Reducing and preventing physician medication order entry errors

Physician medication orders entered for the wrong patient is a constant battle for hospitals. At MKC Medical Management, as we investigate our client’s claims and cases, we see it all of the time.

Many factors can lead to medication errors. In fact, the Institute for Safe Medication Practices has identified 10 key elements with the greatest influence on medication use and notes that weaknesses in these areas can lead to medication errors.

They are:

  • patient information
  • drug information
  • adequate communication
  • drug packaging, labeling and nomenclature
  • medication storage, stock, standardization and distribution
  • drug device acquisition, use and monitoring
  • environmental factors
  • staff education and competency
  • patient education
  • quality processes and risk management

Medication administration is a complex and multistep process that involves prescribing, transcribing, dispensing and administering drugs, as well as, monitoring patient response.  An error can happen at any step, but we see many errors happening in the beginning – at the prescribing stage.  

Researchers tackle issue

With the introduction of electronic medical records, there have been numerous studies focused on ways to reduce and prevent order entry errors.

Researchers at Montefiore Hospital in New York, for instance, wanted to find a way to detect wrong-patient orders in their electronic medical records system. They devised a tool to track errors, such as prescribing medications for the wrong patient, and to suggest ways to reduce potentially life-threatening mistakes.

The study lasted from December 2010 to June 2011. It found that two different interventions could decrease the number of wrong-patient orders that were later retracted.

Phase 1 of Montefiore’s research: Physician Interviews

Interviews with 233 physicians over a four-month period showed that 76 percent of the original orders had been for the wrong patients. They were near misses that could have turned into actual medical errors involving orders for imaging or lab tests or medications.

Their findings of the study translated to wrong-patient electronic orders being entered by one in six clinicians for one in every 37 patients admitted to the hospital, an average of 14 such orders per day. This did not include or reveal how many orders for the wrong patients went through and were carried out.

Phase 2 of Montefiore’s research: Verify Patient Identifiers

In the randomized controlled trial, 4,000 providers were assigned to groups, which were prompted to verify patient identifiers before entering orders, re-entering patient identifiers – or neither.

The results were encouraging compared to the control group. ID verification reduced the odds of retract-and-reorder events by 16 percent; ID reentry decreased them by 41 percent.

It took clinicians only half a second on average to verify a patient’s ID, versus 6.6 seconds for reentering identifiers. The latter could add up to a fair amount of time over many orders, but it did not explain why only half of the wrong-patient orders were prevented even with ID reentry.  

The research is encouraging and provides tested information that will help other hospitals develop similar software programs that would prompt reentering of patient information and not allow the physician to override the prompts.

Ingenuity, creativity required

In fact, one of the nation’s leading hospitals, Johns Hopkins Hospital in Baltimore, has begun requiring clinicians to re-enter patient identifiers before submitting orders. Hopefully, soon others will follow as hospitals continually work to address medication issues with ingenuity and creativity.  

When compared with the old pen-and-paper charts, electronic medical records are believed to prevent far more mistakes than they cause. They also are forcing hospitals to develop new and innovative ways to reduce errors in ordering.

As a nurse, I am very aware of the challenges of the electronic medical chart. It is my belief that adding patient photos to the medical chart is (almost) a surefire way to guarantee you have the right patient.

Leave it to a nurse to solve one of the on-going battles hospitals face.