & Toscano, C. M. (2017). Impact assessment of an automated drug-dispensing system in a tertiary hospital. Clinics, 72(10), 629-636.
Ehteshami, A., Sadoughi, F., Ahmadi, M., & Kashefi, P. (2013). Intensive care information system impacts. Acta Informatics Medica, 21, 185-191. Retrieved June 1, 2021
Ehteshami, A., Tavakoli, N., & Kasaei, M. (2013). The role of health information technology in reducing preventable medical errors and improving patient safety. International Journal of Health Systems and Disaster Management, 1, 195-199. Retrieved June 1, 2021
Kaushal, R., Shojania, K., & Bates, D. (2003). Effects of computerized physician order entry and clinical decision support systems on medication safety: A systematic review. Arch International Medicine, 163, 1409-1416. Retrieved June 1, 2021
Noparatayaporn, P., Sakulbumrungsil, R., Thaweethamcharoen, T., & Sangseenil, W. (2017). Comparison on human resource requirement between manual and automated dispensing systems. Value in health regional issues, 12, 107-111.
Roman, C., Poole, S., Walker, C., & Dooley, M. J. (2016). A ‘time and motion evaluation of automated dispensing machines in the emergency department. Australasian Emergency Nursing Journal, 19(2), 112-117.
Sinnemäki, J., Airaksinen, M., Valaste, M., & Saastamoinen, L. K. (2017). Impact of the automated dose dispensing with medication review on geriatric primary care patients drug use in Finland: a nationwide cohort study with matched controls. Scandinavian journal of primary health care, 35(4), 379-386.
Suryadinata, H. U. (2017). The benefits of automated dispensing machine for hospital pharmacy in Indonesia: situation, implementation, and feasibility. GHMJ (Global Health Management Journal), 1(1), 15-22.
Vicente Oliveros, N., Gramage Caro, T., Pérez Menendez‐Conde, C., Álvarez‐Díaz, A. M., Martín‐Aragón Álvarez, S., Bermejo Vicedo, T., & Delgado Silveira, E. (2017). Effect of an electronic medication administration record application on patient safety. Journal of evaluation in clinical practice, 23(4), 888-894.
Zaidan, M., Rustom, F., Kassem, N., Al Yafei, S., Peters, L., & Ibrahim, M. I. M. (2016). Nurses’ perceptions of and satisfaction with the use of automated dispensing cabinets at the Heart and Cancer Centers in Qatar: a cross-sectional study. BMC nursing, 15(1), 1-8.

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