Healthcare News & Insights

EHRs don’t always catch medication errors: How to respond

Medication errors can cause serious harm to patients – and even death. Many hospitals try to prevent them with the use of electronic health records (EHR) systems that flag providers if issues arise. But these methods are far from foolproof, according to a new report. 

The Leapfrog Group just released a reportThinkstockPhotos-465505283 discussing electronic prescriptions sent through EHRs and whether they’re effective in preventing medication errors.

Most of the hospitals that participate in the patient safety group’s annual survey have a computerized order entry system for prescriptions through their EHR.

According to an article in Kaiser Health News, the Leapfrog Group asked participating hospitals to test their EHRs by creating a “dummy chart” for a fake patient. Clinical staff then used each facility’s electronic medication ordering system to submit a series of prescriptions and see which ones were flagged for review.

Almost 40% of problems that could potentially cause harm to patients went undetected by the systems. This included issues like potential drug interactions and medication being prescribed for the wrong condition.

Systems often wouldn’t flag cases where the wrong dosage was given due to a patient’s size – such as prescribing an adult dose of a drug to a child. They also had issues with alerting providers to the most appropriate drugs for each patient considering all the person’s current conditions and diagnoses (e.g., avoiding beta blockers for patients with asthma).

Even worse: The systems missed 13% of errors that could’ve killed patients.

Data from the Agency for Healthcare Research and Quality (AHRQ) show that one out of every 20 hospital patients is hurt in some way because of a medication issue. And per the AHRQ, half those cases are avoidable.

Keys to avoid mistakes

It may be tempting to rely on a computerized medication ordering system through an EHR. But technology isn’t perfect, and it can miss some critical issues with medications. That’s why many hospitals also have manual checks in place to review medication orders before and after they’re entered in the system.

Also important, according to the Leapfrog Group’s report: manual medication reconciliation. Right at admission, clinicians should get an accurate list of all medications a patient’s taking, including the name, dosage, frequency and route for each. This should be used as a baseline to prescribe the appropriate drugs to patients while they’re in the hospital.

Besides manual reviews, it could be helpful to create a “frequently used drugs” list in your EHR or computerized prescription ordering system so providers don’t always have to scroll through a long list of medications. If your facility goes this route, be sure to keep in mind the conditions your providers treat most often, along with your general patient mix.

Encourage clinical staff to speak up if they notice an issue with any medications a provider orders for a patient. Some may fear getting reprimanded for questioning a provider’s medical judgment. But preventing medication errors takes open communication and teamwork without fear of reprisal or punishment, so your hospital should make sure staff feel comfortable bringing up any issues.

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